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Microfracture
Articular cartilage covers the ends of bones in joints throughout the body. Normal cartilage is smooth allowing easy gliding of the joint. When the cartilage is injured, the smooth surface can become rough. On occasion, the cartilage injury exposes the underlying bone. Microfracture is a technique that can be used to treat an articular cartilage injury or defect that exposes bone. This is performed most often in the knee (it can be used in the elbow, hip, ankle and other joints as well). It is an arthroscopic procedure using a small sharp pick to create a network of holes in the bone at the base of the articular cartilage injury. These holes allow blood into the injured area to form a clot. Over time, this clot turns into organized tissue called fibrocartilage which fills in the injured area. This tissue functions similar to native cartilage to restore joint function and minimize symptoms such as pain and swelling.
The recommended rehabilitation following microfracture is a lengthy process. Depending on the location of the articular cartilage injury, patients often need to use crutches to keep all weight off the knee for 6 weeks. In some cases, patients can put weight on their knee, but must use a brace to keep the knee straight while walking for 6 weeks. The use of a machine to bend the knee (called a continuous passive motion or CPM machine) is recommended for 6-8 hours per day for 6 weeks after surgery. Return to sports is often delayed for 6 to 9 months after surgery.
Microfracture is a simple but cost effective method to treat smaller cartilage injuries. It is not usually used to treat large defects or defects with damage to the underlying bone. Like most procedures to treat articular cartilage injuries, it cannot be used to treat widespread arthritis in a joint. The tissue may not be as durable as the tissue generated by other techniques of cartilage restoration but patients do well in the short and mid-term. It is an excellent choice as an initial treatment of smaller articular cartilage injuries.