Arthroscopy: The Journal of Arthroscopic & Related Surgery
ISAKOS Biologics Series Part ISystematic ReviewTreatment of Articular Cartilage Lesions of the Knee by Microfracture or Autologous Chondrocyte Implantation: A Systematic Review
Section snippets
Methods
A systematic review of the literature was carried out. We searched PubMed/Medline, Embase, and The Cochrane Library databases in the period from January 10 through January 20, 2013. The following Medical Subject Headings were used: “chondral defect and knee”; “microfracture and knee”; “chondrocyte implantation and knee”; and “histology and knee and chondral defect.” The references of identified articles were further reviewed to find related studies. Articles were then examined by the 2 senior
Results
The abstracts of 776 studies were reviewed, and 561 studies were excluded because they were not relevant to the topic, leaving 215 that were examined in detail. Of these studies, 181 met the exclusion criteria, leaving 34 for analysis (Fig 1). The articles were categorized as follows: 7 MF studies4, 5, 6, 7, 8, 9, 10 (Table 1), 18 ACI studies11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 (Table 2, Table 3, Table 4), and 9 comparative studies29, 30, 31, 32, 33, 34, 35, 36
Discussion
The durability of cartilage repair is dependent on the tissue generated to fill the articular void. Initial reports using animal models suggested that the MF technique was an effective way to generate “hyaline-like” tissue at the site of chondral injury.4, 5 Relatively few authors have included histologic results in human subject studies. Difficulty in obtaining biopsy specimens from otherwise asymptomatic patients has limited the amount of postoperative histologic data available. The initial
Conclusions
Direct comparison of cartilage repair techniques is methodologically challenging with the great variety of techniques, absence of long-term follow-up, and heterogeneity of outcome measures. Generally, it would appear from the literature analyzed in this review that MF is effective in smaller lesions and is usually associated with a greater proportion of fibrocartilage production, which may have an effect on durability and eventual failure. ACI is an effective treatment that may result in a
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The authors report that they have no conflicts of interest in the authorship and publication of this article.