What is microfracture?
Microfracture is a medical term used to describe what is probably the most common medical procedure, carried out for repairing cartilage defects. The operation is typically used for defects in the knee, however it is used in other joints as well for example the ankle, shoulder and elbow. The procedure was developed during the late 1980s and early 1990s by Dr. Richard Steadman from the Steadman-Hawkins clinic in Vail, Colorado. Thousand of microfracture procedures are transported out per year both on everyday people and athletes.
Today, there are many other procedures that can treat cartilage defects, however microfracture is the oldest, best studied and cheapest method that can regenerate lost or damaged cartilaginous tissue. In the US, the operation has an average cost of about 1,000 – $ 3,000.
What happens during the procedure?
The operation is reliably quick, lasting 20-40 minutes. First, the patient is sedated, typically using local or spinal anesthesia. Then, the surgeon makes two small incisions on the patients' operated joint. Through the first hole, he inserts an instrument called "arthroscope". This is a tube-like device with an attached camera. Through this camera the doctor is actually able to see inside the patients' joint through a monitor which is also in the operation room. Afterwards, through the other hole the doctor inserts other small, tube-like organs which are used to clear the defect area, preparing it for the actual microfracture operation. Sometimes, the patient presents with other conditions (like a meniscus tear or a torn anterior cruciate ligament) which are also treated using the same holes and instruments. However, this may increase the time the procedure lasts.
After the area with the cartilage defect has been cleared and prepared, the doctor uses a small tool (usually an awl) to drill small holes (fractures) in the damaged area. Immediately, blood starts to flow from these holes which then gradually begins to clot, forming what is known as a " super-blood clot ". This clot contains several ingredients like growth factors, progenitor cells and mesenchymal stem cells.
All the instruments are then removed, the incisions are stitched and the extremity is bandaged. In most cases, the patient stays in the hospital for 1-2 days and then is sent back to his home to recover.
What happens during the recovery period?
As mentioned before, the surgery results in a super clot. During the first weeks, this clot is extremely sensitive and very easy to break. However, slowly but gradually the clot matures and transforms into new cartilage. This newly formed tissue is not the same as the one we are naturally born with (called hyaline cartilage), but instead is inferior in quality, called fibrocartilage. Neverheless, for most people it is good enough to allow them to continue living normally and even participate in high impact activities like sports.
Recovering from microfracture
As stated above, the super clot is very sensitive during the first days. This is why the operative joint must stay non-weight bearing for a long period of time. Practically, this means that the patient has to use a pair of crutches for a period of about 6-8 weeks. Additionally, he will have to do a series of exercises that will help him maintain his muscle tissue and regain the ROM (range of motion) of the operated joint.
In most cases, the patient starts to walk using one crutch after about 6-8 weeks and typically puts more and more weight. All everyday activities are resumed after about 10 weeks. Unfortunately, return to more stressful for the joints activities take a long time, at least 6 months while many patients are advised to never again participate in such activities.
What will happen if someone does not have the operation?
All current studies clearly show that even the smallest cartilage defect lead lead to osteoarthritis. The bigger its size, the faster the sunset of osteoarthritis will be. So, not having the operation will most likely lead to osteoarthritis which is a painful and untreated disease.