Microdrilling Demonstrates Superior Patient-Reported Outcomes and Lower Revision Rates Than Traditional Microfracture: A Matched Cohort Analysis

Abstract

The purpose of this study was to compare patient-reported outcomes and revision rates between the standard microfracture awl versus the microdrilling technique. Methods: Microfracture patients were queried from a singleinstitution database between 2001 and 2016. Patient-reported outcome measure data were collected at preoperative and 6-and 12-month time points, inclusive of the International Knee Documentation Committee (IKDC) score, Short Form 12 (SF12) Physical Component Score (PCS) and Mental Component Score, and all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. A matching algorithm based on previous procedures, lesion size, and demographic factors created 2 technique-based cohorts. Outcomes including revision rates and both statistically and clinically significant differences (i.e., the minimally clinically important difference [MCID]) between awl and microdrill cohorts were compared using univariate statistics. Results: A total of 68 patients (aged 32.0 AE 13.1 years, 48.5% female, body mass index 26.7 AE 5.3 kg/m 2 ), with 34 patients in each group, were included after the match. At 6 months, the microdrilling group demonstrated significantly greater levels of improvement than the awl group on the IKDC, SF12 PCS, and KOOS Pain, Symptom, Sport, and Quality of Life (P < .04), although differences at 1 year were only maintained on the SF12 PCS instrument (P < .001). With respect to MCID achievement, the microdrilling group demonstrated greater achievement rates at 6 months on the IKDC, KOOS Pain, and KOOS Sport (P < .04). The awl group demonstrated a higher rate of revision surgery (P ¼ .02) within 3 years of follow-up and a greater likelihood to require multiple subsequent procedures (41.1% vs 17.6%, P ¼ .03). Conclusions: Microdrilling demonstrated superior outcomes relative to traditional microfracture awl techniques with respect to patient-reported outcomes at 6 months and revision rates within 3 years of followup. In addition, clinically meaningful differences were evident at 6 months in the microdrilling group. Level of Evidence: Level III, retrospective comparative study.

Rehabilitation, Restrictions, and Return to Sport After Cartilage Procedures

“…Compared to standard microfracture with awl, microdrilling results in fewer revision surgeries and superior patient-reported outcomes (PROs). 21…”

Marrow stimulation in football (soccer) players: a narrative review

“…1 ). 33 The deeper, narrower holes created by microdrilling have shown to create greater access to the subchondral bone marrow and produce less bone remodeling and chondrocyte necrosis. 31 , 34-36 These factors have been cited as the reason that microdrilling may provide superior short-term clinical advantages when compared to traditional awl microfracture.…”

Knorpelschaden am Kniegelenk: operative Behandlungsmöglichkeiten und Rückkehr zum Sport

“…1 ) sowohl in Bezug auf die postoperative Knochen- als auch auf die Knorpelqualität bessere Ergebnisse zu erreichen sind 5 . Diese präklinischen Beobachtungen sind vor kurzem auch durch eine klinische Studie mit einem eindeutigen klinischen Vorteil dieser Vorgehensweise für den Patienten bestätigt wurden, sodass dieses Vorgehen im Sinne eines „Mikrodrilling“ von Fachgesellschaften empfohlen wird 2 , 13 .…”