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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.

Figures

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.

What are the advantages and disadvantages of Debridement and microfracture?

What are the advantages of Debridement and microfracture?

Formation of new cartilage following microfracture offers effective pain relief for patients previously suffering from damaged or loose cartilage in their joints.

Two-thirds of patients are expected to show positive results up to 5 years following surgery, and they can typically return to an active lifestyle. It is also a very useful intermediate option, ‘buying’ a few more years of restored function and lifestyle for older patients who will eventually need a total joint replacement.

What are the disadvantages of Debridement and microfracture?

Successful bone and cartilage regrowth following microfracture depends on the individual’s own bone marrow and stem cell viability, and older or overweight patients, in general, show poorer results. In addition, microfracture is only suitable for small damaged areas (no more than 2 cm2 in area). Larger areas of treatment are likely to have poorer outcomes.

The clinical results of this technique are inconsistent. Cartilage derived from microfracture, is predominantly ‘fibrocartilage‘. Unfortunately, this repair tissue does not have the durability of ‘hyaline cartilage‘, which is found naturally in the joints.

In order to enhance cartilage regeneration after microfracture and stabilise the defect site, newer techniques have been developed. For example, resorbable scaffolds can be used to cover the damaged area after microfracture.

Microfracture is also often compared to autologous chondrocyte implantation (ACI) – a therapy in which cartilage cells are harvested from an healthy area of the joint, expanded in lab and re-introduced into the joint to repair damaged cartilage. The main difference is the type of cartilage these procedures help to restore. ACI produces a much higher amount of hyaline cartilage than microfracture.

Frequently Asked Questions (FAQs)

Should I try microfracture before autologous chondrocyte implantation (ACI)?

ACI can be less effective if the patient has already undergone microfracture. Speak to your orthopaedic surgeon to discuss an appropriate ongoing plan for your needs.

Will I get worse after having microfracture surgery?

There should be no additional pain following microfracture surgery. Generally, there will be some improvement in pain levels for all patients. However, it is important to remember that microfracture carries with it the usual risks associated with any surgery (infection, anaesthesia complications, etc.) although these complications are extremely rare.

What are my chances of improvement?

Two-thirds of patients are expected to improve when using basic rehabilitation techniques. However, this is based on your individual pathology that is causing you pain and discomfort.

To protect against wear…
ICRShttps://cartilage.org/content/uploads/icrs.jpg
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