Eirik Solheim1,2,3, Janne Hegna2, Eivind Inderhaug1. 1. Department of Orthopedics, Deaconess University Hospital, Bergen, Norway. 2. Department of Orthopedics, Aleris Nesttun Hospital, Bergen, Norway. 3. Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Abstract
OBJECTIVE: To investigate survival of cartilage repair in the knee by microfracture (MFX; n = 119) or mosaicplasty osteochondral autograft transfer (OAT; n = 84). DESIGN: For survival analyses, "failure" was defined as the event of a patient reporting a Lysholm score <65 or undergoing an ipsilateral knee replacement. The Kaplan-Meier method was used for construction of a survival functions plot for the event "failure." Log rank (Mantel-Cox) test was used for comparison of survival distributions in the 2 groups. RESULTS: The long-term failure rate (62% overall) was significantly higher in the MFX group (66%) compared with the OAT group (51%, P = 0.01). Furthermore, the mean time to failure was significantly shorter (P < 0.001) in the MFX group, 4.0 years (SD 4.1) compared with the OAT group, 8.4 years (SD 4.8). In the OAT group, the survival rate stayed higher than 80% for the first 7 years, and higher than 60% for 15 years, while the survival rate dropped to less than 80% within 12 months, and to less than 60% within 3 years in the MFX group, log rank (Mantel-Cox) 20.295 (P < 0.001). The same pattern was found in a subgroup of patients (n = 134) of same age (<51 years) and size of treated lesion (<500 mm2), log rank (Mantel-Cox) 10.738 (P = 0.001). The nonfailures (48%) were followed for median 15 yeas (1-18 years). CONCLUSIONS: MFX articular cartilage repairs failed more often and earlier than the OAT repairs, both in the whole cohort and in a subgroup of patients matched for age and size of treated lesion, indicating that the OAT repair is the more durable. LEVEL OF EVIDENCE: Therapeutic study, Level III.
OBJECTIVE: To investigate survival of cartilage repair in the knee by microfracture (MFX; n = 119) or mosaicplasty osteochondral autograft transfer (OAT; n = 84). DESIGN: For survival analyses, "failure" was defined as the event of a patient reporting a Lysholm score <65 or undergoing an ipsilateral knee replacement. The Kaplan-Meier method was used for construction of a survival functions plot for the event "failure." Log rank (Mantel-Cox) test was used for comparison of survival distributions in the 2 groups. RESULTS: The long-term failure rate (62% overall) was significantly higher in the MFX group (66%) compared with the OAT group (51%, P = 0.01). Furthermore, the mean time to failure was significantly shorter (P < 0.001) in the MFX group, 4.0 years (SD 4.1) compared with the OAT group, 8.4 years (SD 4.8). In the OAT group, the survival rate stayed higher than 80% for the first 7 years, and higher than 60% for 15 years, while the survival rate dropped to less than 80% within 12 months, and to less than 60% within 3 years in the MFX group, log rank (Mantel-Cox) 20.295 (P < 0.001). The same pattern was found in a subgroup of patients (n = 134) of same age (<51 years) and size of treated lesion (<500 mm2), log rank (Mantel-Cox) 10.738 (P = 0.001). The nonfailures (48%) were followed for median 15 yeas (1-18 years). CONCLUSIONS:MFX articular cartilage repairs failed more often and earlier than the OAT repairs, both in the whole cohort and in a subgroup of patients matched for age and size of treated lesion, indicating that the OAT repair is the more durable. LEVEL OF EVIDENCE: Therapeutic study, Level III.
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