Microfracture

This surgery is typically recommended for patients with small, isolated areas of cartilage damage or degeneration in the knee. It’s most effective for younger patients who are active, as their bodies are generally better at healing and regenerating tissue. Knee microfracture is not usually recommended for patients with widespread cartilage damage, such as those with advanced osteoarthritis, or much larger isolated lesions.

You’ll be given either general anesthesia or a nerve block to numb the leg so you don’t feel the surgery. The procedure is performed arthroscopically, using a few small incisions and specialized instruments. An arthroscope (a small camera) is inserted into your knee through one of the incisions which provides a clear view of the inside of the knee joint. The damaged area of cartilage is identified, and any loose or unstable fragments are removed. Then, a small, sharp tool is used to create tiny holes (microfractures) in the bone beneath the damaged cartilage. This process stimulates the release of bone marrow cells into the area.

Recovery timelines vary, but you may need to use crutches and limit weight-bearing activities for 6-8 weeks after surgery to allow the fibrocartilage to develop. Typically, patients can return to light activity or desk jobs within 3 months, while full recovery and return to sports can take 4-6 months or longer.

After surgery, you’ll be monitored in the recovery room as the anesthesia wears off and you can go home. Your knee may be swollen, and you’ll likely be wearing a knee brace. You will be able to walk with crutches so you don’t put any weight on your leg. You will have some discomfort after surgery, but pain medication will be prescribed to manage discomfort.

Physical therapy is crucial for recovery and often begins shortly after surgery. During the initial stage, the emphasis is on managing swelling and pain, as well as maintaining the range of motion in your knee. In the second stage, the focus shifts to strengthening exercises and gradually increasing weight-bearing activities. Finally, a gradual return to full weight-bearing, normal daily activities, and eventually, sport-specific training. This entire process could take up to 4-6 months until you are ready to resume these activities.

Potential risks associated with knee microfracture surgery, while rare, can include:

• Infection: This occurs in a small percentage of cases and can usually be treated with antibiotics. Antibiotics are given to you during surgery to minimize this risk.
• Blood clots: There’s a small risk of developing a blood clot in the leg veins (deep vein thrombosis). You will take an aspirin daily to help prevent blood clots
• Failure to relieve symptoms: Some patients may not experience significant relief from pain or improvement in knee function. Which could need another cartilage procedure down the line.
• Damage to surrounding structures: There is a small risk of injury to nearby nerves, blood vessels, or cartilage. This is very rare for this surgery.

If knee microfracture surgery is recommended and not pursued, the damaged area of cartilage may continue to cause pain, swelling, and limited mobility. Over time, the unstable cartilage may lead to further damage in the knee joint, potentially resulting in osteoarthritis.