Long-term outcomes of arthroscopic single-anchor fixation versus microfracture for osteochondral fractures of the knee weight-bearing area in adolescents and young adults

Abstract

Purpose

Osteochondral fractures involving the weight-bearing area of the knee in young patients require stable restoration of the native osteochondral fragment whenever possible. This study aimed to evaluate the long-term clinical and radiological outcomes of arthroscopic single-anchor fixation and to compare them with those of microfracture.

Methods

This retrospective comparative study included 24 adolescents and young adults with osteochondral fractures of the femoral condyle or trochlear region treated between 2016 and 2017. Twelve patients underwent arthroscopic single-anchor in situ fixation, and 12 underwent microfracture. The fixation technique used one double-loaded suture anchor to obtain multi-point compression of the osteochondral fragment while preserving the subchondral plate. Clinical outcomes were assessed using the Lysholm, International Knee Documentation Committee, and Tegner scores. Magnetic resonance imaging was evaluated using the MOCART 2.0 score. The mean follow-up was 93.7 months.

Results

The single-anchor group showed a significantly higher intraoperative contact area ratio than the microfracture group (96.5% ± 3.2% vs. 85.8% ± 5.6%, P < 0.001). At final follow-up, the single-anchor group had superior Lysholm scores (91 ± 5 vs. 83 ± 8, P = 0.009), IKDC scores (86 ± 6 vs. 78 ± 7, P = 0.010), and Tegner activity levels (5.0 ± 1.1 vs. 3.9 ± 0.9, P = 0.012). MRI evaluation also favored single-anchor fixation, with higher MOCART 2.0 scores at 12 months (82.3 ± 6.4 vs. 61.7 ± 8.1, P < 0.001) and at final follow-up (79.4 ± 7.0 vs. 57.9 ± 9.0, P < 0.001). No fixation failure or revision occurred in the single-anchor group, whereas two patients in the microfracture group required reoperation.

Conclusion

Arthroscopic single-anchor in situ fixation provided durable clinical improvement and superior long-term MRI repair quality compared with microfracture in adolescents and young adults with osteochondral fractures of the knee weight-bearing area. By preserving the native osteochondral fragment and minimizing subchondral disruption, this technique may represent a useful joint-preserving option for selected young patients with reducible osteochondral fragments.