What Is Involved in Microfracture Rehabilitation?

Microfracture surgery is a technique commonly used to repair knee cartilage damage. The doctor uses an articular lens to remove the damaged cartilage, and then drills a few holes in the bone to make the bone marrow cells and blood coagulate to become a smooth and solid repair tissue instead of the cartilage. The microfracture method is simple and easy to operate. It is a safe and effective method for treating full-thickness cartilage injury of the knee joint, whether it is acute or chronic cartilage injury. Both can significantly improve the joint function of patients, reduce pain symptoms, and improve quality of life.

Microfracture surgery

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Microfracture surgery is a technique commonly used to repair knee cartilage damage. The doctor uses an articular lens to remove the damaged cartilage, and then drills a few holes in the bone to make the bone marrow cells and blood coagulate to become a smooth and solid repair tissue instead of the cartilage. The microfracture method is simple and easy to operate. It is a safe and effective method for treating full-thickness cartilage injury of the knee joint, whether it is acute or chronic cartilage injury. Both can significantly improve the joint function of patients, reduce pain symptoms, and improve quality of life.

Chinese name

Microfracture surgery

Chronic cartilage damage cannot repair itself. However, due to severe trauma or skeletal cartilage damage caused by some surgery, since the bone can be deep down to the cartilage, the multifunctional mesenchymal stem cells of human bone marrow can leak out from the injury, which may generate fibrous tissue and fibrocartilage. Or alternative tissue composed of hyaline cartilage to repair damage. This type of surgery includes, for example, Priedie drilling, spongialization, abrasion, or microfracture surgery.

Human skeletal cartilage is hyaline cartilage, so microfractures cannot really repair the damaged cartilage itself, but only provide a substitute with similar properties.

Microfracture surgery is a minimally invasive surgery using arthroscope. Through arthroscopy, the doctor first removes the calcified cartilage in the joint, and then drills a small hole in the bone below the cartilage at the place where the cartilage is defective, so that part of the bone marrow and blood leak out of the hole to form a blood clot. This blood clot contains stem cells from which cartilage-forming cells can differentiate. The human body itself treats the microfracture as a physical injury, so surgery can provide patients with new alternative cartilage.

Blood clots produced after surgery are very fragile and need to be carefully protected. After about 8 to 15 weeks, the clot will turn into fibrous tissue, which will usually turn into fibrocartilage four months after surgery, and the rehabilitation process can begin.

Current research shows that for patients aged 45 years or younger, the success rate of microfracture surgery is about 75% to 80%, even among professional athletes. With the help of physical therapy, patients can usually return to the arena (or engage in other strenuous exercise) after 4 months. However, this is only the best condition. Whether it can be achieved depends on the degree of cartilage damage and the condition of the joints.

Microfracture surgery itself is a relatively small operation that does not require hospitalization and will only cause minor discomfort. The really difficult part is the limitations that patients face in the recovery process after surgery. This is the biggest challenge for many patients. To get the best conditions for re-growth of the cartilage surface, the patient needs to be very patient and cooperative. They often need to abduct for 4-6 weeks or even longer; sometimes they need to wear fixed protective gear, depending on the condition of the injury. Patients preferably have a CPM (Continuous Passive Motion) machine for 6-8 hours a day to help cartilage growth.

Dr Richard Steadman, the main contributor to this surgery, believes that the natural structure of the joints and patients' strict adherence to "rehabilitation discipline" have similar effects on rehabilitation.

The quality of the alternative tissue generated by microfracture surgery depends on a variety of factors, including race, age, size and location of cartilage damage, and surgical techniques-including how the skeletal platform under the cartilage is treated, and rehabilitation after surgery Plan and more.

This procedure is less effective for older patients, overweight patients, and patients with cartilage defects greater than 2.5 cm. In addition, there is a higher risk that after 1 to 2 years after surgery, as fibrocartilage wears out, symptoms will recur, forcing patients to undergo articular cartilage repair again. This does not always happen, but microfracture surgery is considered to be a transitional method.

Studies have shown that microfracture techniques cannot completely fill cartilage damage, because fibrocartilage is generated instead of hyaline cartilage. The mechanical strength of fibrocartilage is not as high as that of hyaline cartilage, and it is denser than hyaline cartilage, so it is more easily broken than hyaline cartilage under the pressure of repeated daily activities.

alternative plan

Since the cartilage growth after microfracture surgery is theoretically determined by the number of stem cells in the patient's bone marrow, some people believe that increasing the number of stem cells can increase the chance of successful surgery. Some doctors are investigating alternative treatments by transplanting autologous mesenchymal stem cells into damaged cartilage to avoid the need to damage the bone under the cartilage.

A cell technology-based articular cartilage repair treatment called CCI (Chondrocyte Implantation procedures) seeks to provide complete hyaline cartilage tissue for repairing cartilage. In February 2008, a paper published by CCI researchers claimed that this method could provide better structural repair for knee cartilage damage. According to the paper, one year after treatment, the tissue produced under this treatment is of better quality than microfracture surgery.