Muthu S, Viswanathan VK, Sakthivel M, Thabrez M. Does progress in microfracture techniques necessarily translate into clinical effectiveness? World J Orthop 2024; 15(3): 266-284 [PMID: 38596189 DOI: 10.5312/wjo.v15.i3.266]
Corresponding Author of This Article
Sathish Muthu, DNB, MS, Assistant Professor, Research Associate, Surgeon, Department of Orthopaedics, Orthopaedic Research Group, Ramanathapuram, Coimbatore 641045, Tamil Nadu, India. drsathishmuthu@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
Core Tip
Core Tip: Chondral lesions have been reported in 60% of patients undergoing arthroscopic procedures of the knee; and such defects are described as one of the leading causes of chronic knee pain. As compared with the other cartilage restoration strategies, microfracture (MFx) is relatively cost-effective, simple, minimally-invasive and may also be performed in a single stage. Nevertheless, recent studies have demonstrated that modifications of the traditional MFx technique, such as the use of synthetic and autologous biological adjuvants may enhance the repair tissue quality, resilience, and overall efficacy of the procedure. Based on the current network meta-analysis we could conclude that the use of acellular and cellular adjuvants has shown only marginal improvement in the clinical (pain and functional scores) and radiological outcome in patients undergoing microfracture for cartilage defects of the knee. The safety and efficacy of the higher generation MFx procedures are also clearly evident from our review. However, there is a substantial potential for further 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 achieve demonstrable significant outcome improvement.
