Abstract
Objective: To statistically summarize all available results presented in the literature; to compute an inherently meaningful best estimate of the mean expectable treatment effect; to provide statistical evidence that advanced age and large chondral lesions adversely effect the outcome after microfracture. Methods: We searched four electronic databases for prospective and retrospective studies that included sufficient statistical information. In order to convert all score values to the most frequently used Lysholm Score a regression analysis had to be performed at first, using data of 26 own patients. Subsequently, meta-, subgroup and regression analyses were performed. Results: 16 studies representing 777 patients aged from 13 to 72 years with chondral lesions from 0.2 cm² to 20 cm² of size, evaluated after a follow-up period of six to 17 years referred to our eligibility criteria. We calculated an overall best estimate of 26.76 Lysholm points for the mean treatment effect. With values of 22.38 Lysholm points for group 1 (patients younger than 38 years on average) and 31.11 Lysholm points for group 2 (patients with a mean age greater-than-or-equal to 38 years) our subgroup analysis revealed a barely significant difference between the two means (p=0.499). Due to the fact that the mean preoperative score value in group 2 was considerably lower than in group 1 these findings might be caused by the uneven increase of the Lysholm Score and not by age-related facts. However, neither a subgroup analysis referring to the defect size, nor a linear regression with mean age as the predicting variable could reveal significant results. Conclusion: Our meta-analysis enables patients to take a realistic view on their improvement in quality of life after knee microfracture, but it does not facilitate surgeon’s decision whether microfracture is the appropriate technique to treat a given full-thickness cartilage lesion of the knee.
Highlights
Since 1980, Steadman has followed a minimal-invasive specific approach to treat full-thickness chondral defects of the knee [1] in order to “recreate the structures of the knee that protect it from impact and provide stability” [2]
Our analyses did not prove that small lesion size and low patient age have an adverse impact on the treatment effect achieved by knee microfracture
As the regeneration capacity of cartilage is reduced in older patients a repair tissue of inferior quality is formed after microfracture, resulting in lower postoperative score values [49]. This does not mean that the treatment effect has to be expected lower because it represents an improvement referring to the starting point
Summary
Since 1980, Steadman has followed a minimal-invasive specific approach to treat full-thickness chondral defects of the knee [1] in order to “recreate the structures of the knee that protect it from impact and provide stability” [2]. Whereas it was applied only by about 1% of orthopedic surgeons worldwide in 1994, that statistic was up to 85% 10 years later [3]. The objective of this paper was to provide a inherently meaningful (not standardized) best estimate of the avarage expected treatment effect by summarizing all available studies. We intended to provide statistical evidence that advanced age and large chondral lesions have a negative impact on the outcome after microfracture of the knee
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