Microfracture versus Enhanced Microfracture Techniques in Knee Cartilage Restoration: A Systematic Review and Meta-Analysis

Abstract

This study aimed to compare the efficacy and safety of the microfracture (MFx) and microfracture augmented (MFx + ) techniques for the treatment of cartilage defects of the knee. The PubMed and EMBASE databases were searched from 1 January, 1950 to 1 May, 2019. RevMan5.3 was used to perform statistical analysis. Relative risk was calculated for binary variables, and weighted mean difference and standardized mean difference (SMD) were measured for continuous variables. The 95% confidence interval (CI) of each variable was assessed. Thirteen trials with 635 patients were included. There was a significant difference in the Lysholm's score (SMD = 0.26, 95% CI: 0.01–0.50, p = 0.04) and magnetic resonance observation of cartilage repair tissue score (SMD = 14.01, 95% CI: 8.01–20.02, p < 0.01) between the MFx and MFx+ groups. There was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index score (SMD = − 12.40, 95% CI: −27.50 to 32.71, p = 0.11), International Knee Documentation Committee score (SMD = 8.67, 95% CI: −0.92 to 18.27, p = 0.08), visual analog scale score (SMD = − 0.20, 95% CI: −2.45 to 0.96, p = 0.57), Tegner's score (SMD = 0.26, 95% CI: −0.67 to 1.18, p = 0.59), modified Cincinnati's score (SMD = − 4.58, 95% CI: −14.31 to 5.14, p = 0.36) and modified International Cartilage Repair Society pain score (SMD = 0.09, 95% CI: −0.37 to 0.55, p = 0.70) between the groups. Results of the pooled analyses of the MFx+ and MFx groups suggested that the MFx+ technique is slightly superior to the MFx technique for the treatment of articular cartilage defects of the knee. Further research is required and future studies should include assessments of the outcomes at long-term follow-ups. Trial registration number is PROSPERO CRD42019135803

Clinical and Magnetic Resonance Imaging Outcomes After Microfracture Treatment With and Without Augmentation for Focal Chondral Lesions in the Knee: A Systematic Review and Meta-analysis

“…These findings are consistent with 2 previous systematic reviews that similarly reported improvement in Lysholm scores when MFx treatment was augmentation. 1,55…”

“…Moreover, when comparing MFx + augmentation to MFx alone, the authors noted in a subjective synthesis that 2 randomized controlled trials (RCTs) demonstrated significantly greater improvements in IKDC and KOOS scores after MFx + augmentation, with 2 other RCTs demonstrating comparable postoperative outcomes. Similarly, a systematic review and meta–analysis by Wen et al 55 evaluating 13 clinical trials, comprising a total of 635 patients, compared the efficacy and safety of isolated MFx versus MFx + augmentation. Comparable with the findings from our investigation, the authors reported no significant difference in IKDC, WOMAC, and VAS pain scores between the 2 groups.…”

“…These findings are consistent with 2 previous systematic reviews that similarly reported improvement in Lysholm scores when MFx treatment was augmentation. 1,55 Patients undergoing MFx + augmentation also possessed improved magnetic resonance imaging (MRI) outcomes based on MOCART scores when compared with patients undergoing isolated MFx. Although the confidence of this conclusion may also be limited by the inclusion of only 3 studies in this meta-analysis, it was the most we could include based on our inclusion/exclusion criteria.…”

Bone Marrow Aspirate Concentrate versus Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells for Combined Cartilage Regeneration Procedure in Patients Undergoing High Tibial Osteotomy: A Systematic Review and Meta-Analysis

“…The superior results of the combination of HTO and cartilage regeneration procedures compared with HTO alone have been reported in several studies [ 21 , 22 ]. Despite promising results regarding cartilage regeneration procedures using MSC-based orthobiologics, the optimal cartilage regeneration procedure that can be performed with HTO remains unclear.…”

Autologous matrix-induced chondrogenesis is effective for focal chondral defects of the knee

“…For symptomatic defects smaller than 2 cm 2 , microfractures (MFx) have been proposed 9 – 12 . MFx is a bone marrow stimulating procedure of simple execution which can be conducted in a fully arthroscopic fashion 13 . During MFx, the cartilage is debrided to its viable border, and microfractures are performed to promote cell migration from the subchondral bone 14 , 15 .…”