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Review
. 2018 Apr;26(4):1044-1052.
doi: 10.1007/s00167-017-4802-5. Epub 2017 Nov 11.

Microfracture is more cost-effective than autologous chondrocyte implantation: a review of level 1 and level 2 studies with 5 year follow-up

Tommy Frøseth Aae  1   2 , Per-Henrik Randsborg  3 , Hilde Lurås  4   5 , Asbjørn Årøen  3   4   6 , Øystein Bjerkestrand Lian  7   8
Affiliations
Review

Microfracture is more cost-effective than autologous chondrocyte implantation: a review of level 1 and level 2 studies with 5 year follow-up

Tommy Frøseth Aae et al. Knee Surg Sports Traumatol Arthrosc. 2018 Apr.

Abstract

Purpose: Focal cartilage defects in the knee may have devastating effect on the knee joint, where two of the main surgical treatment options are microfracture and autologous chondrocyte implantation. Comparative studies have failed to establish which method yields the best clinical results. A cost-effectiveness analysis of microfracture and autologous chondrocyte implantation would contribute to the clinical decision process.

Methods: A PubMed search identifying level I and level II studies with 5 year follow-up was performed. With the data from these studies, decision trees with associated service provision and costs connected to the two different techniques were designed. In addition to hospital costs, we included costs connected to physiotherapy following surgery. To paint a broader cost picture, we also included indirect costs to the society due to productivity loss caused by work absence.

Results: Four high-quality studies, with a follow-up of 5 years, met the inclusion criteria. A total of 319 patients were included, 170 undergoing microfracture and 149 autologous chondrocyte implantation. The re-operation rate was 23 (13.5%) following microfracture, and 18 (12.1%) for autologous chondrocyte implantation. Both groups achieved substantially better clinical scores at 5 years compared to baseline. Microfracture was more cost-effective when comparing all clinical scores.

Conclusion: Microfracture is associated with both lower costs and lower cost per point increase in patient reported outcome measures. There is a need of well-designed, high-quality randomized controlled trials before reliable conclusions regarding cost-effectiveness in the long run is possible.

Level of evidence: III.

Keywords: Articular cartilage lesion; Autologous chondrocyte implantation; Cost-effectiveness; Microfracture.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no competing interests.

Funding

Funded by research grants from the Norwegian Research Council, awarded the Norwegian Cartilage Project (NCP), Grant No. 2015107.

Ethical approval

The manuscript uses clinical data based on previous published literature, all approved by an ethics committee. This study is in accordance with the ethical standards of the 1964 Declaration of Helsinki.

Figures

Fig. 1
Fig. 1
Flow diagram of article selection included in the study
Fig. 2
Fig. 2
Microfracture decision tree. n number of patients, MF microfracture, ACI autologous chondrocyte implantation, TKA total knee arthroplasty
Fig. 3
Fig. 3
Autologous chondrocyte implantation decision tree. n number of patients, MF microfracture, HTO high tibial osteotomy, TKA total knee arthroplasty
See this image and copyright information in PMC

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