Microfracture produces inferior outcomes to other cartilage repair techniques in chondral injuries in the paediatric knee.
BACKGROUND
Chondral injuries are becoming increasingly common in the paediatric knee. First line surgical therapy is usually microfracture (MF), but the emergence of alternative techniques raises the question of what is the optimal treatment in paediatric patients.


METHODS
A comprehensive search of PubMed, OVID, Web of Science, SportDiscus and Cochrane databases was performed using the key words 'autologous chondrocyte implantation, MF, mosaicplasty, juvenile, paediatric'.


RESULTS
Each technique demonstrated a significant post-surgical improvement in clinical outcome scores. However, MF demonstrated poorer outcomes in larger lesions (>3 cm(2)) and shorter durability.


RESULTS
The quality of the available literature is poor, and there is a lack of comparative trials.


CONCLUSIONS
The impact of defect characteristics, mechanism of injury and concomitant surgeries should be investigated.


CONCLUSIONS
Appropriately powered randomized controlled trials with suitably long follow up and condition-specific outcome measures should compare different techniques against each other and placebo.
Imperial College School of Medicine, Imperial College London, London, UK.
Amit
A
Chawla
Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Richard
R
Twycross-Lewis
Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentistry, Salerno, Italy Queen Mary University of London, London, UK Barts and The London School of Medicine and Dentistry, London, UK Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK n.maffulli@qmul.ac.uk.
Nicola
N
Maffulli
D054544:Arthroplasty, Subchondral / Q000379:methods*; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery*; D002648:Child; D019902:Chondrocytes / Q000637:transplantation; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D016896:Treatment Outcome
cartilage repair; microfracture; paediatric