Does scaffold enhancement show significant superiority over microfracture alone for treating knee chondral defects? A systematic review and meta-analysis of randomised clinical trials

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-10-06 DOI:10.1002/ksa.12495

Karol Pałka, Marta Kubisa, Anna Akbas, Michał Kubisa, Michał Dobrakowski

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Abstract

Purpose

Chondral and osteochondral lesions in the knee are common conditions that significantly impair individuals' well-being and can lead to osteoarthritis, 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 chondral defects, but its long-term efficacy is often inadequate. Although recent randomised controlled trials have compared microfractures 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 randomised controlled trials (RCTs) comparing microfractures alone to matrix-induced chondrogenesis for knee chondral defects with at least a 12-month follow-up. Ten randomised controlled trials conducted between 2013 and 2024, enroling 378 patients, were included.

Results

The meta-analysis showed no significant superiority of scaffolds over MF (p > 0.05) in International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome, Visual Analog Scale, and Magnetic Resonance Observation of Cartilage Repair Tissue scores at 12 and 24 months. However, individual studies suggested the potential benefits of scaffolds, especially in long-term outcomes. Clinical improvements from MF typically decline after 2–3 years, underscoring the need for long-term follow-up in future research.

Conclusion

Our meta-analysis shows no significant difference between MF and MF with scaffold in treating knee cartilage defects, though some long-term RCTs demonstrate statistically significant differences. The absence of a universally accepted algorithm for analysing knee chondral defects limits this study. Establishing reliable guidelines and standardised study protocols is essential to improve long-term patient outcomes and the quality of future papers.

Level of Evidence

Level I.

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在治疗膝关节软骨缺损方面，支架增强疗法比单纯微骨折疗法有明显优势吗？随机临床试验的系统回顾和荟萃分析。

目的：膝关节软骨和骨软骨损伤是一种常见疾病，严重影响个人健康，并可导致骨关节炎，给医疗系统带来沉重负担。关节软骨的自然愈合能力有限，因此需要创新的治疗策略。微骨折（MF）是一种广泛用于膝关节软骨缺损的技术，但其长期疗效往往不佳。虽然最近的随机对照试验对微骨折和支架增强疗法进行了比较，但目前还缺乏全面的系统回顾和荟萃分析：方法：按照 PRISMA 指南在 PubMed 和 EMBASE 数据库中进行了广泛的文献检索。纳入标准主要是比较单独微骨折与基质诱导软骨生成治疗膝关节软骨缺损的随机对照试验（RCT），随访至少 12 个月。10项随机对照试验在2013年至2024年间进行，共纳入378名患者：荟萃分析表明，在12个月和24个月时，在国际膝关节文献委员会、膝关节损伤和骨关节炎结果、视觉模拟量表和软骨修复组织磁共振观察评分方面，支架与MF相比没有明显优势（P > 0.05）。不过，个别研究表明支架具有潜在的益处，尤其是在长期疗效方面。MF带来的临床改善通常在2-3年后下降，这强调了在未来研究中进行长期随访的必要性：我们的荟萃分析表明，在治疗膝关节软骨缺损方面，MF 和带支架的 MF 没有显著差异，尽管一些长期研究表明两者之间存在统计学意义上的显著差异。缺乏普遍接受的膝关节软骨缺损分析算法限制了这项研究。制定可靠的指南和标准化的研究方案对于改善患者的长期治疗效果和提高未来论文的质量至关重要：证据等级：一级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).