Following the microfracture surgical procedure, the rehabilitation program after microfracture is crucial to optimize the success of the surgical technique. Karthikeyan S, Roberts S, Griffin D (2012) Microfracture foracetabular chondral defects in patients with femoroacetabularimpingement: results at second-look arthroscopic surgery. The first long-term outcomes paper was published on the microfracture technique in 2003 19). Arthroscopy 28, 322–329. In one study, he and his colleagues found that leaving the calcified cartilage layer interferes with new cartilage formation and significantly decreases the chances of growing new cartilage. “This made us more adherent to the principle of creating a raw bone bed at the base of the lesion,” he said. Issue: July 2007 The goal of microfracture is to stimulate the growth of new articular cartilage by creating a new blood supply. The amount of weight put on the area of microfracture must be limited.2 This allows the cells to grow in develop in the area that underwent the microfracture treatment. Ankle Arthroscopy with Microfracture Precautions: The patient will be splinted to restrict ROM. Two comparative groups with and without microfractures were defined. J Bone Joint Surg Am 2007; 89:2105-2112. enable_page_level_ads: true In 2012, Karthikeyan et al. Passive motion is allowed with the brace removed, but otherwise the brace must be worn at all times. Fifteen percent noticed no change, and five percent continued to have joint deterioration. Microfracture surgery is quick (typically lasting between 30–90 minutes), minimally invasive, and can have a significantly shorter recovery time than an arthroplasty (knee replacement). Technically, microfracture surgery is a bone marrow stimulation procedure and is based on the puncturing of the subchondral bone plate into the bone marrow, the generation of a blood clot containing precursor cell populations derived from the subchondral bone marrow, and the spontaneous transformation of the repair clot into a fibrocartilaginous repair tissue. These angles are avoided during strength training for approximately 4 months. Figure 1. (Center) Awl is used to make holes in the subchondral bone. All measured functional scores had significant improvements; however, there was no comparative group in this study. Some patients, however, like to continue to wear the brace for strenuous exercise for a few more months up to about 6 months. Microfracture surgery fails at an alarming rate ending the careers of many pro athletes. For those lesions that cause symptoms in patients, several lines of treatment have been developed. In 2008, he published a series of nine patients who underwent revision arthroscopy after previous arthroscopic treatment with microfractures for a full-thickness chondral lesion. This loose cartilage is also removed so that there is a stable edge of cartilage surrounding the defect. The goal is to have the patient on the machine for 6 to 8 hours in a 24 hour period. Can microfracture be used in joints other than the knee? https://pdfs.semanticscholar.org/b729/1ccd704e1a90191f0ca30f6840d05545d428.pdf, Young patients who have a single injury and healthy subchondral bone (bone underlying the articular cartilage). Steadman JR, Briggs KK, Matheny LM, Guillet A, Hanson CM, Willimon SC. Am J Sports Med 2008; 36:1763-1769. Three small incisions are made to insert the arthroscope and other instruments. Steadman JR, Dragoo J, Hines S, Briggs KK. To reach all areas of the knee joint, various angled picks were developed. Cold therapy is usually implemented for 1 to 7 days after surgery. I had microfracture done on my ankle 3 years ago, and I am NOT a big fan of because of the increase in pain, however, I have found no valid alternative to date. Earlier bone remodelling was noted by changes in porosity 7). Standard anteriorposterior and lateral images are also reviewed. Experience shows that this hybrid repair tissue is durable and functions similarly to articular cartilage. (adsbygoogle = window.adsbygoogle || []).push({}); (adsbygoogle = window.adsbygoogle || []).push({ When the microfracture is on the top of the shin bone (tibia) or the end of the thigh bone (femur), weight is limited by having a patient use crutches. Get the latest news and education delivered to your inbox, Receive an email when new articles are posted on, Please provide your email address to receive an email when new articles are posted on, Tell us what you think about Carefully reviewing your situation with your doctor to determine if youre a good candidate for this surgery is critical. 31) published a series of 30 patients with femoroacetabular impingement and grade 4 chondral lesions. Overview Total ankle replacement (also called ankle arthroplasty) is a surgical option for patients with arthritis of the ankle. The average time from surgery to return to competition was 13.4 months (range 0.5 to 25.3 months). Microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. Then, a period of dynamic biking with increasing resistance. The incisions will then be covered. Microfracture surgery is considered the best procedure to treat cartilage injuries less than ½ inch or 15 mm. Microfracture may be indicated for the following: Contraindication for microfracture surgery of the hip will be defects larger than 4 cm² as well as in cases of more advanced osteoarthritis (extensive acetabular lesions, equivalent lesions of the femoral head) 2). Twenty two percent of the patients remain unchanged and about three percent are made worse. Steadman and colleagues at the Steadman Hawkins Clinic have conducted numerous studies on microfracture, showing long-term success up to 11 years and success in high-level athletes, as shown in a 2003 study on National Football League players. Age (e.g. El Bitar Y, Lindner D, Jackson T, Domb B (2014) Joint-preserving surgical options for management of chondralinjuries of the hip. More concerning is a recent review of many studies that shows the effects, despite the invasiveness of the surgery, are short lived. A cartilage stimulating procedure (microfracture) has been performed to encourage the body to cover the exposed bone with scar tissue. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. By the next season, 76% of the players returned to play and continued to play for an additional 4 seasons. In addition, there is an emphasis on range of motion of the patella and patellar tendon motion. This research review in the Journal Arthroscopy reviewed 15 higher quality research papers that had been published about the effectiveness of microfracture. Hurst JM, Steadman JR, O’Brien L, Rodkey WG, Briggs KK. When the microfracture is o… From microfracture surgery to cutting edge non-surgical therapy, we are Atlanta’s leading choice for effective cartilage restoration in the ankle. In 2015 Fontana and de Girolamo 36) published a study comparing the clinical results after five-year follow-up of microfracture with a technique of enhanced microfracture autologous matrix-induced chondrogenesis (autologous matrix-induced chondrogenesis) for acetabular chondral lesions grades 3 and 4. In degenerative knees it has been found to have about a 75% success rate. J Knee Surg 2003; 16:83-8. The surgeon literally pokes holes in the knee bone of the cartilage hole trying to prompt bleeding of the bone marrow into the area. The study identified age as the only independent predictor of Lysholm improvement. The microfracture technique produces a rough bone surface that the clot adheres to more easily. Often, the patient has had an injury to the ankle and has had a period of several months to years of conservative care with a chronic ache in the ankle. To determine angular deformity, a long-standing hip to ankle image radiograph is taken. 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