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Microfracture Surgery Improves Knee Function

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Microfracture Surgery Improves Knee Function March 2006 • www.rheumatologynews.com Arthritis 19 Microfracture Surgery Improves Knee Function BY DOUG BRUNK the mean Lysholm scores improved from strenuous sports activities, we found they tissue at a level adjacent with normal ar- San Diego Bureau 57 to 87; the Tegner scores improved from increased to 80% in the first 2 years but ticular surface and were firm when pal- 3 to 5; and the subjective evaluation im- then gradually decreased to 55% at final pated with a probe. Biopsies from these S AN D IEGO — Microfracture as a treat- proved from 40/100 to 70/100. At base- follow-up,” Dr. Gobbi added. Changing to same 10 patients showed areas of fi- ment for full thickness chondral lesions line, only three patients scored an A or B a low-risk sport, advancing age of the bromyxoid tissue with differentiation, a provided functional improvement in a on the IKDC, but by final follow-up, 70% study participants, work and family oblig- transition zone with cartilage tissue, and group of professional and recreational of patients scored an A or B. ations, and the influence of degenerative initial hyaline transformation tissue. athletes at 6-year follow-up, but the level Also by final follow-up, activities of dai- joint disease may have contributed to the Candidates should be evaluated by age, of postoperative sports participation de- ly living improved in 65% of patients while decline in postsurgical sports activity. activity level, type of sport, type of injury, clined with time, Dr. Alberto Gobbi re- imaging studies revealed increased de- Second-look arthroscopy performed in expectations, associated pathologies, like- ported at a symposium sponsored by the generative changes in 30% of patients. 10 patients showed that the articular de- lihood of rehabilitation compliance, and International Cartilage Repair Society. “When we analyzed the [return to] fects were covered with fibrocartilaginous the articular depth of the defect. ■ The finding suggests that while mi- crofracture can be performed as a simple, minimally invasive method to promote car- tilage healing, it “may not be the definitive treatment for the athletes’ knee, as further procedures may Rheumatologists prescribe Compared with be indicated in EVOXAC® (cevimeline HCl) more than preoperative the future,” said Dr. Gobbi, an any other secretory agonist* evaluation, orthopedic sur- postoperative geon with the Orthopedic imaging showed Arthroscopic increased Surgery Inter- national Re- degenerative search Center in changes in the Milan. “Howev- knee joint in er, it can relieve symptoms and 30% of delay the need patients. for further treat- ment.” Dr. Gobbi and his associate Dr. Ramces Francisco followed 53 professional and recreational athletes who underwent mi- crofracture surgery for unilateral knee ar- ticular cartilage injury at their center. Mean patient age was 38 years. Of the patients, 33 were male, and 26 were professional athletes. Mean follow-up was 6 years. Outcomes were assessed using the Lysholm score, Tegner activity level score, the International Knee Documentation EVOXAC® first line— Committee (IKDC) scoring system, and a proven relief for the dry-mouth symptoms of Sjögren’s syndrome subjective evaluation based on a 100-point scale. Roentgenograms, MRI, or CT scans were done pre- and postoperatively. Patients treated with EVOXAC reported signifi cant improvement Dr. Gobbi reported that the cause of for the following end points1-3†‡ : most injuries was related to sports micro- trauma (38%) and macrotrauma (21%), al- though 38% of patients did not report any traumatic etiology and 4% showed patel- lar malalignment. The most common lo- cation of injury was the medial femoral Feeling of mouth Ability to speak Ability to chew and Ability to sleep condyle (61%), and the mean defect size Dryness of mouth without swallow food Dryness of tongue drinking liquids among study participants was 4 cm2. Between baseline and final follow-up Safety considerations • Special care should be exercised when cevimeline is taken • The most frequently reported adverse events associated with by geriatric patients, considering the greater frequency of the pharmacologic action of a muscarinic agonist (>10% decreased hepatic, renal, or cardiac function incidence) in clinical trials of cevimeline were: excessive • Cevimeline can potentially alter cardiovascular function. sweating, nausea, rhinitis, and diarrhea. Consult the brief Consult the brief summary of prescribing information summary of prescribing information for other adverse events concerning these potential effects • Cevimeline is contraindicated in patients with uncontrolled • Caution should be advised while driving at night or asthma, known hypersensitivity to the drug, and in acute performing hazardous activities in reduced lighting OBBI G iritis and narrow-angle (angle-closure) glaucoma * IMS Health. National Prescription Audit Plus TM for the 6-month period ending • Consult the brief summary of prescribing information for March 2004. † In 1 or more clinical trials, patients reported signifi cant improvement for these LBERTO safety considerations concerning drug interactions, special secondary end points at various measurement intervals using a visual analogue . A R populations, patients with a history of cardiac disease, scale (VAS) (P 0.05). D F controlled asthma, chronic bronchitis, COPD, nephrolithiasis, ‡ Statistical signifi cance was not observed consistently for every secondary end or cholelithiasis point at each point of measurement across all studies. OURTESY C Please see accompanying brief summary of prescribing information. For more information about EVOXAC, visit www.evoxac.com MRI shows degeneration 6 years after microfracture surgery on chondral lesion..
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