Clinical Commentary on Microfracture Treatment of Chrondral Defects
Sometimes surgeons offer other surgeons their knowledge on a particular topic. When published in a journal, this is called a clinical commentary. This commentary on treating articular cartilage defects with the microfracture method comes from orthopedic surgeons at Harvard Medical School.
They review the goals of surgery when treating chondral defects, discuss the two types of defects (partial- or full-thickness), and surgical treatment for both. A chondral defect is a tear or damage of the knee cartilage clear down to the bone. When and how to do the surgery is presented along with results reported from various studies.
Damaged or destroyed cartilage does not heal itself. There is a remodeling system that goes to work after injury but the response is limited. Surgery is needed with the goals of decreasing pain, improving function, and preventing further joint degeneration.
The microfracture technique puts tiny holes in the cartilage down through the bone to the bone marrow. The goal is to stimulate the bone marrow to bring blood to the area. This response starts the healing process.
Some studies show that results are better with smaller defects (less than three millimeters in diameter) with this method of treatment. Others report no difference in results based on size or location of the defect. Microfracture can be used with defects from injury or degeneration.
Some patients may not benefit from microfracture treatment. It is not advised with defects deeper than 10 millimeters or for patients with poor knee alignment. For those patients who do have this treatment, rehab is important. Motion is important but weight-bearing must be limited.
Results of this procedure have been reported. Surgeons use arthroscopy to take a second look. In at least half the knees, defects fill in normally. Other knees show uneven, fragmented, or incomplete healing. Microfracture may fail if tissue repair is more fibrocartilage than hyaline cartilage.
Thomas J. Gill, MD, et al. The Treatment of Articular Cartilage Defects Using the Microfracture Technique. In Journal of Orthopaedic & Sports Physical Therapy. October 2006. Vol. 36. No. 10. Pp. 728-738.
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