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Debridement and microfracture
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Debridement and microfracture

To protect against wear and damage, joints in the body rely on lubricating tissue, known as cartilage, to allow low-friction movement between the joint bones. When this cartilage is damaged or worn down, proper joint function is impaired, and patients can suffer a great deal of pain due to the friction between the various components of the joint.

There are a number of options to repair or replace damaged cartilage, ranging from simple, non-invasive measures all the way to total joint replacement with plastic and metal components. One particular set of techniques involves taking away damaged or loose cartilage and encouraging the body to release new cartilage-building cells that can restore proper function.

This two-step process builds on two established techniques. The first, known as debridement, involves removing pieces of cartilage that are no longer functioning properly. In the second step, known as microfracture, surgical incisions are made into the bone, which ‘trick’ the body into releasing cartilage-repairing cells into the damaged space.

Microfracture is an effective tool for pain relief especially in case of smaller, well-contained lesions, or lesions with good surrounding cartilage. It can help prevent further damage to other structures in the joint and slow the development of arthritis.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about debridement and microfracture, as well as anyone interested in cartilage problems.

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Debrid Microfracture

What is debridement (cartilage shaving) and lavage?

Debridement – which can be simply thought of, as “shaving away damaged tissue” – has been an established technique for removing loose cartilage defects for a number of decades. Loose pieces of cartilage or large meniscal tears can cause a lot of pain, and this basic technique can therefore offer a short-term option to alleviate pain and treat mechanical symptoms such as locking or catching of the knee. Lavage is a procedure during which intra-articular fluid is aspirated and the joint is ‘washed out’.

However, debridement and/or lavage as sole treatment are rarely used nowadays since studies have shown that this approach will not show long lasting success.

What is microfracture?

The ultimate goal when removing damaged cartilage is to replace it with new, functioning cartilage. To achieve this, microfracture has emerged as an effective tool to kick-start the body into restoring a cartilage like material naturally in the damaged area.

Following a debridement to remove the old and damaged cartilage, an orthopaedic surgeon makes several small holes in the bone to a depth of around 2–4 mm. This causes blood and bone marrow to seep out of the fractures and create a fibrin cloth on the damaged area. This clot contains cartilage-building stem cells and other biological factors that work to form new cartilage. The new tissue that is formed after microfracture is called fibrocartilage. It might take up to a year before the fibrocartilage formation is completed.

Following surgery

It is of paramount importance that patients undergoing microfracture surgery follow a regime of physiotherapyRehabilitation programme should be designed to stimulate the bone marrow cells clotting in the holes to develop into cartilage cells.

For the first few weeks after surgery, it is likely you will be using a continuously passive motion (CPM) machine, which will move, or ‘articulate’, the joint to reduce inflammation and pain, and help promote healing and repair of the new tissue.

Weight bearing on the affected joint should be minimised for about 8 weeks following surgery, to ensure that proper function is restored.

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