Effects of unloader bracing on clinical outcomes and articular cartilage regeneration following microfracture of isolated chondral defects: a randomized trial

Abstract

PurposeTo determine whether the use of an unloading brace can increase the thickness of cartilage regenerate after microfracture surgery. MethodsThis is a randomized (1:1) controlled clinical trial. Twenty‐four patients who underwent microfracture between 2012 and 2015 were identified and were randomly assigned to an unloading brace group or a no‐brace group. All patients were kept non‐weight bearing for the first eight weeks after surgery and then patients in the intervention group began using an unloading brace for an average of 63.9 (SD = 41.6) days to protect clot stability by exerting a varus or valgus force on the knee to decrease the force on the knee’s lateral or medial compartment, respectively. Quality of the cartilage repair was assessed with knee magnetic resonance imaging to determine repair tissue thickness (primary outcome), repair tissue volume, and T2 relaxation times at 12 and 24 months after surgery. Clinical outcomes were evaluated with KOOS, Tegner, SF12, and Lysholm questionnaires at six, 12 and 24 months after surgery. ResultsThree patients were lost to follow‐up, resulting in 21 patients ultimately analyzed. The unloading brace repair tissue was greater than the no‐brace group in volume (26.8 ± 23.7 mm3 vs − 8.4 ± 22.7 mm3, p = 0.005) and thickness (0.2 ± 0.2 mm versus − 0.4 ± 0.3 mm, p = 0.001) at 12 months and in cartilage thickness in the unloading brace group at 24 months (0.4 ± 0.4 mm versus − 0.1 ± 0.3 mm, p = 0.029). There was a positive correlation between wearing the brace longer and improved 6‐month KOOS symptom scores (r = 0.82, p = 0.013), 6‐month KOOS QOL scores (r = 0.80, p = 0.017), 6‐month Tegner scores (r = 0.94, p = 0.002), and Tegner score changes from baseline to 6 months (r = 0.80, p = 0.032). ConclusionThis study found a significant mid‐term increase in cartilage repair tissue thickness following unloading bracing in patients recovering from microfracture for isolated chondral defects. Level of evidenceII.

New frontiers for cartilage repair, joint preservation and prevention

“…Besides the possible use of unloading osteotomies also unloader brace could be useful to give the repair tissue best chances for a positive development. 92 Furthermore, comprehensive preoperative evaluation of patient-specific factors like the patient expectations, patient age, and activity level are important to perform for a secure final decision of how to treat the cartilage lesion. To improve decision making, use of artificial intelligence-based apps will be available.…”