ΕλληνικάTHE 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:
- Full thickness defect in a weight bearing area of the knee (grade IV) according to the Outerbridge classification
· Defects ≤ 2-2,5cm2
· Stable knee normally aligned
· Less than 60 years old
Technique:
- Arthroscopic debridement with curette and shaver until steep and intact surrounding cartilaginous tissue was obtained
- With microfracture awls creation of holes started from the periphery of the lesion to the center, 3-4mm in depth at 3 to 4 mm intervals. Bone marrow cells and blood from the holes combine to form a “super clot” that adheres to the rough bone surface that the microfracture technique produces. Loosening of tourniquet and the irrigation pump pressure is reduced.
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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Recent Articles
Acute Lateral Ankle Sprains In Track & Field Athletes: A Proposal Of An Expanded Classification
We present a longitudinal observational study on classification of acute lateral ankle ligament injuries in track & field athletes, based on objective criteria. These very common and sometimes troublesome sports injuries are treated functionally but there is a lack in international literature in predicting the time needed for full recovery.
Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes
Objective: To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively.
Design: We reviewed high level athletes with an anterior cruciate ligament rupture on either MRI or arthroscopic evaluation more than 10 years previously, who were treated conservatively. They were pair-matched with patients who had had an anterior cruciate ligament reconstruction with bone-patella-tendon-bone, with respect to age, gender and Tegner activity score before injury.Participants: In total 50 patients were pair-matched.
Results: We found no statistical difference between the patients treated conservatively or operatively with respect to osteoarthritis or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.
Conclusion: We conclude that the instability repair using
a bone-patella-tendon-bone anterior cruciate ligament reconstruction is a good knee stabilising operation. Both treatment options however show similar patient outcome at 10 year follow up.
ACL injuries. Diagnosis, treatment and rehabilitation
The ability to recognize the ACL deficient knee is lacking, even among orthopaedic surgeons. The history of an acute ACL tear is remarkably constant, because the injury is often non contact, and patients usually report a twist on the flexed knee, turning to the same side as the injured knee, although hyperextension or direct injury is the cause in some sports. Patients often remember a loud pop, but, because there are no nociceptors in the ACL, pain is not an immediate feature in the isolated lesion. Players may attempt to continue to play, but they usually stop because the knee feels insecure. Pain ensues in association with a hemarthrosis: 70% of acute hemarthroses of the knee are associated with a tear of the ACL. The diagnosis must be confirmed before treatment is offered.
