THE MICROFRACTURE TECHNIQUE FOR ARTICULAR CARTILAGE LESIONS

THE MICROFRACTURE TECHNIQUE FOR ARTICULAR CARTILAGE LESIONS

 

Tsoukas Dimitrios, MD

Director Orthopaedic Clinic Athens Euroclinic

Director Minimally Invasive Orthopaedic and Sports Medicine Surgery Center MIOSMED Center

 

 

            Full thickness articular cartilage lesions of the knee are among the important problems in current orthopaedic surgery.  Cartilage lesions can be managed with a wide spectrum of treatment modalities.  Articular repair procedures such as abrasion chondroplasty microfracturing and articular reconstructive procedures with autologous chondrocyle implantation and mosaicplasty have been preferred.

When:

·       Defects ≤ 2-2,5cm2

·       Stable knee normally aligned

·       Less than 60 years old

Technique:

The rehabilitation program after microfracture is crucial to optimize the success of the technique.  For chondral defects on the femur or tibia the patient is started on a continuous passive motion machine almost immediately.  In a range of motion of 300 to 700 for 6 hours per day and this is increased as tolerated by 100 to 200 until full range of motion is obtained.  Partial weight bearing 20%-30% of their body weight for 6-8 weeks.  Return to sports after 4-6 months (protocol according to Richard Steadman).

·       Second look arthroscopyand biopsy materials: healing tissue was of intermediate histologic structure between laginous fibrocarti and hyaline cartilage tissue.

·       Best functional results:

Ø     Age younger than 35 years

Ø     size of defect ≤2cm2

Ø     BMI ≤ 25kgr/m2

Ø     surgery as soon as possible (within 12 months)

Ø     lesions on the femoral condyles

The microfracture technique is appropriate in patients performing high-level activities

There are reports of microfracture being used in the shoulder, hip and ankle.  The long term effectiveness of the technique in these joints is unknown.

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