Microfracture surgery

Microfracture surgery
Left knee-joint from behind, showing interior ligaments. (Lateral meniscus and medial meniscus are cartilage.)
Specialtyorthopedic

Microfracture surgery is an articular cartilage repair surgical technique that works by creating tiny fractures in the underlying bone. This causes new cartilage to develop from a so-called super-clot.

The surgery is quick (typically lasting between 30 and 90 minutes), minimally invasive, and can have a significantly shorter recovery time than an arthroplasty (knee replacement).

Chronic articular cartilage defects do not heal spontaneously.[1] However, acute traumatic osteochondral lesions or surgically created lesions extending into subchondral bone, e.g. by Pridie drilling,[2] spongialization[3] abrasion[4] or microfracture causing the release of multipotent mesenchymal stem cells from the bone marrow, may heal with repair tissue consisting of fibrous tissue, fibrocartilage or hyaline-like cartilage.[5] The quality of the repair tissue after these "bone marrow stimulating techniques" depends on various factors including the species and age of the individual, the size and localization of the articular cartilage defect, the surgical technique, e.g., how the subchondral bone plate is treated, and the postoperative rehabilitation protocol.[6]

According to a 2017 article in the Journal of Orthopaedics, "Studies have shown that microfracture techniques do not fill in the chondral defect fully, and it forms fibro cartilage rather than hyaline cartilage. The microfracture techniques became controversial due to a lack of favourable reports on the long-term effects."[7]

  1. ^ Hunter, William (31 December 1743). "Of the structure and diseases of articulating cartilages". Philosophical Transactions of the Royal Society of London. 42 (470): 514–521. Bibcode:1742RSPT...42..514H. doi:10.1098/rstl.1742.0079. JSTOR 104206.
  2. ^ Pridie K.H. "A method of resurfacing osteoarthritic knee joints" in: "Proceedings and Reports of Universities Colleges, Councils and Associations". The Journal of Bone and Joint Surgery. British Volume. 41-B (3): 616–639. August 1959. doi:10.1302/0301-620X.41B3.616.
  3. ^ Ficat, RP; Ficat, C; Gedeon, P; Toussaint, JB (October 1979). "Spongialization: a new treatment for diseased patellae". Clinical Orthopaedics and Related Research (144): 74–83. PMID 535254.
  4. ^ Johnson, Lanny L. (January 1986). "Arthroscopic abrasion arthroplasty historical and pathologic perspective: Present status". Arthroscopy. 2 (1): 54–69. doi:10.1016/s0749-8063(86)80012-3. PMID 3954840.
  5. ^ Key, J. Albert (October 1931). "Experimental arthritis: the changes in joints produced by creating defects in the articular cartilage". The Journal of Bone & Joint Surgery. 13 (4): 725–739.
  6. ^ Alford, J. Winslow; Cole, Brian J. (March 2005). "Cartilage Restoration, Part 2: Techniques, Outcomes, and Future Directions". The American Journal of Sports Medicine. 33 (3): 443–460. doi:10.1177/0363546505274578. PMID 15716263.
  7. ^ Karuppal, Raju (June 2017). "Current concepts in the articular cartilage repair and regeneration". Journal of Orthopaedics. 14 (2): A1–A3. doi:10.1016/j.jor.2017.05.001. PMC 5440635. PMID 28559648.