A Systematic Review And Meta-Analysis Of Randomized Controlled Trials (Rcts) On Single-Stage Surgical Procedures Of Microfracture With And Without Scaffold Enhancement Therapy For Focal Chondral Lesions In The Knee

A Systematic Review And Meta-Analysis Of Randomized Controlled Trials (Rcts) On Single-Stage Surgical Procedures Of Microfracture With And Without Scaffold Enhancement Therapy For Focal Chondral Lesions In The Knee

Marta Gabriela Kubisa, MD, POLAND Karol Palka, MD, POLAND Anna Akbas, PhD, POLAND

Szpital Carolina, Warszawa, Woj. Mazowieckie, POLAND


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Treatment / Technique

Anatomic Structure

Diagnosis / Condition

Diagnosis Method


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


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.