Microfracture produces inferior outcomes to other cartilage repair techniques in chondral injuries in the paediatric knee

Introduction: Chondral injuries are becoming increasingly common in the paediatric knee. First line surgical therapy is usually microfracture (MF), but the emergence of alternative techniques raises the question of what is the optimal treatment in paediatric patients. Sources of data: A comprehensive search of PubMed, OVID, Web of Science, SportDiscus and Cochrane databases was performed using the key words 'autologous chondrocyte implantation, MF, mosaicplasty, juvenile, paediatric'. Areas of agreement: Each technique demonstrated a significant post-surgical improvement in clinical outcome scores. However, MF demonstrated poorer outcomes in larger lesions (> 3 cm(2)) and shorter durability. Area of controversy: The quality of the available literature is poor, and there is a lack of comparative trials. Growing points: The impact of defect characteristics, mechanism of injury and concomitant surgeries should be investigated. Areas timely for developing research: Appropriately powered randomized controlled trials with suitably long follow up and condition-specific outcome measures should compare different techniques against each other and placebo.