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Microfracture returned 44% of high-impact athletes to sport
Young athletes did best, as did those with smaller lesions or whose symptoms persisted for <12 months prior to treatment.
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KEYSTONE, Colo. — Outcomes of a study on using microfracture to repair knee cartilage in high-impact athletes suggested that treating lesions as early as possible may speed the return to sport.
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In doing this research, investigators identified a handful of factors that significantly affected return to sport (RTS). Among them was the degree and duration of symptoms. “Players having less than one year of symptoms before microfracture returned at 86%, compared to 16% in players who had longer symptoms,” said Kai Mithoefer, MD, who is at Brigham and Women’s Hospital in Boston.
“These lesions need to be addressed early,” he said when presenting results at the recent American Orthopaedic Society for Sports Medicine 2005 Annual Meeting, here.
Also, an athlete’s young age, especially if he or she was under 40-years-old, and having few or no prior surgeries, positively impacted results with microfracture in this population.
Single lesions treated
Mithoefer and his colleagues prospectively studied microfracture done with a standard technique in 32 high-impact athletes identified from the Hospital for Special Surgery (HSS) cartilage registry, most of whom were men (84%). Their average age was 38-years-old and their body mass index equaled 26±0.6 kg/m2.
Study participants presented with single, symptomatic, low-grade femoral cartilage lesions — 53% of them were on the medial femoral condyle and 22% on the lateral femoral condyle. The average lesion size was 497 mm².
Surgeons used a standard arthroscopic microfracture technique described by J. Richard Steadman, MD. The surgeons removed damaged cartilage to a stable margin and then micropenetration of the subchondral bone and formation of a blood clot containing pluripotent cells. Eight patients underwent concomitant partial meniscectomies, four of which were done in the same compartment as the lesion.
Postop program, analysis
The postoperative rehabilitation program for all the patients consisted of the protocol Steadman originally described.
Outcome evaluation involved a subjective rating and four different validated outcome scores, Mithoefer explained. Outcomes instruments included the activities of daily living (ADL) score, the physical component subscale of the SF-36 score, the Marx activity rating, and the Tegner activity score.
“At the last count, 66% of our patients and athletes reported good to excellent outcomes after microfracture, which was an improvement from preoperatively. In particular, there also was a significant reduction in the preoperative number of poor ratings,” he said.
For 75% of the patients, the postop ADL, SF-36 and Tegner activity scores increased significantly after microfracture (P<.001). Their post-microfracture Marx activity ratings also increased significantly (P<.01).
Lesion size also impacted the results: Athletes with smaller lesions of about <200 mm² had significantly higher RTS rates, Mithoefer said.
But, functional scores in 47% of the patients diminished by 24 months postop.
“Future studies now need to address which factors cause the decrease in initial functional improvement and whether this technique can help us prevent the high rate of osteoarthritis in high-impact athletes.”
For more information:
- Mithoefer K, Williams RJ, Warren R, et al. High-impact athletics after knee articular cartilage repair: A prospective evaluation of the microfracture technique. Presented at the American Orthopaedic Society for Sports Medicine 2005 Annual Meeting. July 14-17, 2005. Keystone, Colo.