Summary

The meta-analysis of RCT's did not demonstrate the superior effectiveness of scaffolds over microfracrures.

Abstract

Purpose

Chondral and osteochondral lesions in the knee are common conditions that significantly impair individuals' well-being and can lead to osteoarthritis (OA), imposing substantial burdens on healthcare systems. The limited natural healing capacity of articular cartilage necessitates innovative treatment strategies. Microfracture (MF) is a widely used technique for knee lesions, but its long-term efficacy is often inadequate. Although recent randomized controlled trials (RCTs) have compared MF with scaffold- enhanced therapies, a comprehensive systematic review and meta-analysis are lacking.

Methods

An extensive literature search was conducted in PubMed and EMBASE databases following PRISMA guidelines. Inclusion criteria focused on RCTs comparing microfracture alone to matrix-induced chondrogenesis (AMIC) for knee chondral defects with at least a 12-month follow-up. Ten RCTs conducted between 2013 and 2023, enrolling 378 patients, were included.

Results

The meta-analysis did not demonstrate the superior effectiveness of scaffolds over microfracrures. However, individual studies suggested potential benefits of scaffolds, especially in long-term outcomes. Clinical improvements from microfractures typically decline after 2-3 years, underscoring the need for long-term follow-up in future research.

Conclusion

While scaffolds may yield more favorable outcomes compared to microfractures alone, the lack of a universally accepted algorithm for knee lesion analysis limits this meta-analysis. Establishing reliable guidelines and standardized study protocols will enhance long-term patient outcomes and improve the quality of future meta-analyses.