Microfracture surgery is not a perfect solution to repairing torn or damage cartilage but it is the preferred method to repair knee cartilage. It has been performed on many professional athletes who have seen their careers continued on with the advancements of medicine.
Microfracture is used as a surgical option for a patient who is diagnosed with damaged cartilage and is in need of treatment to correct the deformity. Microfracture is performed in an attempt to stimulate new growth by the cartilage. When it was first used, “Microfracture was originally developed for the treatment of acute traumatic cartilage defects. It is generally indicated for traumatic and degenerative focal high-grade chondral lesions of the weight-bearing femoral condyles, trochlea, patella, and tibia” (Mithoefer, K., & Steadman, R. J. (2006). The Microfracture Technique . Chestnut Hill, MA).
There are many factors to assess before a decision is to be made to have microfracture surgery or not. Some of the factors to attribute to the decision but are not limited to whether a patient has limited areas of cartilage, pain or swelling caused by damage to the cartilage and patients who are active participants in sports or activities but are not limited due to their symptoms. Patients who are not active in sports or activities, unwilling to participate with rehabilitation following surgery or have widespread arthritis in joints. It is very important to ensure that a person is thoroughly evaluated and given all methods of relief to aid in the recovery of each patient. It is optimal for microfracture to be performed early after the damage to cartilage as there is a much better chance of recovery to the fullest extent.
Once a patient has been determined to be a candidate for microfracture surgery there are some things that they must know prior to the surgery. The first step in this process is be evaluated by an orthopedic surgeon who will perform routine tests during a physical examination. They will discuss the patient’s lifestyle and ability to recovery successful after surgery. The surgeon will then have the patient obtain x-rays along with an MRI to determine the extent of the injury and assess whether the damage is too severe for microfracture. If it is determined that the area of damage is greater than 4cm, there is a great chance that the patient will not be recommended for the surgery and will have to utilize other options to deal with the damaged area.
After the determination that surgery is best option for a patient they are setup for surgery. Before the patient is taken into surgery they are first prepped by the physician who is to perform the surgery. The nurse or attending physicians will check your vitals and prep the area where the surgery is being performed. Next an anthesiaologists will administer the anathesia, whether it is general or regional to the patient. After a certain time frame that will allow for the anethsia to set in the patient will be taken back to the operating room. Microfracture surgery usually takes between 60 and 90 minutes.
The first step in the procedure will be for “the surgeon who will make a 1/4-inch surgical cut (incision) on your knee” (Ogiela, D. (2012). Knee microfracture surgery. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007255.htm). Once the incision is made a thin, long device called an arthoscope will placed in the incision. This device is a camera which is attached to a video monitor in the operating room and it will be utilized by the surgeon to perform the surgery. This tool is very important because it gives the surgeon a up close view of what he is working on and will assist the surgeon in providing the best results possible. The surgeon will then make additional holes to allow the tools that he/she will be using for the surgery. There will then be a tool which is “A small pointed tool called an awl which is used to make very small holes, called microfractures (tiny breaks), in the bone near the damaged cartilage” (Ogiela, D. (2012). Knee microfracture surgery. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007255.htm). This tool will make small holes in the bones to release cells to aid in the building of new cartilage. The body will naturally build cartilage to replace the old cartilage which has been cleaned out by the surgeon.
After the surgery the patient is taken to a recovery room for an extended period of time to ensure that the anathesia will wear off and the patient will begin to function normally. This usually takes between 1-3 hours and after being cleared the patient is released to a responsible party to be transported home to begin the recovery process.
The recovery process will begin once you are at home as you will be given a machine which is used to bend and straighten the knee to aid in the buildup of cartilage. The timetable for this is about 6 weeks after surgery and for 6 to 8 hours per day. It is essential to utilize the machine for this time as you will be immobile for an extended period of time and this is very helpful in the healing process. You will be instructed to not put any weight on the knee for 6 to 8 weeks and using crutches will be your primary mode of maneuverability. Once you have completed the first 6 to 8 weeks of recovery you will then begin the rehabilitation process with physical therapy which usually take 3 to 6 months.