Platelet-Derived Growth Factor-BB-Immobilized Asymmetrically Porous Membrane for Enhanced Rotator Cuff Tendon Healing

Rotator cuff tear is a common musculoskeletal disease that often requires surgical repair. Despite of recent advances in surgical techniques, the re-tear rate of the rotator cuff tendon is very high. In this study, a platelet-derived growth factor-BB (PDGF-BB)-immobilized asymmetrically porous membrane was fabricated to investigate the feasibility for enhancing rotator cuff tendon regeneration through the membrane. PDGF-BB is recognized to promote tendon regeneration. The asymmetrically porous membrane was fabricated by polycaprolactone and Pluronic F127 using an immersion precipitation technique, which can allow selective permeability (preventing scar tissue invasion into defect region but allowing permeation of oxygen/nutrients) and incorporation of bioactive molecules (e.g., PDGF-BB) via heparin binding. The PDGF-BB immobilized on the membrane was released in a sustained manner over 42 days. In an animal study using Sprague-Dawley rats, the PDGF-BB-immobilized membrane group showed significantly greater regeneration of rotator cuff tendon in histological and biomechanical analyses compared with the groups of control (suturing) and membrane without PDGF-BB immobilization. The enhancing regeneration of rotator cuff tendon of the PDGF-BB-immobilized membrane may be caused from the synergistic effect of the asymmetrically porous membrane with unique properties (selective permeability and hydrophilicity) as a scaffold for guided tendon regeneration and PDGF-BB sustainedly released from the membrane.

Clinical Features of Distal Tibial Fractures and Treatment Results of Minimally Invasive Plate Osteosynthesis / 대한족부족관절학회지

PURPOSE: The purpose of this study is to analyze the clinical features of distal tibia fractures and to evaluate the treatment outcomes of minimally invasive plate osteosynthesis (MIPO). MATERIALS AND METHODS: From January 2004 to December 2009, 84 cases of 81 patients treated with plate fixation for distal tibia fracture were enrolled in this retrospective review. We investigated age, sex, injury mechanism, fracture patterns, and complications, and the clinical features were analyzed. To evaluate the treatment outcomes of MIPO, we divided into two groups. MIPO group consisted of 55 patients were treated with MIPO technique and conventional group consisted of 18 patients were treated with open reduction and internal fixation with conventional anterolateral plating. The results were compared between two groups by assessing bony union time, operation time, amount of blood loss, range of ankle motion, clinical score by American Orthopaedic Foot and Ankle Society (AOFAS) score, and post-operative complications. RESULTS: The mean age of 81 patients with distal tibia fracture was 54.8 years. According to AO classification, A1:2:3 were 16, 20, 16 patients, B1:2:3 were 2, 8, 7, C1:2:3 were 1, 3, 11 patients. According to injury mechanism, slip down injury was patients, traffic accident was 26, fall from height injury was 14 patients respectively. The type A fractures were lower energy trauma and more older patients. The type C fractures were higher energy trauma and younger patients. MIPO group was better than conventional group in operative time, blood loss, bony union time, and ankle joint motion. In complications, MIPO group showed no nonunion and infection, one malunion, one skin necrosis, nine skin irritations, and one screw breakage. Conventional group showed two nonunion, four infections, two skin necrosis, and one metal failure. CONCLUSION: Distal tibial fractures caused by low energy trauma were on the increase. Minimal invasive plate osteosynthesis was shorter bony union time and operation time, less blood loss, and larger ankle motions than conventional open reduction and plate fixation.

Reverse Shoulder Arthroplasty for Humeral Head Fracture with Massive Rotator Cuff Tear in Elderly Patient / 대한정형외과학회잡지

There are several methods to treat anatomic neck fracture of humerus in elderly patients. It is not easy to obtain optimal clinical or radiological results because of unstable fixaton of fractured site attributed to multifractured osteoporotic tuberosities and combined massive rotator cuff tears in these patients. These factors often lead to high failure rate of implantation. Alternative methods of treatment have been proposed to reduce complications and improve shoulder functions. Reverse shoulder prosthesis was originally designed for patients with cuff tear arthropathy. Indications for reverse shoulder arthroplasty have expanded with initial success. However, there are few reports to perform reverse shoulder prosthesis in proximal humerus fracture. We performed reverse shoulder arthroplasty in a 74-year-old man with right anatomic neck fracture of humerus and concomitant massive rotator cuff tear.

