Here's the third installment in my series on treatments for cartiage issues in Masters athletes. In this installment, I explore "microfracture."
Well Masters athletes, when conservative measures do not relieve the pain and swelling of damaged knee cartilage, there are several techniques for cartilage repair. The important factor to remember, however, is that cartilage is inherently avascular (it has basically no blood supply), and blood is vital for repair of any tissue. When it comes to cartilage you are essentially born with what you are going to have for the rest of your life. The type of cartilage you are born with is called “hyaline cartilage.”
One method for filling in lost cartilage is called “microfracture.” When this technique is successful the “hole” in your cartilage is replaced with “scar cartilage.” This type of cartilage is called “fibrocartilage.” Fibrocartilage fills in the gap in your native knee surface, but the material you grow is not as biomechanically sound as your original cartilage.
The microfracture technique essentially uses your body’s own blood stem cells (cells that can become any cell) to grow the scar cartilage. The stem cells get to the hole in your cartilage through small holes your surgeon makes (microfracture) in the bone underlying the bad spot in your cartilage.
Microfracture is normally performed by first examining your knee with an arthroscope (camera).The area of cartilage loss is prepared with special instruments called curettes in order to make the side of the hole straight up and down like a canyon. An awl is then used to make several small holes in the bone to allow the bone marrow containing stem cells to fill the canyon. This bone marrow forms a clot and over the next 6 months will become scar cartilage.
This procedure is appropriate for small holes (smaller than 2 centimeters) in cartilage and works best for younger people. If the procedure works, 80 percent of patients report good to excellent results even 11 years out. If the procedure does not work, it does not burn any bridges for future cartilage procedures.
Tags: Treatment Osteoarthritis
