Microfracture

FAQs on Cartilage Microfracture Repair in Gilbert, Chandler & Mesa AZ

 

Developed in the early 1990s, microfracture is widely used to repair damaged knee joint cartilage. Performed using the arthroscopic procedure, the cartilage microfracture repair is less invasive, less time intensive, and have significantly faster recovery compared to arthroplasty.

What is cartilage microfracture repair?

Cartilage microfracture repair is a surgical technique used to repair damaged articular cartilage in the knee joint. As the name suggests, it creates tiny fractures on the supporting bone, which in turn elicit blood and bone marrow flow leading to “super clot” in the damaged area. New cartilage generates from this super clot.

In a way, microfracture cartilage repairing induces the natural healing process of the body to repair and stimulate regrowth of worn-out knee joint cartilage.

What is articular cartilage and how is it damaged?

The microfracture technique is used to treat damaged knee cartilage, a fibrous band of thick tissue located between two bones. It acts as a smooth gliding surface for bones preventing friction between bones, catching and also becomes shock observer for the joint.

However, sudden force, trauma, repetitive stress and degeneration results in damage to the cartilage or its separation from the bone surface. Self-healing or regrowth of cartilage becomes impossible, as the area covered by thick surface subchondral bone inhibits good blood flow. As a result, patients experience knee pain, chronic inflammation, impaired motion, and other knee joint problems.

How does cartilage microfracture repair work?

Microfracture cartilage repair involves drilling into the hard surface bone layer up to where the cartilage is located. The process allows vascular bone to access the damaged area and inflow of blood and bone marrow to it. A super clot gradually develops there. It has growth factors, including mesenchymal stem cells capable of taking the progenitor role. This leads to development of fibrocartilage cells and transformation of the clot to scar tissue cartilage. Thus, the cartilage regenerates and allows returning to normal activities.

Though not as good as the original cartilage, the regenerated cartilage helps in painless activities, prevents further knee injury, forbids the need for knee replacement, and inhibits progression to arthritis.

Who is a candidate for cartilage microfracture repair?

The microfracture repair of cartilage is for those

  • suffering from knee problem for long despite non-surgical management of cartilage injury
  • with limited cartilage damage
  • without significant knee arthritis or total cartilage damage

People without obesity, aged less than 55, and with cartilage damage less than 2.5 centimeters are found to have better results with the procedure. Inactive and patients with obesity may not be benefitted significantly.

How is cartilage microfracture repair performed?

Cartilage microfracture repair is an arthroscopic procedure. The first stage includes an arthroscopic assessment of the damage and removal of fragmented or damaged parts of the cartilage though a quarter-inch knee incision. Most patients have only cartilage damages within an area of 2 square centimeters. Surgeons drill 5 to 15 microfactures or small holes, depending on the damaged area.  

Blood began to flow into the deeper area following the drilling and clot is formed within a few hours. However, the regeneration takes time and patients require 4 to 6 months to experience improvements. It requires 2 to 3 years before your return to your optimal level.

How long does cartilage microfracture repair surgery take?

It takes 30 to 60 minutes. Patients are discharged same day or next day after the observation period is over.

What are the restrictions following cartilage microfracture repair?

  • Keep the incision area clean and dry
  • Rest for 3-4 days
  • No driving for three weeks
  • Use crutches for the first week (not for those with less than 1 cm cartilage damage)
  • Avoid weight bearing for six weeks
  • Use a brace for 10-12 weeks
  • No resistance training before 12 weeks
  • Avoid return to sports for at least six months

What kind of rehabilitation is needed following cartilage microfracture repair?                  

Start using continuous passive motion machine from the third day for 6 to 8 hours a day. Practice knee straightening and bending exercises 500 times a day for two weeks. Limited strength training, Stationary biking, and aqua therapy can be started in the second week, but no high-impact resistance training until 12 weeks.

Limited weight bearing should be there after 4-5 weeks depending on the recovery and tolerance level. However, limit the flexion to less than 30 degree. Start bearing full weight, elastic resistance cord workouts, and progressive intense knee motion after 8 weeks. However, for machine or free weights you have to wait until 16 weeks.

Resume sports, such as pivoting and jumping, after 15 weeks. Continue strenuous workouts for six months and beyond.

How long is the recovery period following cartilage microfracture repair?

Full recovery may take 2 to 3 years. However, patients experience significant recovery in six months and you can start sports activities.

What are the potential complications of cartilage microfracture repair?

  • Avoidable surgical complications, such as bleeding, vascular damage, and infections
  • Temporary swelling and stiffness
  • Mild postoperative transient pain
  • Temporary, rare grating sensation when you start weight bearing

References

Mitheofer K, et al. “High-Impact Athletics After Knee Articular Cartilage Repair” Am. J. Sports Med., Sep 2006; 34: 1413 – 1418.

Rodrigo, J. et al. Improvement of full thickness chondral defect healing after debridement and microfracture using continuous passive motion. Am J Knee Surg. 1994;7:109–116

Blevins, F. et al. Treatment of articular cartilage defects in athletes: An analysis of functional outcome and lesion appearance. Orthopaedics. 1998;21:761–768

Miller, B.S., Steadman, J.R., Briggs, K.K. et al, Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg. 2004;17:13–17.

Steadman, J R et al. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg. 2003;16:83–86.

Gudas, R., Stankevicius, E., Monastyreckiene, E. et al, Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes. Knee Surg Sports Traumatol Arthrosc. 2006;14:834–842.

Goyal, D., Keyhani, S., Lee, E.H. et al, Evidence-based status of microfracture technique: A systematic review of level I and II studies. Arthroscopy. 2013;29:1579–1588.

Briggs, K.K., et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19:477–484.

Rodkey, W.G., Briggs, K.K. Microfracture to treat full-thickness chondral defects. J Knee Surg. 2002;15:170–176.

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