Microfracture Technique Can Help Athletes with Arthritis Avoid Knee Replacement

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Microfracture Technique Can Help Athletes with Arthritis Avoid Knee Replacement
Sports orthopaedic expert discusses fast, minimally invasive procedure to restore knee function

NY, NY and Greenwich, CT, November 2007 In discussing treatment options for a knee that’s been worn out from the rigors of an active lifestyle, the suggestion of placing small holes into the joint to help it heal might seem like adding insult to injury. Yet, just such a procedure called Microfracture is gaining in popularity as a safe, effective and less painful alternative to arthroscopic knee replacement surgery.

Microfracture has become more prevalent over the past several years, because it offers patients a speedy, minimally invasive surgical experience, a faster and more comfortable recovery than that of knee replacement surgery, and a substantial success rate of about 85%, explains Dr. Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area and an official orthopaedic surgeon for the U.S. Ski & Snowboard teams.

The Microfracture procedure involves using a pointed awl to poke small holes in the bones of the joint where the cartilage has been worn away. Blood and bone marrow, rich with stem-cells, seep out of the fractures and create blood clots that release cartilage-building cells. The body’s normal immune response to what it perceives as an injury completes the task of rebuilding the cartilage in the treated area. The procedure takes about 30 minutes, and the entire healing and rehabilitative process takes approximately four to six months.

Microfracture was developed nearly 20 years ago by Dr. Richard Steadman, MD, of the Steadman-Hawkins Clinic in Vail, Colorado. After an 11-year followup study published in the June, 2003 issue of the journal Arthroscopy, Dr. Steadman and his colleagues proved that Microfracture was as safe and effective as other treatments, even over the long term.

This procedure is ideal for younger patients who are very active, and wish to return to their sport or activity as quickly as possible, Dr. Plancher notes. He adds, The best candidates for Microfracture are those patients whose cartilage degeneration is limited to small areas in the knee, and who are willing to commit to a fairly rigorous physical therapy regimen afterward in order to restore full functioning in the joint.

For these reasons, many of the patients who choose Microfracture as an alternative to knee replacement surgery are professional athletes. Dr. Plancher points out, Players in the National Football League, the National Basketball Association and the National Hockey League have undergone high-profile Microfracture procedures over the past several years, and many of them “such as Jason Kidd of the New Jersey Nets and Steve Yzerman of the Detroit Red Wings” have returned to play at or near their peak performance levels. As recently as last year, Amare Stoudemeyer a star player with the Phoenix Suns who underwent Microfracture in 2005 was able to return to the court and perform to his stellar standard of play in all 87 regular season games, as well as in the NBA All-Star Game.

The rehabilitation process for Microfracture usually takes one half to one third of the time that a surgical knee-replacement procedure does, but it begins as soon as the procedure is completed. Depending upon the location and the size of the area being treated, passive range-of-motion exercises might be initiated the same day as the treatment or a day later, Dr. Plancher notes, Because gentle motion will actually stimulate the development of the cartilage. The motion exercises might be done by the patient, a physical therapist, or with the use of a passive motion machine. In fact, some patients use the CPM machine nightly during sleep to speed the cartilage-building process. Weight-bearing, however, is usually limited for 6 weeks after the procedure, as pressure on the joint could harm the regenerating cartilage.

In all, Microfracture is an excellent choice for relatively young, active patients with specific areas of cartilage degeneration in the knee, because it allows them to return to play “at whatever level” confidently and more quickly than the alternatives, Dr. Plancher concludes. Microfracture is currently being considered for its applicability to other joints as well, including the shoulder, hip and the ankle, at and the OFALS clinical studies are underway.

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