Comparative Study of MR-arthrography and Arthroscopy in Partial Thickness Rotator Cuff Tears

PURPOSE: The purpose of this study was to assess the efficacy of MR arthrography to detect partial thickness rotator cuff tears. MATERIALS AND METHODS: One hundred and seventy seven patients with a high suspicion for rotator cuff disease were studied by performing MR-arthrography and subsequent arthroscopy. The ability of MRarthrography to detect partial thickness tears was evaluated according to the location of the tears. We determined the correspondence between the measurements of the articular side partial tears on MR arthrography and those on the arthroscopic findings. RESULTS: The arthroscopic diagnosis of partial thickness rotator cuff tears was divided into 3 groups according to their location. There were 63 cases on the articular side, 41 cases on the bursal side and 20 cases on both sides. The sensitivity of MR-arthrography was 82% for the articular side tears and 11% for the bursal tears. The specificity was 88% for the articular side tears and 100% for the bursal tears. MRarthrographic measurement correctly predicted 72% in 28 repaired cases of 56 articular side partial thickness tears. CONCLUSIONS: MR-arthrography may be a reliable tool for diagnosing articular side partial thickness rotator cuff tears, but it has limitations for bursal side tears.

Comparison of Intra-articular versus Intra-venous Patient Controlled Analgesia (PCA) following Arthroscopic Shoulder Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the postoperative analgesic effects and side effects of an intra-articular PCA infusion of bupivacaine and morphine using an intravenous PCA infusion of morphine following arthroscopic shoulder surgery. METHODS: Seventy-one patients, undergoing arthroscopic shoulder surgery under general anesthesia, were randomly assigned to one of two groups. In group 1 (n = 32), morphine and ondansetron, 8 and 4 mg, respectively, were intravenously injected following surgery, with the subsequent infusion of normal saline 100 ml, including morphine and ondansetron, 32 and 12 mg, respectively, through an intra-venous PCA catheter. In group 2 (n = 39), 0.25% bupivacaine, 40 ml, including an intra-articular injection of morphine, 3 mg, followed by an infusion of 0.25% bupivacaine, 100 ml, including morphine, 5 mg, were administered through an intra-articular PCA catheter. In groups 1 and 2, the PCA infusion rate was 2 ml/h, with a bolus dose of 0.5 ml, with a lock out time of 8 min. The VAS for pain at rest, and the range of motion (ROM) exercise and side effects were assessed 0.5, 1, 2, 4, 12, 18 and 24 h postoperatively. RESULTS: The patients in group 2 had significantly lower VAS for pain for the ROM than those in group 1 30 min postoperatively. However, the VAS for pain at rest was significantly lower in group 1 than 2 after 18 and 24 h, but the VAS for pain for the ROM was significantly lower in group 1 than 2 24 h postoperatively. There was no significant difference in the side effects between the two groups, with the exception of dizziness, which was more severe in group 2 at 1, 2 and 4 h postoperatively. CONCLUSIONS: An intra-articular PCA infusion of bupivacaine and morphine is no more effective than an intra-venous PCA infusion of morphine and ondansetron with respect to postoperative analgesia and side effects.

Acute Isolated Pisiform Dislocation: A Case Report / 대한정형외과학회잡지

There are few reports of an isolated dislocation of the pisiform. An isolated dislocation of the pisiform without other injuries involving the carpal bones is particularly uncommon. This type of injury can be neglected in the acute period. We report a case of an isolated dislocation of the pisiform without a carpal bone injury in a young man treated primarily with a closed reduction, pinning and immobilization.

