Department of Orthopedics, Deaconess University Hospital, Haraldsplass, Bergen, Norway.
Department of Orthopedics, Aleris Nesttun Hospital, Bergen, Norway.
Am J Sports Med. 2018 Mar;46(4):826-831. doi: 10.1177/0363546517745281. Epub 2017 Dec 18.
Few comparative randomized long-term studies on microfracture versus mosaicplasty have been published, and only 2 studies reported a follow-up of 10 years. Hypothesis/Purpose: The purpose was to compare the clinical outcome of microfracture versus mosaicplasty/osteochondral autograft transfer in symptomatic cartilage lesions. The null hypothesis was that the outcome was not statistically different at any point of time.
Randomized controlled trial; Level of evidence, 1.
Forty patients with articular cartilage defects were randomized to undergo cartilage repair by either microfracture (n = 20) or mosaicplasty (n = 20). Inclusion criteria were as follows: age 18 to 50 years at the time of surgery, 1 or 2 symptomatic focal full-thickness articular chondral defects on the femoral condyles or trochlea, and size 2 to 6 cm. The main outcome variable was the Lysholm knee score recorded before the surgery and at 12 months, median 5 years, median 10 years, and minimum 15 years after the surgery.
Forty patients were included in the study (28 men, 12 women; median age, 32 years; range, 18-48 years). Defects with a median size of 3.5 cm (range, 2-5 cm) were treated. A significant increase in the Lysholm score was seen for all subjects- from a mean 53 (SD, 16) at baseline to 69 (SD, 21) at the minimum 15-year follow-up ( P = .001). The mean Lysholm score was significantly higher in the mosaicplasty group than the microfracture group at 12 months, median 5 years, median 10 years, and minimum 15 years: 77 (SD, 17) versus 61 (SD, 22), respectively ( P = .01), at the last follow-up. At all follow-up time points, the difference in mean Lysholm score was clinically significant (>10 points).
At short, medium, and long term (minimum 15 years), mosaicplasty results in a better, clinically relevant outcome than microfracture in articular cartilage defects (2-5 cm) of the distal femur of the knee in patients aged 18 to 50 years.
关于微骨折术与马赛克plasty 比较的长期随机对照研究较少，仅有 2 项研究报道了 10 年的随访结果。假设/目的：本研究旨在比较微骨折术与马赛克plasty/骨软骨自体移植术治疗症状性软骨损伤的临床结果。零假设为任何时间点的结果均无统计学差异。
随机对照试验；证据水平，1 级。
40 例关节软骨缺损患者随机分为微骨折组（n = 20）或马赛克plasty 组（n = 20）行软骨修复术。纳入标准如下：手术时年龄 1850 岁，股骨髁或滑车有 1 或 2 个症状性局灶性全层关节软骨缺损，大小为 26cm。主要观察变量为术前及术后 12 个月、中位数 5 年、中位数 10 年和最小 15 年的 Lysholm 膝关节评分。
本研究共纳入 40 例患者（28 例男性，12 例女性；中位年龄 32 岁；范围 1848 岁）。治疗的缺损大小中位数为 3.5cm（范围 25cm）。所有患者的 Lysholm 评分均显著增加，从基线时的平均 53（SD，16）分增加至最小随访 15 年时的 69（SD，21）分（P =.001）。在 12 个月、中位数 5 年、中位数 10 年和最小随访 15 年时，马赛克plasty 组的 Lysholm 评分均显著高于微骨折组，分别为 77（SD，17）分比 61（SD，22）分（P =.01）。在所有随访时间点，平均 Lysholm 评分的差异均具有临床意义（>10 分）。
在 1850 岁患者中，对于股骨远端 25cm 的关节软骨缺损，微骨折术与马赛克plasty 相比，短期、中期和长期（最小随访 15 年）随访结果显示马赛克plasty 可获得更好的、具有临床意义的结果。
