Are Weightbearing Restrictions Required After Microfracture for Isolated Chondral Lesions of the Knee? A Review of the Basic Science and Clinical Literature.

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Date

2021-03

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Abstract

Context

A strict rehabilitation protocol is traditionally followed after microfracture, including weightbearing restrictions for 2 to 6 weeks. However, such restrictions pose significant disability, especially in a patient population that is younger and more active.

Evidence acquisition

An extensive literature review was performed through PubMed and Google Scholar of all studies through December 2018 related to microfracture, including biomechanical, basic science, and clinical studies. For inclusion, clinical studies had to report weightbearing status and outcomes with a minimum 12-month follow-up.

Study design

Clinical review.

Level of evidence

Level 3.

Results

Review of biomechanical and biology studies suggest new forming repair tissue is protected from shear forces of knee joint loading by the cartilaginous margins of the defect. This margin acts as a shoulder to maintain axial height and allow for tissue remodeling up to at least 12 months after surgery, well beyond current weight bearing restriction trends. A retrospective case-control study showed that weightbearing status postoperatively had no effect on clinical outcomes in patients who underwent microfracture for small chondral (<2 mm2) defects. In fact, 1 survey showed that many orthopaedic surgeons currently do not restrict weightbearing after microfracture.

Conclusion

This clinical literature review suggests that weightbearing restrictions may not be required after microfracture for isolated tibiofemoral chondral lesions of the knee.

Strength of recommendation taxonomy

C.

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Citation

Published Version (Please cite this version)

10.1177/1941738120938662

Publication Info

Jain, Deeptee, Elshaday S Belay, John A Anderson, William E Garrett and Brian C Lau (2021). Are Weightbearing Restrictions Required After Microfracture for Isolated Chondral Lesions of the Knee? A Review of the Basic Science and Clinical Literature. Sports health, 13(2). pp. 111–115. 10.1177/1941738120938662 Retrieved from https://hdl.handle.net/10161/29925.

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Scholars@Duke

Lau

Brian Chei-Fai Lau

Assistant Professor of Orthopaedic Surgery

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