Tried and Tested Recommendations
The benefits of the microfracturing technique in the medium to long term are questionable. This applies particularly to cartilage lesions larger than 4 cm2 (1). Osteochondral transfer methods—for example, mosaicplasty—yield good results even in the longer term. If lesions exceed 4 cm2 in size, however, the complication and failure rates associated with this approach increase substantially (2). This finding generally does not apply to autologous chondrocyte transplantation (ACT) (2).
A study with an evidence level of 1, which compared conventional ACT (using quality assured chondrocytes) versus microfracturing, yielded significantly better histological results after ACT. Clinically, too, some of the 3 year results for ACT were significantly superior to those achieved by microfracturing. Another randomized study investigating a carrier-based ACT versus microfracturing reported significantly better results for ACT for all clinical scores after only 2 years. A recently published study with up to 20 years’ follow-up also points at stable long-term results from ACT and a high degree of patient satisfaction (3). However, similarly reliable long-term results after microfracturing, especially for larger cartilage lesions, have not been reported so far, and neither have mainly good results of this method subsequent to failed ACT or mosaicplasty. In sum, the evidence base for ACT—especially in contrast to microfracturing—has improved steadily in the recent past. Our working group’s recommendations for indications and methods for the different biological reconstructive approaches (microfracturing, mosaicoplasty, and ACT) for cartilage lesions of the knee have thus become tried and tested, or even been confirmed, and should therefore continue to be considered in everyday clinical practice (2).
Arbeitsgemeinschaft Geweberegeneration und Gewebeersatz der Deutschen Gesellschaft für Unfallchirurgie (DGU) und der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC).
Dr. med. Dirk Albrecht
72076 Tübingen, Germany
Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR: Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 2009; 37: 2053–63. MEDLINE|
|2.||Behrens P, Bosch U, Bruns J, et al.: Indikations- und Durchführungsempfehlungen der Arbeitsgemeinschaft „Geweberegeneration und Gewebeersatz” zur Autologen Chondrozyten-Transplantation (ACT). Z Orthop Ihre Grenzgeb 2004; 142: 529–39. MEDLINE|
|3.||Peterson L, Vasiliadis HS, Brittberg M, Lindahl A: Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 2010; Feb 24. [Epub ahead of print]. MEDLINE|
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