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World J Orthop. Sep 18, 2014; 5(4): 444-449
Published online Sep 18, 2014. doi: 10.5312/wjo.v5.i4.444
Enhanced microfracture techniques in cartilage knee surgery: Fact or fiction?
Stefan Bark, Tomasz Piontek, Peter Behrens, Sabreen Mkalaluh, Deike Varoga, Justus Gille
Stefan Bark, Sabreen Mkalaluh, Justus Gille, Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany
Tomasz Piontek, Rehasport Clinic, 60-201 Poznań, Poland
Peter Behrens, Chirurgie, Unfallchirurgie, Notfälle und Orthopädie (CUNO) Hamburg, 22045 Hamburg, Germany
Deike Varoga, Department of Orthopaedic and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
Author contributions: All authors created clinical studies which are presented in this paper; Bark S wrote the paper and Gille J corrected it.
Correspondence to: Bark Stefan, MD, Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Ratzeburger Allee 160, 23538 Campus Luebeck, Germany.
Telephone: +49-451-5002642
Received: January 3, 2014
Revised: May 28, 2014
Accepted: June 10, 2014
Published online: September 18, 2014

The limited intrinsic healing potential of human articular cartilage is a well-known problem in orthopedic surgery. Thus a variety of surgical techniques have been developed to reduce joint pain, improve joint function and delay the onset of osteoarthritis. Microfractures as a bone marrow stimulation technique present the most common applied articular cartilage repair procedure today. Unfortunately the deficiencies of fibrocartilaginous repair tissue inevitably lead to breakdown under normal joint loading and clinical results deteriorate with time. To overcome the shortcomings of microfracture, an enhanced microfracture technique was developed with an additional collagen I/III membrane (Autologous, Matrix-Induced Chondrogenesis, AMIC®). This article reviews the pre-clinical rationale of microfractures and AMIC®, presents clinical studies and shows the advantages and disadvantages of these widely used techniques. PubMed and the Cochrane database were searched to identify relevant studies. We used a comprehensive search strategy with no date or language restrictions to locate studies that examined the AMIC® technique and microfracture. Search keywords included cartilage, microfracture, AMIC®, knee, Chondro-Gide®. Besides this, we included our own experiences and study authors were contacted if more and non published data were needed. Both cartilage repair techniques represent an effective and safe method of treating full-thickness chondral defects of the knee in selected cases. While results after microfracture deteriorate with time, mid-term results after AMIC® seem to be enduring. Randomized studies with long-term follow-up are needed whether the grafted area will maintain functional improvement and structural integrity over time.

Keywords: Cartilage, Microfracture, Autologous, Matrix-Induced Chondrogenesis, Knee, Chondro-Gide®

Core tip: Articular cartilage has a limited healing potential which presents a well-known circumstance in orthopedic surgery. This fact has led to a variety of surgical techniques for treating articular defects and currently the microfracturing presents the most commonly used procedure. The aim of this article is to give an overview about actual studies regarding microfracture and the AMIC® technique in cartilage knee surgery and to show recent developments.