Effects of unloader bracing on clinical outcomes and articular cartilage regeneration following microfracture of isolate
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Effects of unloader bracing on clinical outcomes and articular cartilage regeneration following microfracture of isolated chondral defects: a randomized trial Jaclyn A. Konopka1 · Andrea K. Finlay1 · Felix Eckstein2,3 · Jason L. Dragoo1 Received: 31 October 2019 / Accepted: 10 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose To determine whether the use of an unloading brace can increase the thickness of cartilage regenerate after microfracture surgery. Methods This is a randomized (1:1) controlled clinical trial. Twenty-four patients who underwent microfracture between 2012 and 2015 were identified and were randomly assigned to an unloading brace group or a no-brace group. All patients were kept non-weight bearing for the first eight weeks after surgery and then patients in the intervention group began using an unloading brace for an average of 63.9 (SD = 41.6) days to protect clot stability by exerting a varus or valgus force on the knee to decrease the force on the knee’s lateral or medial compartment, respectively. Quality of the cartilage repair was assessed with knee magnetic resonance imaging to determine repair tissue thickness (primary outcome), repair tissue volume, and T2 relaxation times at 12 and 24 months after surgery. Clinical outcomes were evaluated with KOOS, Tegner, SF12, and Lysholm questionnaires at six, 12 and 24 months after surgery. Results Three patients were lost to follow-up, resulting in 21 patients ultimately analyzed. The unloading brace repair tissue was greater than the no-brace group in volume (26.8 ± 23.7 mm3 vs − 8.4 ± 22.7 mm3, p = 0.005) and thickness (0.2 ± 0.2 mm versus − 0.4 ± 0.3 mm, p = 0.001) at 12 months and in cartilage thickness in the unloading brace group at 24 months (0.4 ± 0.4 mm versus − 0.1 ± 0.3 mm, p = 0.029). There was a positive correlation between wearing the brace longer and improved 6-month KOOS symptom scores (r = 0.82, p = 0.013), 6-month KOOS QOL scores (r = 0.80, p = 0.017), 6-month Tegner scores (r = 0.94, p = 0.002), and Tegner score changes from baseline to 6 months (r = 0.80, p = 0.032). Conclusion This study found a significant mid-term increase in cartilage repair tissue thickness following unloading bracing in patients recovering from microfracture for isolated chondral defects. Level of evidence II.
Introduction The optimal treatment of isolated chondral defects has historically been challenging as damaged articular cartilage possesses limited spontaneous healing or regenerative capacity [8, 15]. Current treatment options include * Jason L. Dragoo [email protected] 1
Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway, MC 6342, Redwood City, CA 94063, USA
2
Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
3
Chondrometrics GmbH, Ainring, Germany
conservative measures with mild symptoms or debridement, microfracture, osteochondral grafting, autologous chondrocyte implantation (ACI), and matrix-assis
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