Harvard Vanguard Orthopedics and Sports Medicine, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Am J Sports Med. 2009 Oct;37(10):2053-63. doi: 10.1177/0363546508328414. Epub 2009 Feb 26.
Despite the popularity of microfracture as a first-line treatment for articular cartilage defects in the knee, systematic information on its clinical efficacy for articular cartilage repair and long-term improvement of knee function is not available.
Systematic analysis of the existing clinical literature of microfracture in the knee can improve the understanding of the advantages and limitations of this cartilage repair technique and can help to optimize its indications and clinical outcomes.
Systematic review.
A comprehensive literature search was performed using established search engines (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials) to identify original human studies of articular cartilage repair with microfracture. Modified Coleman Methodology Scores were used to analyze the quality of the existing studies. Clinical efficacy of articular cartilage repair was evaluated by systematic analysis of short- and long-term functional outcome scores, macroscopic and microscopic repair cartilage quality, and findings of postoperative magnetic resonance imaging.
Twenty-eight studies describing 3122 patients were included in the review. The average follow-up was 41 months, with only 5 studies reporting follow-up of 5 years or more. Six studies were randomized controlled trials and the mean Coleman Methodology Score was 58 (range, 22-97). Microfracture effectively improved knee function in all studies during the first 24 months after microfracture, but the reports on durability of the initial functional improvement were conflicting. Several factors were identified that affected clinical outcome. Defect fill on magnetic resonance imaging was highly variable and correlated with functional outcome. Macroscopic repair cartilage quality positively affected long-term failure rate, while the influence of histologic repair tissue quality remained inconclusive.
This systematic analysis shows that microfracture provides effective short-term functional improvement of knee function but insufficient data are available on its long-term results. Shortcomings of the technique include limited hyaline repair tissue, variable repair cartilage volume, and possible functional deterioration. The quality of the currently available data on micro-fracture is still limited by the variability of results and study designs. Further well-designed studies are needed to determine the long-term efficacy of microfracture and to define its specific clinical indications compared to other cartilage repair techniques.
尽管微骨折术作为膝关节软骨缺损的一线治疗方法广受欢迎，但目前尚无系统信息表明其对软骨修复的临床疗效及其对膝关节功能的长期改善效果。
对膝关节微骨折术的现有临床文献进行系统分析，可以提高对该软骨修复技术的优势和局限性的认识，并有助于优化其适应证和临床效果。
系统综述。
使用已建立的搜索引擎（MEDLINE、EMBASE、CINAHL、Cochrane 对照试验中心注册库）全面检索关节软骨修复的微骨折术原始人类研究文献。使用改良 Coleman 方法学评分分析现有研究的质量。通过系统分析短期和长期功能结果评分、宏观和微观修复软骨质量以及术后磁共振成像结果来评估关节软骨修复的临床效果。
本综述共纳入 28 项研究，共 3122 例患者。平均随访时间为 41 个月，仅有 5 项研究的随访时间超过 5 年。6 项研究为随机对照试验，平均 Coleman 方法学评分为 58 分（范围 22-97 分）。在微骨折术后的头 24 个月内，所有研究均证实微骨折术可有效改善膝关节功能，但关于初始功能改善的持久性报告结果存在矛盾。确定了一些影响临床效果的因素。磁共振成像上的缺损填充高度可变，与功能结果相关。宏观修复软骨质量对长期失败率有积极影响，而组织学修复组织质量的影响仍不确定。
本系统分析表明，微骨折术可有效改善膝关节功能的短期功能，但关于其长期结果的资料有限。该技术的不足之处包括透明软骨修复组织有限、修复软骨体积可变以及可能出现功能恶化。目前关于微骨折术的现有数据质量仍受结果和研究设计的差异限制。需要进一步开展设计良好的研究，以确定微骨折术的长期疗效，并确定其与其他软骨修复技术相比的具体临床适应证。