Clinical Features and Arthroscopic Findings of Partial Thickness Rotator Cuff Tears / 대한정형외과학회잡지

PURPOSE: To compare the clinical features of partial thickness rotator cuff tears according to location of the tear and to classify the partial thickness rotator cuff tears based on arthroscopic findings. MATERIALS AND METHODS: This study evaluated 138 patients who were arthroscpically proven to be partial thickness rotator cuff tears. Three groups were identified; 56 in the articular side tear, 58 in the bursal side tear, 24 in the both sides tear. The comparison included preoperative clinical features such as pain, range of motion and impingement sign. The partial thickness rotator cuff tears were classified according to the arthroscopic findings. RESULTS: There was no significant difference in the clinical features between articular, bursal and both sides tears. Partial thickness rotator cuff tear can be divided into 5 groups. Type I (n=41): fraying or fibrillation on surface of the cuff. Type II (n=35): fiber disruptions with or without displacement. Type III (n=38): flap tear or fragmentation. Type IV (n=16): both articular and bursal side tears without communications. Type V (n=8): impending a full thickness tear. CONCLUSION: It is difficult to differentiate the clinical features based on the physical examinations according to the locations of tears. Newly designed classification may help in deternmining the appropriate arthroscopic treatment of a partial thickness rotator cuff tear.

The Biomechanical Effect of Stem Design and Methods of Fixation in Revision Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study examined the effect of the stem design and method of fixation on biomechanical features around a stem tip in revision total knee arthroplasty using finite analysis. MATERIALS AND METHODS: A 3D Finite element model was reconstructed for a CT scan of the normal tibia from a 26 year old male and the CAD model of total knee arthroplasty revision was developed. The design change in the stem such as the length, diameter, slot, press fit and coefficient of friction was performed. The contact pressure, von-Meises stress around the stem and the micromotion were evaluated. RESULTS: A longer length and larger diameter press fit stem significantly increased the contact pressure and stress at the end of stem. The distal slot reduces the contact pressure and stress at the end of stem. Less displacement between the tibial component and bone was noted in the increased coefficient of friction. CONCLUSION: A stem with shorter length sufficient to engage proximal diaphysis, a closer diameter of the proximal canal and a minimal press fit can be used to reduce the contact pressure and stress if the patient's surgical anatomy such as bone loss and quality is tolerable in revision total knee arthroplasty.

Intraoperative Imaging to Monitor the Alignment of Acetabular Cup for Total Hip Replacement Arthroplasty

PURPOSE: This study examined intraoperative imaging to monitor the alignment of the acetabular cup for total hip replacement arthroplasty (THRA) using C-arm fluoroscopy and to increase the accuracy of THRA prosthetic fixation. MATERIALS AND METHODS: From March 2004 to April 2007, 54 patients underwent THRA monitored by the imaging. 40degreesinclination and a 15degreesanteversion angle was considered to be ideal. The items compared included the alignment of the acetabular cup and the follow up rates of the hip dislocation. RESULTS: There was one case of hip dislocation. The mean inclination angle of the acetabular component was 39.9degreeswith a standard deviation of 3.038. The mean anteversion angle of the acetabular component was 14.9degreeswith a standard deviation of 1.398. The mean difference examination and variance in the anteversion angle showed a significant result.(P<0.05) CONCLUSION: Intraoperative imaging increases the alignment accuracy of the acetabular cup and helps stabilize the prosthesis.

Secondary Septic Arthritis Due to Lateral Malleolar Bursitis: A Case Report / 대한족부족관절학회지

Lateral malleolar bursitis rarely progresses to septic arthritis. In our case, the 27 year old man visited due to progressive left ankle pain, despite the antibiotics treatment of lateral malleolar bursitis. 8 years ago, modified Brostrom procedure was performed owing to chronic ankle instability. Previous surgery altered anatomical structure of lateral ankle bursa, so it may cause the infection to spread to the ankle joint. We reported rare case of secondary septic arthritis caused by lateral malleolar bursitis.

Superior Labrum Anterior to Posterior Lesion Type II with Accompanied Findings: Assessment of Shoulder MR Arthrographic Findings

