Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA.
Eur J Radiol. 2012 Jul;81(7):1618-24. doi: 10.1016/j.ejrad.2011.04.071. Epub 2011 Jun 17.
Recent literature revealed good short-term results after microfracturing (MFX) of isolated focal cartilage defects in the knee joint. Study purpose was a long-term evaluation of patients who received MFX through a multimodal approach, correlating clinical scores and morphological pre- and postoperative MRI-scans.
Between 2000 and 2007 158 patients were treated with MFX for focal femoral or tibial defects at our department. Patients with instabilities, secondary surgical intervention, patellofemoral lesions, a plica mediopatellaris or more than one cartilage defect site and age >55 were excluded. 15 patients were included. Minimum postoperative follow-up (FU) was 18 months (18-78 m). Mean age at surgery was 45 years (27-54), mean FU-interval 48 months (18-78 m). Male to female ratio was 9:6. For clinical assessment the Knee Osteoarthritis Ou tcome Score (KOOS) and Lysholm Score were used, radiological evaluation was performed with radiographs and 3Tesla-MRI.
Clinical knee function was rated good to excellent in 1 patient, fair in 2 and poor in 10 patients. 2/15 patients received full knee replacement due to insufficient cartilage repair through MFX during FU period. Evaluation of pre- and postoperative MRI showed good cartilage repair tissue in 1 (7.7%), moderate repair in 2 (15.4%) and poor fill in 10 patients (76.9%). In these 10 patients the defect size increased. Average defect size preoperatively was 187 mm(2) (range 12-800 mm(2)) and postoperatively 294 mm(2) (40-800 mm(2)). The KOOS-Pain averaged 60 (39-94), KOOS-Symptoms 60.6 (21-100), KOOS-ADL 69 (21-91), KOOS-Sports 35.7 (5-60) and KOOS-QUL 37.2 (6-81). The average Lysholm Score was 73.9 (58-94). 10 patients showed a varus leg axis deviation (Ø 5.9°), 3 had a neutral alignment. The alignment correlated positively with KOOS and especially with the Lysholm Score.
Our study demonstrated that MFX as a treatment option for cartilage defect in the knee did not show the anticipated clinical and radiological long-term results. In 12 of 15 patients the cartilage defect size had increased after MFX, in 2 patients indicating full-knee replacement. Especially those with a leg malalignment >5° in varus were more prone to suffer from an increase in defect size. In our cohort the clinical scores correlated with the radiological findings.
最近的文献显示，膝关节孤立性局灶性软骨缺损行微骨折（MFX）后短期效果良好。本研究旨在通过多模态方法对接受 MFX 治疗的患者进行长期评估，将临床评分与术前和术后 MRI 扫描的形态学结果相关联。
2000 年至 2007 年间，我们科室对 158 例股骨或胫骨局灶性缺陷患者进行了 MFX 治疗。排除不稳定、二次手术干预、髌股关节病变、中髌骨支持带或多个软骨缺陷部位以及年龄>55 岁的患者。纳入 15 例患者。术后最短随访时间为 18 个月（18-78m）。手术时的平均年龄为 45 岁（27-54 岁），平均随访时间为 48 个月（18-78m）。男女比例为 9:6。临床评估采用膝关节骨关节炎结局评分（KOOS）和 Lysholm 评分，影像学评估采用 X 线和 3 Tesla MRI。
1 例患者临床膝关节功能评为优，2 例评为良，10 例评为差。在随访期间，2/15 例患者因 MFX 未能充分修复软骨而接受全膝关节置换。术前和术后 MRI 评估显示 1 例（7.7%）软骨修复组织良好，2 例（15.4%）中度修复，10 例（76.9%）修复不良。在这 10 例患者中，缺损面积增大。术前平均缺损面积为 187mm²（12-800mm²），术后为 294mm²（40-800mm²）。KOOS 疼痛平均为 60（39-94），KOOS 症状为 60.6（21-100），KOOS-ADL 为 69（21-91），KOOS-运动为 35.7（5-60），KOOS-QUL 为 37.2（6-81）。平均 Lysholm 评分为 73.9（58-94）。10 例患者出现内翻下肢轴线偏差（Ø 5.9°），3 例为中立位。下肢对线与 KOOS 评分特别是与 Lysholm 评分呈正相关。
本研究表明，MFX 作为膝关节软骨缺损的治疗选择，并未显示出预期的临床和影像学长期效果。在 15 例患者中，12 例患者在 MFX 后软骨缺损面积增大，2 例患者需要全膝关节置换。特别是那些内翻下肢对线偏差>5°的患者，更容易出现缺损面积增大。在我们的队列中，临床评分与影像学发现相关。
