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High-Impact Athletics After Knee Articular Cartilage Repair

A Prospective Evaluation of the Microfracture Technique

Kai Mithoefer, MD^*, Riley J. Williams, III, MD^,, Russell F. Warren, MD, Thomas L. Wickiewicz, MD and Robert G. Marx, MD

From ^* Harvard Vanguard Orthopedics and Sports Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, and the Hospital for Special Surgery, Weill Cornell Medical College, New York, New York

Address correspondence to Riley J. Williams III, MD, Hospital for Special Surgery, 535 East 71st Street, New York, NY 10021 (e-mail: Williamsr{at}hss.edu).

Background: Knee articular cartilage injuries in athletes present a therapeutic challenge and have been identified as an important cause of permanent disability because of the high mechanical joint stresses in athletes.

Purpose: To determine whether microfracture treatment of knee articular cartilage injuries can return athletes to high-impact sports and to identify the factors that affect the ability to return to athletic activity.

Study Design: Case series; Level of evidence, 4.

Methods: Thirty-two athletes who regularly participated in high-impact, pivoting sports before articular cartilage injury were treated with microfracture for single articular cartilage lesions of the knee. Functional outcome was prospectively evaluated with a minimum 2-year follow-up by subjective rating, activity-based outcome scores, and the ability for postoperative participation in high-impact, pivoting sports.

Results: At last follow-up, 66% of athletes reported good or excellent results. Activity of daily living, Marx activity rating scale, and Tegner activity scores increased significantly after microfracture. After an initial improvement, score decreases were observed in 47% of athletes. Forty-four percent of athletes were able to regularly participate in high-impact, pivoting sports, 57% of these at the preoperative level. Return to high-impact sports was significantly higher in athletes with age <40 years, lesion size <200 mm², preoperative symptoms <12 months, and no prior surgical intervention.

Conclusion: Microfracture is an effective first-line treatment to return young athletes with short symptomatic intervals and small articular cartilage lesions of the knee back to high-impact athletics.

Key Words: articular cartilage • injury • repair • return to sport • microfracture

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