Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2024; 15(3): 266-284
Published online Mar 18, 2024. doi: 10.5312/wjo.v15.i3.266
Does progress in microfracture techniques necessarily translate into clinical effectiveness?
Sathish Muthu, Vibhu Krishnan Viswanathan, Manoharan Sakthivel, Mohammed Thabrez
Sathish Muthu, Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
Sathish Muthu, Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore 641021, Tamil Nadu, India
Sathish Muthu, Manoharan Sakthivel, Department of Orthopaedics, Government Medical College, Karur 639004, Tamil Nadu, India
Vibhu Krishnan Viswanathan, Department of Orthopaedics, Devadoss Multispecialty Hospital, Madurai 625007, Tamil Nadu, India
Mohammed Thabrez, Department of Medical Oncology, Aster Medcity Hospital, Kochi 682034, India
Author contributions: Muthu S contributed to acquisition of data, analysis and interpretation of data, drafting the article, and final approval; Viswanathan VK contributed to acquisition of data, analysis and interpretation of data, drafting the article, and final approval; Sakthivel M and Mohammed T contributed to interpretation of data, revising the article, and final approval.
Conflict-of-interest statement: The authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sathish Muthu, DNB, MS, Assistant Professor, Research Associate, Surgeon, Department of Orthopaedics, Orthopaedic Research Group, Ramanathapuram, Coimbatore 641045, Tamil Nadu, India. drsathishmuthu@gmail.com
Received: December 4, 2023
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

To explore the clinical effectiveness of the various generations of the MFx technique to understand their clinical effect in the management of cartilage defects.

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.