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Meta-Analysis
. 2023 Mar;14(1):5-16.
doi: 10.1177/19476035221147680. Epub 2023 Jan 9.

Prognostic Factors for the Clinical Outcome after Microfracture Treatment of Chondral and Osteochondral Defects in the Knee Joint: A Systematic Review

Iris M van Tuijn  1   2 , Kaj S Emanuel  1   3 , Pieter P W van Hugten  1 , Ralph Jeuken  1 , Pieter J Emans  1
Affiliations
Meta-Analysis

Prognostic Factors for the Clinical Outcome after Microfracture Treatment of Chondral and Osteochondral Defects in the Knee Joint: A Systematic Review

Iris M van Tuijn et al. Cartilage. 2023 Mar.

Abstract

Objective: The objective of this study is to establish which patient and lesion characteristics are related to the clinical outcome after microfracture of cartilage defects in the knee.

Study design: Systematic review.

Methods: After preregistration, PubMed, Embase, and Cochrane were searched for studies that analyzed prognostic factors for the outcome of microfracture treatment in the knee. The criteria for inclusion were outcome measured using Patient-Reported Outcome Measures (PROMs), a clinical study with ≥10 participants receiving microfracture, and a minimal follow-up period of 1 year.

Results: For none of the investigated prognostic factors, effect size reporting was sufficiently homogeneous to conduct a meta-analysis. However, a majority of the included studies identified higher age, larger lesion size, longer preoperative symptom duration, and previous surgery on the ipsilateral knee, especially meniscectomy and anterior cruciate ligament reconstruction, as factors that are reported to be correlated to a less favorable outcome. A lesion location that does not include the trochlea or the patellofemoral joint and is not weightbearing, a nondegenerative mechanism of injury, and a single lesion were reported as factors that predict a favorable outcome. As to gender, body mass index, preoperative activity level, smoking, and concomitant knee surgery, the included articles were inconclusive or no effect was reported.

Conclusions: Several factors correlated with the clinical result after microfracture treatment. However, the information on the effect sizes of the influence on clinical outcome is incomplete due to poor reporting. Large-scale registries or pooling of homogeneous, well-reported data is needed to work toward prognostic models. That would be an important step toward personalized treatment.

Keywords: bone marrow stimulation; osteochondral defect; risk factors.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flowchart of the selection process. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; MF = microfracture.
Figure 2.
Figure 2.
MINORS quality assessment. MINORS = Methodological Index for Non-Randomized Studies
See this image and copyright information in PMC

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