Long-term clinical follow-up of microfracture versus mosaicplasty in articular cartilage defects of medial femoral condyle

Background: The purpose of this study was to evaluate the outcome after cartilage repair surgery in focal defects of the knee by microfracture versus mosaicplasty. Methods: A cohort of 102 patients undergoing microfracture (n = 52) or mosaicplasty (n = 50) of a single articular cartilage defect in the medial femoral condyle of <= 50 mm(2) was evaluated by Lysholm score before surgery, at six months, 12 months, five years, 10 years, and 15-18 years after surgery. Results: Median age of patients at the time of surgery was 36 years (range 16-58) and median follow-up time was 16 years (range 14-18). Defects were treated with a median size of three square centimetres (range one to five). A significant increase was seen in the Lysholm score from mean 48 (SD 16) at baseline to 66 (SD 23; P < 0.001) at the 15-18 year follow-up. The Lysholm score was higher in the mosaicplasty group at six months, 12 months, five years and 10 years (P < 0.05 for all comparisons). These differences were clinically significant at all points (>10 points). However, at the final follow-up, the difference (eight points) did not reach statistical significance. Conclusions: In the short-term, medium-term and long-term (10 years), mosaicplasty in a single cartilage defect size one to five square centimetres of the femoral condyle resulted in clinically relevant better outcome than microfracture. However, at 15-18 years after the surgery such a difference could not be found. In the six month to 10-15 year (after surgery) perspective, the mosaicplasty procedure offered a better outcome in this type of lesion. (C) 2017 Elsevier B.V. All rights reserved.