Microfracture for full-thickness chondral lesions of the knee in elite athletes leads to high return-to-play rates.

PURPOSE

Injuries to the knee are common in elite athletes and often involve damage to the articular cartilage. Given the high demands of elite sport, full-thickness articular cartilage defects in the knee can be career-limiting or threatening. Microfracture can promote cartilage repair, but the resultant mixed fibrocartilaginous tissue is believed to be less resilient than the native hyaline cartilage. Doubts remain as to whether it can withstand prolonged and intensive sporting activity, and it has become less popular. Also, there is a view that microfracture compromises the results of subsequent chondral resurfacing surgery options. The aim of this study was to determine the factors affecting return-to-play (RTP) and continued participation in elite sport by athletes after microfracture in the knee.

METHODS

A retrospective review of a consecutive series of elite athletes with chondral injuries in the knee treated with microfracture by the lead surgeon between 2011 and 2020 was undertaken. RTP was defined as competing in at least one match at a professional level or national/international level in amateur sport.

RESULTS

Fifty athletes with a mean age of 24.7 years (±4.0 years) were included. Thirty (60%) footballers, 13 (26%) rugby players and 7 (14%) other elite athletes were treated. Forty-seven (94%) athletes RTP at a mean time of 9.3 months (±4.1months) with 43 (86%) still playing at 2 years, and of the 44 with 5-year follow-up, 24 (54.5%) were still playing. The lateral femoral condyle was the most common location for the chondral lesion (56%). Larger lesions (over 2 cm diameter) significantly reduced RTP (p = 0.048), and the ability to continue to play at 5 years (p = 0.051 and p = 0.002), but this was not significant at 2 years. Multiple lesions significantly reduced playing at 2 and 5 years (p < 0.001).

CONCLUSION

The rate of RTP of professional athletes after microfracture in the knee is high but takes a long time, and the ability to continue playing reduces over time and is affected by the size and number of lesions requiring microfracture.

LEVEL OF EVIDENCE

Level IV, retrospective cohort study.