Steadman and colleagues described the microfracture technique for full‑thickness chondral defects, with the rehabilitation program they consider part of the treatment.
Technique and rehabilitation report from the senior author's experience in more than 1800 patients.
Methods
Indication
Full‑thickness articular cartilage defects
Approach
Arthroscopic awls perforate the subchondral bone plate
Calcified cartilage layer removed completely
Separate rehabilitation for femoral condyle and patellofemoral lesions
Key Points
Holes usually end up about 3 to 4 mm apart, placed as near each other as possible without one breaking into the next, so the subchondral plate is preserved.
Marrow elements released through the holes, including mesenchymal stem cells and growth factors, form what the authors term a super clot, which they describe as an enriched setting for new tissue.
The authors judged thorough removal of the calcified cartilage layer to be extremely important, based on their own basic science work.
Awls cause essentially no thermal necrosis of bone, the authors report, unlike hand‑driven or motorized drills.
Axial malalignment of more than 5° varus or valgus is a relative contraindication, and the weightbearing line should preferably fall in the central quarter of the tibial plateau.
The authors tell patients to expect no improvement for at least 6 months, then slow, steady gains over 2 years, based on their prior experience.
Board pearl
Fat droplets emerging from the marrow cavity signal that a microfracture hole has reached the right depth, about 2 to 4 mm.
Authors' conclusion
The rehabilitation program is crucial to optimize the results of the surgery.
Steadman and colleagues described the microfracture technique for full‑thickness chondral defects, with the rehabilitation program they consider part of the treatment.
Technique and rehabilitation report from the senior author's experience in more than 1800 patients.
Methods
Indication
Full‑thickness articular cartilage defects
Approach
Arthroscopic awls perforate the subchondral bone plate
Calcified cartilage layer removed completely
Separate rehabilitation for femoral condyle and patellofemoral lesions
Key Points
Holes usually end up about 3 to 4 mm apart, placed as near each other as possible without one breaking into the next, so the subchondral plate is preserved.
Marrow elements released through the holes, including mesenchymal stem cells and growth factors, form what the authors term a super clot, which they describe as an enriched setting for new tissue.
The authors judged thorough removal of the calcified cartilage layer to be extremely important, based on their own basic science work.
Awls cause essentially no thermal necrosis of bone, the authors report, unlike hand‑driven or motorized drills.
Axial malalignment of more than 5° varus or valgus is a relative contraindication, and the weightbearing line should preferably fall in the central quarter of the tibial plateau.
The authors tell patients to expect no improvement for at least 6 months, then slow, steady gains over 2 years, based on their prior experience.
Board pearl
Fat droplets emerging from the marrow cavity signal that a microfracture hole has reached the right depth, about 2 to 4 mm.
Authors' conclusion
The rehabilitation program is crucial to optimize the results of the surgery.