Published online Mar 18, 2024. doi: 10.5312/wjo.v15.i3.266
Peer-review started: December 4, 2023
First decision: December 17, 2023
Revised: December 21, 2023
Accepted: January 23, 2024
Article in press: January 23, 2024
Published online: March 18, 2024
Processing time: 102 Days and 1.1 Hours
We have noted improvements in the traditional microfracture (MFx) techniques over the decades of its routine use in the management of cartilage defects. The recent generations include the addition of acellular components and cellular components to the cartilage defect. However, the effectiveness of these modifications is not explored further.
To explore the clinical effectiveness of the various generations of the MFx technique to understand their clinical effect in the management of cartilage defects.
To comparatively explore the clinical, radiological and histological outcomes along with the complications reported in the various generations of MFx in the context of the management of cartilage defects.
We made a systematic review by utilizing the databases such as PubMed, EMBASE, Web of Science, Cochrane, and Scopus to identify the randomized controlled trials (RCTs) reporting the outcomes of utilization of various generations of MFx in the management of cartilage defects. Network meta-analysis was performed among the three generations for the outcomes analysed using Stata.
Forty-four RCTs were included in the analysis with patients of mean age of 39.40 (± 9.46) years. Upon 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 MOCART score in the higher generations of MFx (WMD = 17.44; 95%CI: 0.72, 34.16; P = 0.025; without significant heterogeneity) at 1 year. However, the difference was not maintained at 2 years. There 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).
The higher generations of traditional MFx technique utilizing acellular and cellular components to augment its potential in the management of cartilage defects has shown only marginal improvement in the clinical and radiological outcomes.
Future work could focus on the improvement in the cellular components (chondrocytes over other cellular lineage), culture or processing methodology, delivery modalities (including appropriate scaffolds); as well as better surgical techniques to make the clinical impact with their further advancements.