Saturday, November 12, 2016

Microfracture - what can we say?

Microfracture of Articular Cartilage

A recent JBJS review (JBJS REVIEWS 2016;4(6):e6 · summarized what is known about the procedure of micro fracture in which localized defects in articular cartilage are debrided and the bone beneath punctured numerous times in the hope that new tissue will grow in to fill the defect.

They concluded: 

Microfracture is a treatment option for symptomatic, full-thickness cartilage defects.

Microfracture is most likely to be successful when performed in non obese patients under the age of thirty years for small (,2 to 4-cm2) femoral condylar defects that have been symptomatic for a short time (less than twelve to twenty-four months).

Microfracture has acceptable short-term clinical results, but results can be expected to decline over time.

Comment: It is to be emphasized that this procedure works best for small, relatively acute defects on the convex side of the joint in very young patients. In the shoulder world, we have seen many older patients in which this procedure has been applied to chronic generalized loss of articular cartilage on the glenoid (concave) side of the joint in older patients with uncertain results. There is currently a lack of evidence on the effectiveness of this application.

Even in the best of circumstances it is unclear whether the defect fills in to the extent that the tissue growing into the defect serves any load-bearing function.