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Microfracture not perfect, but results can be maximized

Issue: February 2015

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KOLOA, Hawaii — There will always be a place for microfracture, even though it is not currently the best technique to repair articular cartilage, according to a speaker here.

“Microfracture, in my view, will always be with us to some extent,” Jason L. Dragoo, MD, said at Orthopedics Today Hawaii 2015.

Microfracture is the only resurfacing treatment that reliably gets athletes back the next season, according to Dragoo.

“For those of us who take care of elite athletes, the clock is always ticking,” he said.

Jason L. Dragoo

Another reason to use microfracture, he said, is because patients have surgically identified defects, but surgeons are unprepared for other treatments. However, microfracture is always available.

Dragoo said microfracture is not perfect, but orthopedic surgeons can maximize results if they use the procedure.

“These results may improve with optimizing our current techniques, as well as optimizing our rehab,” he said.

Traditional factors, such as the treatment of lesions smaller than 2 cm²; anatomic alignment; contained lesions only; age less than 50 years, with less than 30 years ideal; and BMI less than 30, maximize the results of microfracture. Evaluation of the subchondral bone will maximize results, as worse outcomes are associated with marrow edema and bone loss. Subchondral bone also should be evaluated, as areas of marrow edema have abnormal perfusion.

Microfracture technique can be updated to remove cartilage at the base, make walls vertical or stable, and remove calcified cartilage layer. Keeping holes 3 mm to 4 mm apart helps, as well as not allowing collapse of bone between holes.

Dragoo said a depth of 6 mm is preferable, as is the use of more hyaline-like cartilage, greater overall fill and evaluation of the pick length. He also advised to be careful with early weight-bearing, and to avoid kissing lesions. – by Kristine Houck, MA, ELS

Reference:

Dragoo JL. Microfracture is good in selected cases. Presented at: Orthopedics Today Hawaii 2015; Jan. 18-22, 2015; Koloa, Hawaii.