This is what I had done...... Microfracture surgery 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 30–90 minutes), minimally invasive, and can have a significantly shorter recovery time than an arthroplasty (knee replacement). Background[edit] Chronic articular cartilage defects do not heal spontaneously.[3] However, acute traumatic osteochondral lesions or surgically created lesions extending into subchondral bone, e.g. by Pridie drilling,[4] spongialization[5] abrasion[6] 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.[7] 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.[8] Development[edit] The surgery was developed in the late 1980s and early 1990s by Dr. Richard Steadman of the Steadman-Hawkins clinic in Vail, Colorado. Steadman slowly refined the procedure through research (including tests on horses).[9] The surgery was soon called controversial by many sportswriters, due to a lack of studies on the long-term effects and the fact that an unsuccessful surgery could end an athletes career.[10] Dr. Steadman has also adapted the surgery into a treatment to help reattach torn ligaments (a technique he calls the healing response) Procedure[edit] The surgery is performed by arthroscopy, after the joint is cleaned of calcified cartilage. Through use of an awl, the surgeon creates tiny fractures in the subchondral bone plate.[11] Blood and bone marrow (which contains stem cells) seep out of the fractures, creating a blood clot that releases cartilage-building cells. The microfractures are treated as an injury by the body, which is why the surgery results in new, replacement cartilage.[12] The procedure is less effective in treating older patients, overweight patients, or a cartilage lesion larger than 2.5 cm.[12] Further on, chances are high that after only 1 or 2 years of the surgery symptoms start to return as the fibrocartilage wears away, forcing the patient to reengage in articular cartilage repair. The effectiveness of cartilage growth after microfracture surgery is thought to be dependent on the patients bone marrow stem cell population and some think increasing the number of stem cells increases the chances of success. A couple of physicians are promoting an alternative treatment implanting autologous mesenchymal stem cells directly into the cartilage defect, without having to penetrate the subchondral bone.[13][14][15] Microfracture Reports[edit] Studies have shown that microfracture techniques do not fill in the chondral defect fully, forming fibrocartilage rather than hyaline cartilage. Fibrocartilage is not as mechanically sound as hyaline cartilage; it is much denser and unable to withstand the demands of everyday activities as well as the original cartilage and is thus at higher risk of breaking down.[16] The blood clot is very delicate after surgery and needs to be protected. In terms of time, the clot takes about 8 weeks to 15 weeks convert to fibrous tissue and is usually fibrocartilage by about four months post surgery, holding implications for the rehabilitation.[16] Chondrocyte Implantation procedures (CCI), a cell based articular cartilage repair procedure that aims to provide complete hyaline repair tissues for articular cartilage repair, have been posed by some as an alternative to microfracture surgery. In February 2008, Saris et. al published a large-scale study claiming that CCI results in better structural repair for symptomatic cartilage defects of the knee than microfracture surgery. According to the study, one year after treatment, the tissue regenerate associated with CCI is of better quality than that of microfracture surgery.[17] Recovery[edit] One study has shown a success rate of 75 to 80 percent among patients 45 years of age or younger.[23][24] It is an outpatient procedure and causes only small discomfort. The harder part is the restrictions that are placed on the patient during the post-operative recovery period. This can be a major challenge for many patients. For optimal re-growth of joint surface, the patients need to be very patient and also extremely cooperative. They usually need to be on crutches for four to six weeks (sometimes longer). Sometimes a brace is needed. This all depends on the size and/or location of the joint surface defect that is being repaired or regenerated. The patients are encouraged to spend approximately 6–8 hours a day on a CPM (Continuous Passive Motion) machine that helps with optimal re-growth of joint surface. The procedure is so painless that some patients avoid these critically important steps and expose the knee to physical activity before the joint fully heals.
Posted on: Sun, 14 Dec 2014 17:04:35 +0000
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