Clin Orthop Surg.  2019 Sep;11(3):282-290. 10.4055/cios.2019.11.3.282.

Clinical and Radiological Changes after Microfracture of Knee Chondral Lesions in Middle-Aged Asian Patients

• Kim JK
• Vaidya R
• Lee SK
• Yu J
• Park JY
• Ro DH
• Lee MC
• Han HS

• KMID: 2462556
• DOI: http://doi.org/10.4055/cios.2019.11.3.282

Abstract

BACKGROUND
Although microfracture is widely accepted as an effective treatment option for knee chondral lesions, little is known about the deterioration of clinical outcomes and radiological progression in middle-aged patients. Therefore, this study was conducted to evaluate the clinical and radiological changes after microfracture of knee chondral lesions in middle-aged Asian patients.
METHODS
A total of 71 patients were included in the study. They were between the ages of 40 and 60 years and underwent arthroscopic microfracture for localized full-thickness cartilage defects of the knee from January 2000 to September 2015. The recovery status of chondral lesions was assessed by using the magnetic resonance observation of cartilage repair tissue (MOCART) score in postoperative magnetic resonance imaging (MRI). Clinical and radiological results were reviewed, and survival rate with conversion to arthroplasty or osteotomy as an end point was evaluated.
RESULTS
The mean age of the patients at surgery was 51.3 ± 4.7 years (range, 40 to 60 years), and the mean follow-up period was 7.2 ± 2.6 years (range, 1.0 to 17.4 years). The MOCART scores of 32 patients at mean postoperative 2.1 years showed three cases (9%) of full recovery, two cases (7%) of hyperplastic recovery, 23 cases (70%) with more than 50% filling, and four cases (14%) with less than 50% filling. Clinical scores improved significantly at 1 year after surgery (p < 0.05); however, the scores deteriorated over time after postoperative 1 year, and the mean values reached preoperative levels at postoperative 10 years. Significant radiological progression of arthritis (Kellgren-Lawrence grade) was observed at 5 years after surgery. Four patients underwent total knee arthroplasty during follow-up.
CONCLUSIONS
Most patients showed more than 50% of defect filling at 2 years after surgery on MRI. Clinical results of microfracture of knee chondral lesion showed the best improvement at postoperative 1 year but gradually worsened thereafter until postoperative 10 years. Radiological progression of arthritis was observed from 5 years after surgery.

Keyword

Microfracture; Treatment outcome; Cartilage; Knee

MeSH Terms

Arthritis
Arthroplasty
Arthroplasty, Replacement, Knee
Asian Continental Ancestry Group*
Cartilage
Follow-Up Studies
Humans
Knee*
Magnetic Resonance Imaging
Osteotomy
Survival Rate
Treatment Outcome

Figure

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  Fig. 1 Flowchart of patient inclusion and reasons for exclusion.

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  Fig. 2 Changes in clinical scores. All clinical results at 1 year after surgery showed significant improvement (*) and tended to deteriorate with time at 2, 5, 7, and 10 years. In particular, Lysholm, International Knee Documentation Committee (IKDC), and visual analog scale (VAS) scores showed statistically significant deterioration from 1 to 10 years after surgery (#). KOOS: Knee Injury and Osteoarthritis Outcome Score.

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  Fig. 3 Changes in Kellgren-Lawrence (KL) grade. There were significant changes with time. The significant degenerative change was confirmed from 5 years after surgery (*).

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  Fig. 4 Kaplan-Meier survival analysis curve. During the 17-year follow-up period, there were four failures. All four patients underwent total knee arthroplasty (TKA). The mean duration of conversion to TKA after index microfracture was 7 years.

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