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Knee microfracture surgery

  • Definition
    • Knee microfracture surgery is a common procedure used to repair damaged knee cartilage. Cartilage helps cushion and cover the area where bones meet in the joints.

  • Alternative Names
    • Cartilage regeneration - knee

  • Description
    • Three types of anesthesia may be used for knee arthroscopy surgery:

      The surgeon will perform the following steps:

      • Make a one quarter-inch (6 mm) surgical cut on your knee.
      • Place a long, thin tube with a camera on the end through this cut. This is called an arthroscope. The camera is attached to a video monitor in the operating room. This tool lets the surgeon look inside your knee area and work on the joint.
      • Make another cut and passes tools through this opening. A small pointed tool called an awl is used to make very small holes in the bone near the damaged cartilage. These are called microfractures.

      These holes release cells from your bone marrow that can build new cartilage to replace the damaged tissue.

  • Why the Procedure Is Performed
    • You may need this procedure if you have damage to the cartilage:

      • In the knee joint
      • Under the kneecap

      The goal of this surgery is to prevent or slow further damage to the cartilage. This will help prevent knee arthritis. It can help you avoid the need for a partial or total knee replacement.

      This procedure is also used to treat knee pain due to cartilage injuries.

      A surgery called autologous chondrocyte implantation or mosaicplasty can also be done for similar problems.

  • Risks
    • Risks of anesthesia and surgery in general are:

      Risks for microfracture surgery are:

      • Cartilage breakdown over time. The new cartilage made by microfracture surgery is not as strong as the body's original cartilage. It can break down more easily.
      • Increased stiffness of the knee.
  • Before the Procedure
    • Always tell your health care provider what drugs you are taking, including medicines, herbs, or supplements you bought without a prescription.

      During the 2 weeks before your surgery:

      • Prepare your home.
      • You may need to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and others.
      • Ask your provider which drugs you should still take on the day of your surgery.
      • If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see the provider who treats you for these conditions.
      • Tell your provider if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
      • If you smoke, try to stop. Ask your provider for help. Smoking can slow down wound and bone healing.
      • Always let your provider know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

      On the day of your surgery:

      • You may be asked not to drink or eat anything for 6 to 12 hours before the procedure.
      • Take the drugs your doctor told you to take with a small sip of water.
      • Your doctor or nurse will tell you when to arrive at the hospital.
  • After the Procedure
    • Physical therapy may begin in the recovery room right after your surgery. You will also need to use a machine, called a CPM machine. This machine will gently exercise your leg for 6 to 8 hours a day for several weeks. This machine is most often used for 6 weeks after surgery. Ask your provider how long you will use it.

      Your doctor will increase the exercises you do over time until you can fully move your knee again. The exercises may make the new cartilage heal better.

      You will need to keep your weight off your knee for 6 to 8 weeks unless told otherwise. You will need crutches to get around. Keeping the weight off the knee helps the new cartilage grow.

      You will need to go to physical therapy and do exercises at home for 3 to 6 months after surgery.

  • Outlook (Prognosis)
    • Many people do well after this surgery. Recovery time can be slow. Many people can go back to sports or other intense activities in about 4 to 6 months. Athletes in very intense sports may not be able to return to their former level.

      People under age 40 with a recent injury often have the best results. People that are not overweight also have better results.

  • References
    • Basad E, Ishaque B, Bachmann G, Stuarz H, Steinmeyer J. Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):519-27. PMID: 20062969.

      Hurst JM, Steadman JR, O'Brien L, Rodkey WG, Briggs KK. Rehabilitation following microfracture for chondral injury in the knee. Clin Sports Med. 2010 Apr;29(2):257-65, viii. PMID: 20226318.

      McCoy BW, Hussain WM, Griesser MJ, Parker RD. Patellofemoral pain. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 105.

      Miller RH, Azar FM. Knee injuries. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 45.

      OrthoInfo: articular cartilage restoration. American Association of Orthopedic Surgeons. February 2009. Accessed May 10, 2016.

      Saris DB, Vanlauwe J, Victor J, et al; TIG/ACT/01/2000&EXT Study Group. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med. 2009 Nov;37 Suppl 1:10S-19S. PMID: 19846694.

      Vanlauwe J, Saris DB, Victor J, Almgvist KF, Bellemans J, Luyten FP. Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. Am J Sports Med. 2011 Dec;39(12):2566-74. PMID: 21908720.