PURPOSE: To describe the pattern of various shoulder abnormalities with an associated superior labrum anterior to posterior (SLAP) lesion type II using magnetic resonance (MR) arthrography, and to assess the clinical significance of the associated abnormalities. MATERIALS AND METHODS: A retrospective review of the MR arthrographic findings of 92 cases of a shoulder with an arthroscopically confirmed SLAP lesion type II was performed. The MR arthrography images were reviewed and analyzed. MR arthrographic analysis noted the presence of a rotator cuff abnormality, acromioclavicular arthritis, adhesive capsulitis, glenohumeral arthritis, a labral abnormality besides the SLAP lesion, and a paralabral cyst. The patients with SLAP lesions were divided into two age groups: those over 40 years of age and those forty years old or younger. Statistical analysis was performed to evaluate the influence of age on the various shoulder abnormalities with associated SLAP lesion. RESULTS: Of the 92 SLAP lesions type II, there were 7 cases (8%) of isolated SLAP lesions without any associated any shoulder abnormality. Eighty-five (92%) SLAP lesions were associated with various shoulder abnormalities including rotator cuff tendinosis (30/92, 33%), partial-thickness tear (36/92, 39%), full-thickness tear (2/92, 2%), acromioclavicular arthritis (46/92, 50%), adhesive capsulitis (7/92, 8%), glenohumeral arthritis (15/92, 16%), labral abnormality (26/92, 28 %) and paralabral cyst (7/92, 8%). The SLAP lesions (60/92, 65%) in patients over forty years of age were accompanied by a significantly high number of rotator cuff abnormalities (p < 0.001), glenohumeral osteoarthritis (p = 0.001), and acromioclavicular osteoarthritis (p < 0.001). In contrast, the SLAP lesions (32/92, 35%) in patients forty years old or younger had a significantly high number of anterior or posterior labral lesions (p < 0.001). CONCLUSION: Isolated SLAP lesions type II without other associated shoulder abnormalities are uncommon, and the age of the patient influences the prevalence of other shoulder abnormalities associated with SLAP lesions. In addition, MR arthrography can help detect shoulder abnormalities accompanying the SLAP lesions.

Lower Limb Position in Oxford Unicompartmental Knee Arthroplasty

PURPOSE: To compare the accuracy of tibial cutting between in dangling position and standing position of the lower limb for Oxford unicompartmental knee arthroplasty. MATERIALS AND METHODS: From September 2001 to September 2003, While performing Oxford unicompartmental knee arthroplasty, we cut tibial plateau with lower extremity in dangling position and standing position alternately. Group 1 consisted of 12 cases underwent tibial cutting in dangling position. Group 2 consisted of 12 cases underwent tibial cutting in standing position. Clinical assessments consisted of radiologic evaluation and HSS knee score. RESULTS: There were no significant differences in limb alignments and HSS knee scores between group 1 and group 2 at one year postoperatively. In anteroposterior radiographs, the mean alignment of tibial component of group 1 was measured 4.07+/-5.7 degrees varus to the tibial axis and that of group 2 was measured 2.34+/-2.4 degrees varus to the tibial axis(P=0.35). CONCLUSION: In Oxford unicompartmental knee arthroplasty, tibial cutting in standing position showed a tendency to cut tibia more perpendicular to the tibial axis. But it was statistically not significant.

Cross Pin Femoral Fixation for Posterior Cruciate Ligament Reconstruction Using Quadruple Hamstring Tendon

PURPOSE: The purpose of this study is to introduce new fixation technique for posterior cruciate ligament (PCL) reconstruction using quadruple hamstring tendon autograft. MATERIALS AND METHODS: From September 2001 to March 2002, eight patients received PCL reconstruction using quadruple hamstring autograft for PCL injury without associated procedures for posterolateral complex injures. All femoral tunnels were fixed with cross pins and all tibial tunnels were fixed with Intrafix(Mitek , USA). Clinical assessments consisted of Lysholm knee scores, International Knee Documentation Committee(IKDC) evaluation form and manual maximal side to side difference using KT-2000 arthrometer. RESULTS: The average Lysholm knee score improved from 54 preoperatively to 89 postoperatively. At the final IKDC evaluation, 2 cases were graded as normal, 5 nearly normal, 1 abnormal. Mean side to side difference of manual maximum posterior displacement with knee in 70 degrees flexion using the KT-2000 arthrometer was 3.7mm. CONCLUSION: In PCL reconstruction using quadruple hamstring autograft, cross pins are good fixation method with high strength and stiffness.

