Mithoefer Kai, Williams Riley J, Warren Russell F, Potter Hollis G, Spock Christopher R, Jones Edward C, Wickiewicz Thomas L, Marx Robert G
Institute for Cartilage Repair, The Hospital for Special Surgery, 525 East 70th Street, New York, NY 10021, USA.
J Bone Joint Surg Am. 2005 Sep;87(9):1911-20. doi: 10.2106/JBJS.D.02846.
Microfracture is a frequently used technique for the repair of articular cartilage lesions of the knee. Despite the popularity of the technique, prospective information about the clinical results after microfracture is still limited. The purpose of our study was to identify the factors that affect the clinical outcome from this cartilage repair technique.
Forty-eight symptomatic patients with isolated full-thickness articular cartilage defects of the femur in a stable knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twenty-four months with a combination of validated outcome scores, subjective clinical rating, and cartilage-sensitive magnetic resonance imaging.
At the time of the latest follow-up, knee function was rated good to excellent for thirty-two patients (67%), fair for twelve patients (25%), and poor for four (8%). Significant increases in the activities of daily living scores, International Knee Documentation Committee scores, and the physical component score of the Short Form-36 were demonstrated after microfracture (p < 0.05). A lower body-mass index correlated with higher scores for the activities of daily living and SF-36 physical component, with the worst results for patients with a body-mass index of >30 kg/m(2). Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in twenty-four knees demonstrated good repair-tissue fill in the defect in thirteen patients (54%), moderate fill in seven (29%), and poor fill in four patients (17%). The fill grade correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twenty-four months.
Microfracture repair of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of two years. The best short-term results are observed with good fill grade, low body-mass index, and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade is associated with limited short-term durability.
微骨折术是修复膝关节软骨损伤常用的技术。尽管该技术应用广泛，但关于微骨折术后临床结果的前瞻性资料仍然有限。本研究的目的是确定影响该软骨修复技术临床疗效的因素。
48例有症状的膝关节稳定的股骨单纯全层软骨缺损患者接受了微骨折技术治疗。采用经过验证的疗效评分、主观临床评级和软骨敏感磁共振成像相结合的方法，对患者预后进行前瞻性评估，随访时间至少为24个月。
在最近一次随访时，32例患者（67%）的膝关节功能评定为良好至优秀，12例患者（25%）为中等，4例患者（8%）为差。微骨折术后，日常生活活动评分、国际膝关节文献委员会评分以及简短健康调查问卷36项身体成分评分均显著提高（p < 0.05）。较低的体重指数与较高的日常生活活动评分和简短健康调查问卷36项身体成分评分相关，体重指数>30 kg/m²的患者结果最差。术前症状持续时间少于12个月的患者，日常生活活动评分的显著改善更为常见（p < 0.05）。对24个膝关节的磁共振成像显示，13例患者（54%）缺损处修复组织填充良好，7例（29%）为中等填充，4例患者（17%）为填充不佳。填充等级与膝关节功能评分相关。所有填充良好的膝关节功能均有改善，而填充等级差与24个月后改善有限和功能评分下降有关。
膝关节软骨损伤的微骨折修复在至少两年的随访中能显著改善功能。填充等级良好、体重指数低和术前症状持续时间短的患者短期效果最佳。高体重指数对短期预后有不利影响，填充等级差与短期耐久性有限有关。
