Kreuz Peter C, Erggelet Christoph, Steinwachs Matthias R, Krause Stefanie J, Lahm Andreas, Niemeyer Philipp, Ghanem Nadir, Uhl Markus, Südkamp Norbert
Department of Orthopaedic and Trauma Surgery, Albert Ludwig University of Freiburg, Freiburg, Germany.
Arthroscopy. 2006 Nov;22(11):1180-6. doi: 10.1016/j.arthro.2006.06.020.
Age-dependent studies about the clinical result after microfracture of cartilage lesions in the knee are still missing. This prospective study was performed to discover age-dependent differences in the results after microfracture over a period of 36 months.
Between 1999 and 2002, 85 patients (mean age, 39 years) with full-thickness chondral lesions underwent the microfracture procedure and were evaluated preoperatively and at 6, 18, and 36 months after surgery. Depending on the patients' age (< or =40 years or >40 years) and the localization of the defects (femoral condyles, tibia, and patellofemoral joint), the patients were assigned to 6 different groups. Exclusion criteria were meniscal pathologic conditions, tibiofemoral malalignment, and ligament instabilities. Baseline clinical scores were compared with follow-up data by use of paired Wilcoxon tests for the modified Cincinnati knee score and the International Cartilage Repair Society (ICRS) score.
The scores improved in all groups over the whole study period (P < .05). Patients aged 40 years or younger had significantly better results (P < .01) for both scores compared with older patients. Between 18 and 36 months after microfracture, the ICRS score deteriorated significantly (P < .05) in patients aged over 40 years whereas younger patients with defects on the femoral condyles and on the tibia showed neither a significant improvement nor a significant deterioration in the ICRS score (P > .1). Magnetic resonance imaging 36 months after surgery revealed better defect filling and a better overall score in younger patients (P < .05). The Spearman coefficient of correlation between clinical and magnetic resonance imaging scores was 0.84.
The clinical results after microfracture of full-thickness cartilage lesions in the knee are age-dependent. Deterioration begins 18 months after surgery and is significantly pronounced in patients aged older than 40 years. The best prognostic factor was found to be a patient age of 40 or younger with defects on the femoral condyles.
Level IV, prognostic case series.
关于膝关节软骨损伤微骨折术后临床结果的年龄相关性研究仍然缺乏。本前瞻性研究旨在发现微骨折术后36个月内结果的年龄相关性差异。
1999年至2002年期间，85例（平均年龄39岁）全层软骨损伤患者接受了微骨折手术，并在术前以及术后6、18和36个月进行评估。根据患者年龄（≤40岁或＞40岁）以及缺损部位（股骨髁、胫骨和髌股关节），将患者分为6个不同组。排除标准为半月板病变、胫股关节排列不齐和韧带不稳定。通过配对威尔科克森检验对改良辛辛那提膝关节评分和国际软骨修复协会（ICRS）评分的基线临床评分与随访数据进行比较。
在整个研究期间，所有组的评分均有所改善（P＜0.05）。与年龄较大的患者相比，40岁及以下患者的两项评分结果均显著更好（P＜0.01）。微骨折术后18至36个月，40岁以上患者的ICRS评分显著恶化（P＜0.05），而股骨髁和胫骨有缺损的年轻患者的ICRS评分既无显著改善也无显著恶化（P＞0.1）。术后36个月的磁共振成像显示，年轻患者的缺损填充更好，总体评分更高（P＜0.05）。临床评分与磁共振成像评分之间的斯皮尔曼相关系数为0.84。
膝关节全层软骨损伤微骨折术后的临床结果与年龄相关。术后18个月开始出现恶化，在40岁以上患者中尤为明显。发现最佳预后因素是年龄40岁及以下且股骨髁有缺损的患者。
IV级，预后病例系列。
