Long-term outcome of grade III and IV chondral injuries of the knee treated with Steadman microfracture technique.
INTRODUCTION
The aim of our study is to demonstrate the effectiveness of Steadman microfracture technique in the management of high-grade chondral defects at the level of the knee by clinical follow-ups at eleven years.


MATERIALS AND METHODS
This is a study conducted on fifteen patients suffering from Outerbridge grade III and IV chondral lesions of the knee, who underwent Steadman microfracture surgery between 2003 and 2004. Selective exclusion criteria to prevent that other treatments or comorbidities could invalidate the results were used. Patients were clinically evaluated with Lysholm and IKDC scale scores before surgery and at follow-ups at eleven years.


RESULTS
There has been an improvement in the Lysholm scores (59.33 ± 18.2 at time zero vs 82.13 ± 14.16 at time t; p value: 0.0342) and in the IKDC scores (45.13 ± 17.07 at time zero vs 68.66 ± 21.47 at time t; p value: 0.04) that appears statistically significant.


DISCUSSION
Currently microfracture surgery is not indicated in patients with high-grade chondral defects, but at the same time, it is a technique of easy execution, low cost and good results. The clinical improvement observed appears statistically significant, but we have also noticed a slight clinical worsening in two patients, possibly caused by: improper treatment, new trauma, incorrect rehabilitation and age at time of surgery.


CONCLUSIONS
The study has shown significant clinical improvements in patients, despite the fact that indications to the use of microfracture are still very limited and selective. It's essential to underline the importance of the single patient assessment process, taking into account a variety of aspects including the site, the number and extent of the lesion, the degree of functionality, activity level, age and previous trauma. This shows the importance of a comprehensive assessment of the patient in order to choose the most suitable surgical option, which not necessarily has to strictly adhere to standard practice.
['Pellegrino|Marco|M|', 'Trinchese|Ermanno|E|', 'Bisaccia|Michele|M|', 'Rinonapoli|Giuseppe|G|', 'Meccariello|Luigi|L|', 'Falzarano|Gabriele|G|', 'Medici|Antonio|A|', 'Piscitelli|Luigi|L|', 'Ferrara|Pellegrino|P|', 'Caraffa|Auro|A|']
long-term outcome grade III and IV chondral knee Steadman microfracture technique Outerbridge classification