Anterior Cruciate Ligament Reconstruction Using a Contralateral Hamstring Tendon Graft in Combined Anterior Cruciate and Medial Collateral Ligament Injury / 대한정형외과학회잡지

PURPOSE: We reviewed the results of a series of patients with combined anterior cruciate ligament and medial collateral ligament injury who received nonoperative management of medial collateral ligament with anterior cruciate ligament reconstruction using a contralateral hamstring tendon graft. MATERIALS AND METHODS: From May 2000 to June 2001, 12 cases (20-46 years; mean, 35 years) were available for follow-up (12-23months; mean, 16.7 months) with combined anterior cruciate ligament and medial collateral ligament injury that underwent anterior cruciate ligament reconstruction alone using a contralateral hamstring tendon graft. Follow-up evaluation involved; KT-2000 arthrometer testing, valgus stress testing and the International Knee Documentation Committee (IKDC) evaluation form. RESULTS: Mean side to side difference of manual maximum anterior displacement using the KT-2000 arthrometer was 1.75 mm. All cases showed a firm end point by the valgus stress test. At the final IKDC evaluation, 2 cases were graded as normal, 8 nearly normal, 1 abnormal and 1 severely abnormal. The donor site result of the IKDC evaluation form showed normal in 8, nearly normal in 3 and abnormal in 1. CONCLUSION: These results demonstrate the effectiveness of ACL reconstruction alone using the contralateral hamstring tendon graft as an autograft in combined ACL and MCL injury, which was found to restore satisfactory stability with minimal complications at both injured and donor sites.

Comparative Analysis of Resurfaced and Unresurfaced Patella in Bilateral Total Knee Arthroplasty: A 10 year, Prospective and Controlled Study of Clinical and Radiological Results / 대한정형외과학회잡지

PURPOSE: To analyze the clinical and radiological results of bilateral TKA with and without patellar resurfacing in osteoarthritic patient. MATERIALS AND METHODS: We have prospectively studied 17 patients who had bilateral TKA and whose patella was resurfaced on one side and not on the other. Criteria of patient selection include no preoperative patellofemoral pain and bony eburnation of articular cartilage. The Ortholoc Modular. prosthesis was implanted on both sides by same surgeon using identical technique in all cases. The mean follow-up period was 10.6 years. Evaluation was performed annually using HSS (Hospital for Special Surgery) knee rating score and radiological parameters including tibiofemoral angle, width of patella, length of patella, thickness of patella, tilt of patella and shift of patella. RESULTS: On the basis of long term follow-up results, there was no significant difference between resurfaced and unresurfaced group in clinical and radiological study. According to radiological findings as time passed, tibiofemoral angle and patellar thickness decreased but patellar length and width increased in both groups. There was no relationship between HSS knee score and radiological result in both groups. CONCLUSION: This study showed that long term clinical and radiological results of TKA does not depend on patellar resurfacing. Author can propose that patellar resurfacing is not always required in patients with relatively good condition in articular surface of patella.

Common Peroneal Nerve Palsy Caused by a Ganglion: Case Report / 대한정형외과학회잡지

A common peroneal nerve palsy caused by a ganglion has been rarely reported. A Ganglion may arise from joint, tendon sheath or sheath of peripheral nerve. They may also be intraosseous and intraneural but relatively rare entities. Although intraneural ganglion is a well recognized entity, few reports in the literature describe motor weakness and sensory change as a primary clinical manifestation. The pathogenesis of intraneural ganglion cyst remains controversial. We describe the case of 42-year-old male manual worker with a 2 month history of weakness of the right ankle and foot drop and paresthesia of the anterolateral aspect of the lower leg, as a result of compression of the common peroneal nerve by a ganglion, in both intraneural and intramuscular forms.

Revision Total Knee Arthroplasty of Failed Unicompartmental Knee Arthroplasty

PURPOSE: To analyze the failure mechanism, complexity of surgery, complication and outcome of revision of failed unicompartmental knee arthroplasty(UKA). MATERIALS AND METHODS: 14 patients(16 knees) were followed up a mean 70 months. The patients were a mean age of 58.2 years at time of UKA and predominantly female(85%). Revision surgery was done 14 to 104 months with an average time of 4 years 10 months after UKA. The UKA component that were revised include 10 Microloc, 4 Allegretto, 1 Oxford and 1 Marmor modular II. Clinical and radiographic evaluation were completed preoperatively and at last follow-up. The scoring system used in this study is Hospital for Special Surgery(HSS) knee score. Radiographic assessment was performed using Bauer's method(tibio-femoral angle) and American knee society roentgenographic evaluation system. RESULTS: The predominant failure mechanism was polyethylene wear and femoral component loosening. At the last follow-up, the average HSS knee score significantly improved from 60 to 86. Average tibio-femoral angle was corrected from varus 2o to valgus 5o. The implant type used for the revision was PFC-PS. 11 knees required local autograft but no allograft were used. Femoral block augment and tibial metal wedges with stem were also used to reconstruct the defect. There were 2 cases of complications, subluxation of patella and deep infection after intraarticular injection at local clinic. CONCLUSION: Polyethylene wear and femoral component loosening was common failure mechanism in revision of UKA. Bone defects needed to reconstruct were detected in 11 cases but autograft was enough to reconstruct the defect. Result of failed UKA compares favorably with those of total knee revision.

