Outcomes following Microfracture of Full-Thickness Articular Cartilage Lesions of the Knee in Adolescent Patients

Abstract

The purpose of this study was to document outcomes following microfracture for full-thickness cartilage defects of the knee in adolescents. Our hypothesis was that patients aged 18 years or less would have excellent outcomes and function following microfracture of full-thickness knee articular cartilage defects. This study was approved by the Institutional Review Board. Patients < 19 years old with full-thickness knee articular cartilage defects treated with microfracture between January 1992 and June 2008 were identified. Surgical, demographic data, Lysholm score, Tegner activity scale, and patient satisfaction were collected prospectively. A total of 26 patients (14 females, 12 males) met inclusion criteria. Average age was 16.6 years (range: 12-18.9 years). Ninety-six percent of lesions were patellar (37%) or femoral condyle defects (medial 26%, lateral 33%). Minimum 2-year follow-up was obtained in 22/26 patients (85%) with average follow-up of 5.8 years (range: 2.0-13.3 years). Average postoperative Lysholm score was 90 (range: 50-100). Median Tegner scale was 6 (range: 2-10). Median patient satisfaction with outcome was 10 (range: 1-10). Lysholm correlated with Tegner scale (rho = 0.586; p = 0.011) and patient satisfaction (rho = 0.70; p = 0.001). Average postoperative Lysholm score in males was 93 and 86 in females (p = 0.22). One patient underwent revision microfracture. This study showed that adolescent patients who underwent microfracture for treatment of full-thickness knee chondral defects demonstrated increased activity levels and excellent function following surgery.

Stellenwert der matrixaugmentierten Knochenmarkstimulation in der Behandlung von Knorpelschäden des Kniegelenks: Konsensusempfehlungen der AG Klinische Geweberegeneration der DGOU

“…In der Therapie rein chondraler Defekte unter 2,5 cm 2 Defektfläche gilt die MFx als Verfahren der ersten Wahl [6]. Gerade bei jüngeren Patienten konnten so durchaus auch gute Langzeitergebnisse gezeigt werden [15,16]. Ab einer Defektgröße von 2,5 cm 2 sind jedoch vor allem die mittel-bis langfristigen Ergebnisse der MFx denen der ACT unterlegen [17].…”

How to Manage a Failed Cartilage Repair: A Systematic Literature Review

“…The authors reported 24 failures (21.82%) in the study population. Steadman et al 6 studied a specific population of 26 patients younger than 19 years (mean defect size, 1.77cm 2 ) treated with MF. In this study, 2-year follow-up was obtained in 22 of 26 patients with an average of 5.8 years.…”

“…It is interesting to note that in their adolescent population, the three recorded failures were in female patients treated for patellofemoral defects. 6 …”

Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures

“…58,64-68 Therefore, a subset of young patients with acute, small (<2 cm 2 ), well-shouldered defects in the femoral condyles may be the appropriate candidates for MST treatment. 69-71 However, for most patients, we would not recommend MST alone, especially on the patella, which has worse outcomes than other locations. 72 AMIC may also be considered in these patients as it has shown improved pain and functional outcome scores in patients up to 9 years postoperatively compared to MST alone; however, additional RCTs comparing AMIC to other cartilage therapies are needed.…”