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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Clinical Outcomes After Microfracture of the Knee: Midterm Follow-up
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Clinical Outcomes After Microfracture of the Knee: Midterm Follow-up

机译：膝关节微骨折后的临床结果：中期随访

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Background: Microfracture is a single-stage arthroscopic procedure used to treat small- and medium-sized cartilage defects, the clinical results of which have been mixed to date. Purpose: To retrospectively evaluate prospectively collected patient-reported outcomes (PROs) after microfracture as well as to determine patient-related and defect-related factors associated with clinical outcomes and which factors predict the need for additional surgery. Study Design: Case-control study; Level of evidence, 3. Methods: All patients between the ages of 10 and 70 years who underwent microfracture by the senior author for a focal chondral defect of the knee between January 1, 2005, and March 1, 2010, were eligible for study enrollment. Patients were excluded if they underwent concomitant procedures that violated the subchondral bone. Functional outcomes were determined using preoperative and final follow-up PROs, including the Lysholm, International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form–12 (SF-12), and overall satisfaction scores. Patient-related factors (sex, age, body mass index [BMI]) and defect-related factors (lesion size, location, concomitant procedures, prior procedures) were analyzed for correlations with outcome scores. All patient-related and defect-related factors were also analyzed as predictors for subsequent surgery. Results: Overall, 101 patients (102 knees; 55 male, 46 female; mean age, 35.87 ± 12.52 years; mean BMI, 26.3 ± 5.5 kg/m~(2); mean defect size, 2.635 ± 1.805 cm~(2)) were included. Lesion location included 44.90% at the medial femoral condyle, 21.43% at the trochlea, 11.22% at the lateral femoral condyle, 10.20% at multiple sites, 8.16% at the patella, and 4.08% at the tibial plateau. Microfracture was performed alone in 72 of 102 (71%) knees. At a mean follow-up of 5.66 ± 2.54 years (range, 2-11 years), clinically meaningful and statistically significant improvements were seen in all PROs ( P < .05) except the SF-12 mental component score. Patients who had an isolated tibial plateau defect or multiple defects demonstrated reduced improvements in the symptom rate ( P = .0237). Patients with a BMI >30 kg/m~(2)had lower postoperative scores on the KOOS activities of daily living subscale ( P = .0261) and poorer WOMAC function and WOMAC pain scores ( P = .029 and .0307, respectively). Patient BMI, age, sex, defect location, concomitant procedures, and operative side were not significant predictors for additional surgery. Larger defect size (>3.6 cm~(2)) and prior knee surgery were independent risk factors for additional knee surgery after microfracture. Conclusion: After microfracture, all PROs demonstrated clinically and statistically significant improvements at 5.7 years. Functionally, male patients benefited more from microfracture than female patients. Microfracture of tibial lesions and multisite microfracture provided less benefit than microfracture of isolated femoral defects. Larger lesion size (>3.6 cm~(2)) and prior knee surgery predicted the need for additional knee surgery after microfracture.
机译：背景：微骨折是一种单阶段的关节镜手术，用于治疗中小型软骨缺损，迄今为止其临床结果尚不明确。目的：回顾性评估微骨折后前瞻性收集的患者报告的结局（PRO），并确定与临床结局相关的患者相关和缺陷相关因素，以及哪些因素可以预测是否需要进行其他手术。研究设计：病例对照研究;证据等级，3。方法：所有年龄在10到70岁之间的患者，均在2005年1月1日至2010年3月1日期间接受高级作者因膝关节局灶性软骨缺损而进行微骨折的患者入选。 。如果患者接受了侵犯软骨下骨的伴随手术，则被排除在外。使用术前和最终随访PRO来确定功能结局，包括Lysholm，国际膝关节文献委员会（IKDC），膝关节损伤和骨关节炎结果评分（KOOS），西安大略和麦克马斯特大学骨关节炎指数（WOMAC），简写形式– 12 （SF-12），以及整体满意度得分。分析患者相关因素（性别，年龄，体重指数[BMI]）和缺陷相关因素（病变大小，位置，伴随程序，先前程序）与结局评分的相关性。还分析了所有患者相关因素和缺陷相关因素，作为后续手术的预测指标。结果：总共101例患者（102膝;男性55例，女性46例;平均年龄：35.87±12.52岁;平均BMI：26.3±5.5 kg / m〜（2）;平均缺损大小：2.635±1.805 cm〜（2） ）。病变部位包括股骨内侧con44.90％，滑车21.43％，股外侧lateral11.22％，多处10.20％，骨8.16％和胫骨平台4.08％。仅在102个膝盖中的72个（71％）中进行了微骨折。平均随访时间为5.66±2.54年（范围2-11年），除SF-12精神成分评分外，所有PRO均具有临床意义和统计学上的显着改善（P <.05）。具有孤立的胫骨平台缺损或多处缺损的患者表现出症状率的降低（P = .0237）。 BMI> 30 kg / m〜（2）的患者术后KOOS日常活动量表的评分较低（P = .0261），WOMAC功能和WOMAC疼痛评分较差（分别为P = .029和.0307） 。患者的BMI，年龄，性别，缺损位置，伴随的手术程序和手术侧并不是进行其他手术的重要预测指标。较大的缺损（> 3.6 cm〜（2））和先前进行过膝关节手术是微骨折后再次进行膝关节手术的独立危险因素。结论：微骨折后，所有PRO在5.7年时均表现出临床和统计学上的显着改善。从功能上讲，男性患者比女性患者从微骨折中受益更多。胫骨病变的微骨折和多部位微骨折所提供的益处少于孤立的股骨缺损的微骨折。较大的病变（> 3.6 cm〜（2））和先前的膝盖手术预示了微骨折后需要进行额外的膝盖手术。

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