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Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Microfracture is a well-established treatment procedure for chondral defects in high-demand population with good short-term results. The purpose of our study was to evaluate long-term clinical outcome of microfracture treatment in athletes with full-thickness chondral defects.

Methods

Between 1991 and 2001, 170 patients were treated with microfracture for full-thickness knee chondral lesions at our institute and 67 of them were included in this study and prospectively followed up. Sixty-one athletes (91 %) were available at final follow-up (average 15.1 years). Average lesion size was 401 ± 27 mm2. Lysholm, Tegner and International Knee Documentation Committee (IKDC) (subjective–objective) scores were utilized pre-operatively and at 2-year, 5-year and final follow-up; Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) and Marx scores were also collected at final follow-up.

Results

IKDC, Lysholm and Tegner scores increased significantly at 2 years, but gradually deteriorated at long term; however, average scores were significantly above baseline at final follow-up. Seven patients (11 %) were considered as failures as they underwent another operation because of reinjury or persistent pain during the first 5 years. Pain and swelling during strenuous activities was reported only in nine patients by the end of 2 years and in 35 patients at final follow-up. Patients with smaller lesions (≤400 mm²) and younger patients (≤30 years) showed significantly better results in KOOS, VAS and Marx scores. Radiographs performed at final follow-up showed evidence of progression of osteoarthritis changes in 40 % of the knees, with higher rate in older patients with large or multiple lesions (p < 0.05).

Conclusions

Microfracture when applied in young patients with smaller lesions can offer good clinical results at short- and long-term follow-up; lesion size is more important prognostic factor of outcome than age. Deterioration of the clinical outcome should be expected after 2 and 5 years post-treatment, and degenerative changes are present at long-term follow-up, with higher rate in older athletes with large, multiple lesions.

Level of evidence

IV.

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Acknowledgments

We thank Dr Dnyanesh Lad, fellow at O.A.S.I. Bioresearch Foundation, for his help. We also thank Andrea Primo, Professional Statistician, for statistical analysis of our study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Orthopaedic Arthroscopic Surgery International, Gobbi N.P.O., Via G.A. Amadeo 24, 20133, Milan, Italy

    Alberto Gobbi, Georgios Karnatzikos & Anup Kumar

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  1. Alberto Gobbi
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  2. Georgios Karnatzikos
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  3. Anup Kumar
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Correspondence to Alberto Gobbi.

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Gobbi, A., Karnatzikos, G. & Kumar, A. Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc 22, 1986–1996 (2014). https://doi.org/10.1007/s00167-013-2676-8

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  • DOI: https://doi.org/10.1007/s00167-013-2676-8

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