The Results of PFC Total Knee Arthroplasty: comparative study of cruciate retaining versus substitution and cement versus cementless fixation / 대한정형외과학회잡지

PURPOSE: To analyze clinical, radiological results and survival rates of Press Fit Condylar total knee arthroplasty and compare the results of cruciate-retaining versus cruciate-substitution, and cement versus cementless fixation. MATERIALS AND METHODS: We analyzed 364 patients, 520 knees, which had undergone PFC total knee arthroplasty during the period January 1988 to January 1999. Average follow-up period was 7.1 years (3-14 years). Cases were divided into 2 categories: cruciate-retaining (CR) versus substitution (CS) and cement versus cementless fixation. The clinical results were evaluated using the Hospital for Special Surgery knee scoring system and radiological results were obtained by measuring tibiofemoral angle using Bauer's method. Survivorship analysis was performed using Kaplan-Meier method with revision for any reason as the end point. RESULTS: Clinical, radiological results and the survival rate in the cruciate substitution group were slightly better than those of the cruciate retaining group but no statistical difference was found. Survival rate in the cemented group was significantly higher than that in the cementless group. Clinical and radiological results of the cemented group were better but there was no statistical significance between the two groups. CONCLUSION: No differences were found in the postoperative results of the CR and CS groups. Survival rate in the cemented group was superior to that of the cementless group, which was used even in good bone stock and less deformed cases. This results may be related to a design problem of the cementless prosthesis.

Results and Survivorship of High Tibial Osteotomy / 대한정형외과학회잡지

PURPOSE: To determine survivorship and establish the ideal correction angle in high tibial osteotomy for primary osteoarthritis through retrospective study. MATERIALS AND METHODS: One hundred and eleven valgus osteotomies of the tibia were performed in seventy-nine patients from 1985 to 1997. The average follow-up period was 9 year 6 months (range, 2.4 to 14.1 years). Failure I was defined as the need for conversion of a high tibial osteotomy to a total knee arthroplasty, and Failure II as the need for conversion or in a patient with less than 60 HSS knee score points. The probability of survival was estimated using the Kaplan-Meier survivorship method. RESULTS: The HSS knee score averaged 60 points preoperatively, 94 points at the 1 year follow-up and 87 points at the last followup. The 4 year and 14 year survival rates were 99% and 85.0% using the first definition of failure, and 96.4% and 75.1% using the second. CONCLUSION: High tibial osteotomy is a reliable method for treating unicompartmental osteoarthrtis, provided that the postoperative femorotibial angle is corrected by more than 7degrees of valgus.

Quantitative Analysis of Type II Collagen with Western Blotting in Microfracture Surgery / 대한정형외과연구학회지

PURPOSE: To measure the amount of type II collagen with western blotting method and to verify its relations with the clinical, radiological and second look arthroscopic findings in patients who were treated with microfracture surgery. MATERIALS AND METHODS: From October 1997 to December 2000, second look arthroscopies and biopsies were performed in 21 knees of 20 patients at 1 year after surgery. Their mean age at the time of operation was 62.7 years(range, 44-77years) and mean follow-up period were 1 year 3months(range, 10-30 months). 21 cases were classified into 3 groups (Group I >70%, Group II 20-70%, Group III < 20% of normal control) according to the result of western blotting of type II collagen. We analyzed the relationship of western blotting of type II collagen with clinical, radiological, extent of regenerated articular cartilage, patient's age, weight and preoperative varus deformity. RESULTS: Average amounts of type II collagen were 44% of those in control group. The amounts of type II collagen formation had positive correlation with extent of regenerated cartilage and preoperative varus deformity but no correlation with clinical score, joint space widening, patient's weight and age. CONCLUSION: The results of this study provide the rationale to select the osteoarthritic patients indicated for microfracture surgery.