To compare the effects of osteochondral autograft transfer (OAT) and microfracture on the surgical treatment of articular cartilage defect (ACD) by meta-analysis.

The related research literature comparing OAT and microfracture published by PubMed, Excerpta Medica Database (EMbase), Cochrane Library, Wanfang Database, China Science and Technology Journal Database and China National Knowledge Infrastructure(CNKI) until August 2020 was searched by computer. Literature screening, quality evaluation and data extraction were conducted according to inclusion criteria such as randomized case-control studies of direct comparison between OAT and microfracture published at home and abroad, and exclusion criteria such as studies that could not obtain full text and lacked original data. The Lysholm score, recovery activity, excellent and good rate, failure rate and incidence of osteoarthritis were analyzed by meta analysis using Review Manager 5.4 statistical software.

A total of 345 patients with OAT were included in seven articles, including 171 cases and 174 cases of microfracture. Meta-analysis showed that between OAT and microfracture surgery, the postoperative Lyshlom score [mean difference(MD)=-10.19, 95% confidence interval(CI) (-19.28, -1.10), P=0.03], excellent and good rate after operation [odds ratio (OR )=0.24, 95% CI (0.08, 0.72), P=0. 01], failure rate [ OR=5.96, 95% CI (2.58, 13.75), P<0.0001], the number of postoperative recovery activities [OR =0.15, 95% CI (0.08, 0.28), P<0.0001], the number of patients with osteoarthritis [OR =2.76, 95% CI (1.07, 7.10), P=0.03], the differences of all these were statistically significant. In these aspects, OAT was superior to microfracture.

OAT is superior to microfracture in the number of patients with osteoarthritis, clinical score and postoperative recovery activity. OAT is the preferred first-line operation for patients with ACD repair.