Microfracture surgery

DoroWalz By DoroWalz, 7th Aug 2013 | Follow this author | RSS Feed | Short URL http://nut.bz/21g28cg-/
Posted in Wikinut>Health>Recovery & Coping

An article about the microfracture surgery and what to expect from it.

What is microfracture ?

Microfracture is a minimally invasive operation used for the treatment of small cartilage defects. Usually, the operation is carried out on patients with defects on the knee, however the operation is also performed on other joints including the elbow and ankle.

At the moment, microfracture is the first option usually considered both by patients and doctors due to both its effectiveness and low cost.

Development

Microfracture was first developed in the late 1980s to the early 1990s by Dr. Richard Steadman from the Steadman-Hawkins clinic in Vail, Colorado. Dr. Steadman slowly but gradually refined and improved the procedure, first trying it on horses and then on humans.

In the early years many considered the procedure to be "controversial" , especially certain sportswriters, for two reasons:
- There were no real scientific data on the long-term effects
- An unsuccessful microfracture usually meant the end of an athlete's career.

Of course, these "experts" failed to mention that up until then there was no other option to treat cartilage defects, at least not any that could yield even the slightest improvement !

Currently, Dr. Steadman is researching new methods, trying to implement the technique for the treatment of torn ligaments (e.g. the anterior cruciate ligament or the meniscus)

How is the microfracture operation carried out ?

As aforementioned, the operation is minimally invasive and carried out via arthroscopical means. The surgeon will first clear the defect from any damaged or calcified and then proceed with the actual operation. He will use an awl to creates tiny fractures in the bone below the defect and this is the reason the operation is named "microfracture" (micro= small).

Almost immediately, fresh blood starts to flow from these fractures, containing stem cells, growth fractures, progenitor cells and other ingredients which form a blood clot. As time passes, this clot matures and forms new cartilage.

The incisions created during the procedure are very small (less than 1-2 cm in length) and the resulting scarring is minimal

Who is a good candidate

Unfortunately, not all patients can opt in for the procedure. Ideally, the perfect candidate should meet the following qualifications:
1) Be of young age (18-45)
2) Relatively fit (obese patients are usually exluded)
3) Have a small cartilage defect (less than 2.5 cm)
4) Must be willing to undergo intensive rehabilitation

Expected outcome

Long term studies clearly show that generally the operation doesn't "fill"the chondral defect fully. Furthermore, the newly developed cartilage is usually fibrocartilage and not true hyaline cartilage. Unlike hyaline cartilage, fibrocartilage is not as strong and can't handle high impact forces as good as hyaline cartilage does.

Regardless of this, about 80 % of patients manage to fully return back to their previous lifestyle and report good to excellent results ! Some - especially the ones participating in heavy impact sports - have to make minor adjustments or quit sports all together for a certain period of time.

Still, there are many other options for the minority of patients in which microfracture fails including:
1) Autologous Chondrocyte Implantation
2) Mosaicoplasty
3) Stem cell procedure
4) OATS (Osteoarticular Transfer System -)

Rehabilitation after a microfracture

Your surgery is just the beginning of a long and difficult path. During the first days, the blood clot we mentioned before is very sensitive and it takes about 6 months before it has fully matured. For this reason most patients are asked to use crutches and leave the operated joint non-weight bearing for a period of about 6 to 8 weeks. Then you will be allowed to start returning gradually to your activities, like walking and work.

Do not expect to return back to high impact activities (like football or running) before the 6-month mark!

Further Reading

- http://www.microfracture1.com/p/microfracture.html


Don't forget to leave a comment if you have any questions about the operation !

Tags

Microfracture, Rehab, Rehabiliation, Surgery

Meet the author

author avatar DoroWalz
I will be writting for medical-related thingies ! :)

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