Arthroscopic microfracture of chondral ulcers in osteoarthritis of the knee joint : a comparison of two postoperative rehabilitation programs

الملخص EN

Purpose: A hypothesis was put that the treatment of focal, full-thickness chondral defects in cases of non-deformed symptomatic knee osteoarthritis by an identical method of arthroscopic microfracture but with different postoperative regimens would not produce similar results.

Type of study: a randomized prospective clinical study in which the postoperative management was the major variable.

Methods: Eighty six patients with symptomatic osteoarthritis of the knee joint treated over a six-year period (1999 – 2005) with a focal 2-3 cm2, full thickness, and solitary degenerative chondral lesion.

They had arthroscopic microfractures distributed with 3-4 mm intervals.

Postoperatively one group was treated with non-weight bearing and continuous passive knee mobilization for 6 weeks (group I).

The other group was allowed weight bearing as tolerated and did not use CPM, but used active knee mobilization from full extension to the maximum knee flexion as tolerated (group II).

Evaluation was done based on subjective and objective criteria in comparison with the preoperative record, and was tabulated using Lysholm and Tegner knee scores.

Results were compared using an independent t- test, or ?-square test with significance assumed for p< 0.05.

Results: 12 patients were lost to follow up leaving only 76 patients for evaluation with an average 5-years follow up period.

The mean age was 50 years, and there were 28 males, and 46 females at the final follow up.

For group I, Lysholm scores were 52 preoperative, 78 postoperative, and Tegner scores were 2 and 4, respectively.

Group II Lysholm scores were 52 preoperative, 80 postoperative, and Tegner scores were 2 and 4, respectively.

No statistically significant differences between groups were noted.

Conclusion: In relatively small degenerative chondral defects treated by arthroscopic microfracture, this study found no difference in results comparing two rehabilitation programs differing by weight bearing status and use of CPM.

Level of evidence: Level III, Case Control Study.