Microfracture for chondral defects of the knee

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Microfracture for chondral defects of the knee
Mr S. Kaleel, MRCS; Mr Z.Ahmad, MRCS; Mr S. Daivajna, MRCS; Mr C. Servant, FRCS
Department of Orthopaedics, Ipswich Hospital, Ipswich, Suffolk, United Kingdom.
Ipswich NHS Trust
Introduction
Chondral regeneration can occur when provided an
appropriate environment for tissue regeneration.
Microfracture of the bone releases pluripotent
mesenchymal stem cells from the subchondral bone
marrow leading to fibrocartilage formation (Steadman)
Indications for microfracture treatment(Knutsen)
–
–
–
Full thickness loss of articular cartilage
Unstable cartilage overlying sub-chondral bone
Degenerative joint disease with normal alignment
Contraindications (Knutsen):
–
–
–
–
–
–
Malalignment/Instability
Partial thickness loss
Reciprocal lesions
Patient unable or unwilling to comply with rehabilitation
Systemic Inflammatory Arthritis
Clotting disorder
Study Aim
●
5. Recovery Protocol:
PFJ Protocol:
Cyclical exercise
Brace - locked to allow 0 - 30°
FWB within brace
Strength training within range set by brace
After 8 wks, wean out of brace
Closed chain exercises
Return to full activity at 4 months
Results
Age-Tegner Score
100
73
60
40
58
63
43
Lysholm Pre op
Lysholm Post op
20
0
Tibiofemoral protocol:
•
Cyclical exercise
•
Toe-touch weight-bearing for 6-8 wks
•
Cycling – from 1 to 2 weeks
•
Deep Water Exercise – from 1 to 2 weeks
•
After 8 wks, FWB and active ROM
•
No cutting, turning or jumping for 3-4
months
Distribution of defect:
Age-Lysholm Score
80
Age < 40 (N=14) Age > 40 (N=27)
Traumatic group:
23 patients
8 patella compartment
15 femoral compartment
Age Range: 16 to 58
To evaluate the outcome of microfracture treatment for
chondral defects.
Patients and Methods

The patients were prospectively collected are those who
were diagnosed with chondral defects between 20052009
Single surgeon series: A total of 41 patients (27 Male: 14
females) with age range of 16-73 had microfracture
performed on their knees.
We collected the mechanism of injury, compartment
involved, BMI, time since injury, compartment, size of
injury, and Tegner/Lysholm Scores.
Method:
1.
2.
3.
4.
Figure 1
Degenerative Group:
18 patients
10 patella compartment
Compartment Treated:
Make curretage of area to remove unstable cartilage.
Clear subchondral bone(Fig. 1)
Bone is perforated with tapered tool 3mm in diameter
and in depth. (Fig. 2)
Resulting clot will result in fibrocartilagenous
repair.(Fig. 3)
Figure 2
8 femoral compartment
Age Range: 20-73
Conclusion:
Microfracture :
Figure 3
Distribution of BMI:
•Tegner Score stays the same in under 40 year age group.
•Lysholm improves by 30pts to 73 in younger age group.
•Lysholm improves in pts with less than BMI 30 in both tibiofemoral group and patello femoral
group.
•Gives symptom relief for chondral defects
•Is more effective in younger patients and for traumatic lesions
•References:
•Steadman 2003 Arthroscopy:
•Outcomes of Microfracture for Traumatic Chondral Defects of the Knee in under 45 year old
patients
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