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Does progress in microfracture techniques necessarily translate into clinical effectiveness?

World Journal of Orthopedics 2024年第3期15卷 266-284页

作者： Sathish Muthu Vibhu Krishnan Viswanathan Manoharan Sakthivel Mohammed Thabrez Department of Orthopaedics Orthopaedic Research GroupCoimbatore 641045Tamil NaduIndia Department of Biotechnology Karpagam Academy of Higher EducationCoimbatore 641021Tamil NaduIndia Manoharan Sakthivel Department of OrthopaedicsGovernment Medical CollegeKarur 639004Tamil NaduIndia Department of Orthopaedics Devadoss Multispecialty HospitalMadurai 625007Tamil NaduIndia Department of Medical Oncology Aster Medcity HospitalKochi 682034India

BACKGROUND Multitudinous advancements have been made to the traditional microfracture(MFx)technique,which have involved delivery of various acellular 2nd generation MFx and cellular MFx-III components to the area of cartilage *** relative benefits and pitfalls of these diverse modifications of MFx technique are still not widely *** To comparatively analyze the functional,radiological,and histological outcomes,and complications of various generations of MFx available for the treatment of cartilage *** A systematic review was performed using PubMed,EMBASE,Web of Science,Cochrane,and *** of any age and sex with cartilage defects undergoing any form of MFx were considered for *** included only randomized controlled trials(RCTs)reporting functional,radiological,histological outcomes or complications of various generations of MFx for the management of cartilage *** meta-analysis(NMA)was conducted in Stata and Cochrane’s Confidence in NMA approach was utilized for appraisal of *** Forty-four RCTs were included in the analysis with patients of mean age of 39.40(±9.46)*** comparing the results of the other generations with MFX-I as a constant comparator,we noted a trend towards better pain control and functional outcome(KOOS,IKDC,and Cincinnati scores)at the end of 1-,2-,and 5-year time points with MFx-III,although the differences were not statistically significant(P>0.05).We also noted statistically significant Magnetic resonance observation of cartilage repair tissue score in the higher generations of microfracture(weighted mean difference:17.44,95%confidence interval:0.72,34.16,P=0.025;without significant heterogeneity)at 1 ***,the difference was not maintained at 2 *** was a trend towards better defect filling on MRI with the second and third generation MFx,although the difference was not statistically significant(P>0.05).CONCLUSION The higher generations of traditional MFx

关键词： Cartilage injury Microfracture Mesenchymal stem cells Platelet-rich plasma bone marrow aspiration concentrates Clinical outcome Radiological outcome Meta-analysis Network meta-analysis

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