What did the study look at?
Damage to the joint cartilage of the knee can result from injury or wear, and the authors note that its capacity to heal on its own is low. Small defects are treated with marrow-stimulating methods; one of these is microfracture, in which small holes are made in the bone beneath the cartilage. Another option is implanting carbon fibre rods into the damaged area. The study compared the clinical and imaging results of the two methods.
How was it done?
Between January 2012 and February 2014, at two hospitals, 40 patients (10 men, 30 women; aged 22 to 56, mean 37.4) with International Cartilage Repair Society (ICRS) grade 3 to 4 knee cartilage lesions underwent surgery. Before surgery they had received a mean of 12.2 months of joint gel injections (viscosupplementation) and physiotherapy.
- 20 patients had arthroscopic microfracture.
- 20 patients had arthroscopic carbon fibre rod implantation.
- Rehabilitation was standardised; no weight was allowed on the operated leg for 6 weeks.
- Clinical outcome was assessed at 6 and 12 months with the Tegner-Lysholm and modified Cincinnati scores, and imaging at 12 months with magnetic resonance imaging (MRI) and the MOCART score.
What did it find?
- The groups were comparable in age, body mass index, lesion location and size, duration of symptoms and coexisting problems.
- Preoperative scores were higher in the microfracture group (Tegner-Lysholm 39.4 ± 7.3 vs 34.4 ± 4.9; modified Cincinnati 36.4 ± 7.2 vs 30.4 ± 4.0).
- At 12 months, scores improved significantly in both groups (p < 0.001), with greater improvement after microfracture (p < 0.001). According to the article's table, the 12-month Tegner-Lysholm score was 90.2 ± 3.0 vs 74.2 ± 8.5, and the modified Cincinnati score 87.4 ± 3.1 vs 76.2 ± 7.4.
- MRI showed only minimal regenerative tissue in both groups. Lobulation, oedema and overgrowth (hypertrophy) of the new tissue were more common after carbon fibre rods.
- At 12 months the MOCART score was higher after microfracture (59 vs 47, p < 0.001).
- One patient in the carbon fibre group had pain and a non-healing lesion and went on to cell-based treatment; no other complications were noted.
The authors' conclusion
The authors concluded that, in this group of patients, microfracture was superior to carbon fibre rod implantation in terms of clinical and radiological outcome.
Reference
Dasar U, Gürsoy S, Akkaya M, Algin O, Isik C, Bozkurt M. 2016. Microfracture technique versus carbon fibre rod implantation for treatment of knee articular cartilage lesions. Journal of Orthopaedic Surgery (Hong Kong) 24(2):188-193.
DOI: 10.1177/1602400214
Free full text: Journal of Orthopaedic Surgery
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
