Does scaffold enhancement show significant superiority over microfracture alone for treating knee chondral defects? A systematic review and meta-analysis of randomised clinical trials.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(15):18 Knee Surg Sports Traumatol Arthrosc . 2025 Jun;33(6):2027-2043.What this means for my practice?
Scaffold‑augmented microfracture did not demonstrate clinically meaningful superiority over microfracture alone at 12–24 months, though some individual RCTs with longer follow‑up suggest potential advantages. Clinically, prioritize patient selection and lesion characteristics; routine scaffold use for all focal knee defects is not currently supported by RCT‑level pooled data. Major limitations include study heterogeneity (techniques, scaffolds, outcomes) and lack of standardized algorithms/protocols, underscoring the need for longer‑term, harmonized trials.
Study Summary
Ten RCTs including 378 patients with focal knee chondral/osteochondral defects were included in this systematic review and meta‑analysis comparing microfracture plus scaffold augmentation versus microfracture alone. Pooled outcomes of interest included IKDC, KOOS, VAS, and MOCART. Across 12–24 months, pooled effects showed no significant superiority of scaffold augmentation over microfracture on IKDC, KOOS, VAS, and MOCART at 1 yr. In individual trials, some longer‑term signals favored scaffolds, but heterogeneity was high. Overall, the main finding is that routine scaffold augmentation did not outperform microfracture at short‑ to mid‑term, suggesting careful patient selection and the need for standardized methods and longer follow‑up.
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