synonyms: Microfracture, mosiacplasty, osteoarticular autograft transfer
- 29879 Knee arthroscopy with osteochondral autograft
- Limb malalignment
- Arthritic changes
Microfracture Planning / Special Considerations
- Associated malalignment must be corrected before any cartilage restoration procedure. Most isolated lesions involve the MFC and can be associated with varus alignment. Concomitant HTOis indicated.
- Arthrosurface Nanofracture(NanoFx)
- Perform diagnostic knee arthroscopy.
- accurate débridement of all unstable and damaged cartilage in the lesion, including the calcified layer down to the subchondral bone plate. Removal of calcified cartilage layer greatly increases the percentage of defect fill.
- All loose or marginally attached cartilage débrided from the surrounding rim of the defect, to form a stable perpendicular edge of healthy cartilage.
- An arthroscopic awl used to make multiple holes in the defect, 3 to 4 mm apart starting at the periphery of the lesion. Holes must not be so close to each other that they could break into one another.
- Tourniquet deflated / pump pressure reduced to visualize blood, fat droplets / marrow elements coming from the holes.
- Continued symptoms
Microfracture Follow-up care
- Post-op: 6hrs/day CPM, NWB x6wks unless lesion treated was patellofemoral. Postoperative continuous passive motion (CPM) and protected weight bearing for 6 to 8 weeks has similar clinical outcome to early weight bearing and no CPM (Marder RA, Arthroscopy 2005;21:152).
- 7-10 Days: Wound check, continue CPM, NWB
- 6 Weeks: Discontinue CPM, advance to full weight bearing
- 3 Months: Resume all normal ADLs.
- 6 Months: Gradually begin running / sport specific rehab.
- 1Yr: Return to sport / full duty.
- Results similar to autologous chondrocyte implantation at 2 yr f/u. (Gunnar JBJS. 2004; 86A: 455-464)
Microfracture Review References
- (Steadman JR, J Knee Surg. 2002;15:170-6), (Mithoefer K, JBJS 2005;87A:1911). °