Microdrilling Demonstrates Superior Patient-Reported Outcomes and Lower Revision Rates Than Traditional Microfracture: A Matched Cohort Analysis

Alexander Beletsky; Neal B Naveen; Tracy Tauro; Taylor M Southworth; Jorge Chahla; Nikhil N Verma; Adam B Yanke; Brian J Cole

doi:10.1016/j.asmr.2020.10.006

Microdrilling Demonstrates Superior Patient-Reported Outcomes and Lower Revision Rates Than Traditional Microfracture: A Matched Cohort Analysis

Arthrosc Sports Med Rehabil. 2021 Apr 6;3(3):e629-e638. doi: 10.1016/j.asmr.2020.10.006. eCollection 2021 Jun.

Authors

Alexander Beletsky¹, Neal B Naveen¹, Tracy Tauro¹, Taylor M Southworth¹, Jorge Chahla¹, Nikhil N Verma¹, Adam B Yanke¹, Brian J Cole¹

Affiliation

¹ Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.

Abstract

Purpose: The purpose of this study was to compare patient-reported outcomes and revision rates between the standard microfracture awl versus the microdrilling technique.

Methods: Microfracture patients were queried from a single-institution database between 2001 and 2016. Patient-reported outcome measure data were collected at preoperative and 6- and 12-month time points, inclusive of the International Knee Documentation Committee (IKDC) score, Short Form 12 (SF12) Physical Component Score (PCS) and Mental Component Score, and all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. A matching algorithm based on previous procedures, lesion size, and demographic factors created 2 technique-based cohorts. Outcomes including revision rates and both statistically and clinically significant differences (i.e., the minimally clinically important difference [MCID]) between awl and microdrill cohorts were compared using univariate statistics.

Results: A total of 68 patients (aged 32.0 ± 13.1 years, 48.5% female, body mass index 26.7 ± 5.3 kg/m²), with 34 patients in each group, were included after the match. At 6 months, the microdrilling group demonstrated significantly greater levels of improvement than the awl group on the IKDC, SF12 PCS, and KOOS Pain, Symptom, Sport, and Quality of Life (P < .04), although differences at 1 year were only maintained on the SF12 PCS instrument (P < .001). With respect to MCID achievement, the microdrilling group demonstrated greater achievement rates at 6 months on the IKDC, KOOS Pain, and KOOS Sport (P < .04). The awl group demonstrated a higher rate of revision surgery (P = .02) within 3 years of follow-up and a greater likelihood to require multiple subsequent procedures (41.1% vs 17.6%, P = .03).

Conclusions: Microdrilling demonstrated superior outcomes relative to traditional microfracture awl techniques with respect to patient-reported outcomes at 6 months and revision rates within 3 years of follow-up. In addition, clinically meaningful differences were evident at 6 months in the microdrilling group.

Level of evidence: Level III, retrospective comparative study.