Microfracture Versus Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: 2-Year Results From a Multicenter Double-Blinded Randomized Controlled Trial

Per-Henrik Randsborg, Tommy Frøseth Aae, Håvard Visnes, Thomas Birkenes, Jūratė Šaltytė Benth, Øystein Bjerkestand Lian, Heidi Andreassen Hanvold, Asbjørn Årøen
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Abstract

Background: Knee cartilage injuries can lead to significant functional limitations, pain, and diminished quality of life. Microfracture (MF) is the most common surgical procedure for smaller (<2 cm 2 ) cartilage lesions of the knee. However, there is no established gold-standard surgical intervention. Purpose: To compare functional and patient-reported outcomes after MF and arthroscopic debridement (AD) for symptomatic, isolated femoral cartilage injuries <2 cm 2 in patients aged 18 to 50 years. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 65 patients were included, randomized to undergo either MF (n = 31) or AD (n = 34), and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscore. Secondary outcomes included scores for the other KOOS subscales, Tegner activity scale, Lysholm score, and visual analog scale for pain. Results: The mean age at the time of inclusion was 33.2 ± 9.7 years. There were 44 (68%) male patients. The mean size of the lesion was 1.2 ± 0.6 cm 2 . There was no statistically significant difference between the groups in the change in the KOOS Quality of Life subscore from baseline to 2 years (3.5 [95% CI, –10.0 to 16.9]; P = .61). There were 10 complications in 5 patients in the MF group and 2 complications in 2 patients in the AD group. According to a linear mixed model, there were no statistically significant differences between the groups for any of the secondary outcomes at any time point during the 2-year follow-up period. Conclusion: MF was not superior to AD when treating femoral cartilage lesions of the knee <2 cm 2 .
微骨折与关节镜清创治疗症状性膝关节软骨病变:2年多中心双盲随机对照试验结果
背景:膝关节软骨损伤可导致严重的功能限制、疼痛和生活质量下降。微骨折(MF)是膝关节较小(2cm²)软骨病变最常见的手术方法。然而,目前还没有确定的黄金标准手术干预。目的:比较18 - 50岁症状性、孤立性股骨软骨损伤(2cm 2)的MF和关节镜清创(AD)后的功能和患者报告的结果。研究设计:随机对照试验;证据等级:1。方法:共纳入65例患者,随机分为MF组(31例)和AD组(34例),随访2年。主要结局是膝关节损伤和骨关节炎结局评分(kos)生活质量评分的变化。次要结果包括其他oos子量表、Tegner活动量表、Lysholm评分和疼痛视觉模拟量表的得分。结果:患者入组时平均年龄为33.2±9.7岁。男性44例(68%)。病灶平均大小1.2±0.6 cm 2。从基线到2年,两组间kos生活质量评分的变化无统计学差异(3.5 [95% CI, -10.0 ~ 16.9];P = .61)。MF组5例出现10例并发症,AD组2例出现2例并发症。根据线性混合模型,在2年随访期间的任何时间点,两组之间的任何次要结局均无统计学差异。结论:MF治疗膝关节2 cm 2股骨软骨病变效果不优于AD。
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