Microfractures

Steroid Injection Osteotomy

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Microfractures info graphic

What is it and why?

  • The removal of damaged cartilage elements that cause pain or locking through arthroscopy (key-hole surgery) through the knee.

  • It is only appropriate in a small number of situations.

  • Any significant symptoms from damaged meniscus (shock absorbing) cartilage may improve from this.

  • Some select cases of severe isolated arthritis may also benefit from this. Usually for a young adult with a single surface injury or damage.

  • This is not recommended for obtaining diagnosis or for ‘washing out’ damaged joints.

  1. What does it involve?
  2. Effort/burden
  3. Benefits
  4. Chances of cure
  5. Limitations and side effects
  6. Risks
  7. Cost
  8. What if no treatment is done?
  • Applicable stages 4 & 5
  • Best stages 4 & 5
  • Cost Low cost
  • Treatment does not involve Home/self-help
    Home/self-help
  • Treatment involves Hospital
    Hospital
  • Treatment involves Daycase procedure
    Daycase procedure
  • Treatment does not involve Inpatient procedure
    Inpatient procedure
  • Treatment does not involve Local anaesthetic
    Local anaesthetic
  • Treatment involves General anaesthetic
    General anaesthetic
  • Treatment does not involve Regional block / Spina
    Regional block / Spina
  • Pain
    Pain

    Can be severe

  • Mobility
    Mobility

    Crutches 6+ weeks

  • Daily activities
    Daily activities

    Affected for 2+ weeks

  • Driving
    Driving

    No - 3+ months

  • Leisure activities
    Leisure activities

    Affected 2+ weeks

  • Light exercise
    Light exercise

    Affected 8+ weeks

  • Heavy exercise
    Heavy exercise

    Affected 3+ months

  • Light work
    Light work

    No more than usual

  • Heavy work
    Heavy work

    Affected 3+ months

  • Intimate
    Intimate

    Affected 4+ weeks

Overview

What does it involve?

  • This is done under general anaesthetic as a day-case procedure.

  • Making small holes in the bone (microfracture) may be done for small areas of isolated complete cartilage loss with an aim to stimulate fibro-cartilage growth.

Effort/burden

  • The procedure is performed under general anaesthesia

  • You may need to use crutches and remain non-weight bearing for up to six weeks

  • Patients must consider time away from work, difficulty in various daily activities and child-care related issues. You will not be able to drive a car for several weeks

  • Some physiotherapy may also be required

Benefits

  • There is poor to fair evidence to confirm that performing a partial meniscectomy improves locking episodes. It will not cure arthritis and does not work for degenerative tears.

  • Patients who have microfracture, especially on the thigh bone (femoral side) have a significant improvement for up to 5 to 7 years.

Chances of cure

  • These measures will not cure arthritis.

  • However, they can help manage pain levels and improve activities of daily living (ADL).

  • Microfracture may delay the deterioration of arthritis.

Limitations and side effects

  • In the initial stages, some report exacerbation of pain, though this is usually short-lived.

  • Increase activity gradually a few days after receiving the injection.

  • Minor side effects include swelling, superficial infection,  side effects from the anaesthetic, inflammation from where the cannula was placed or a sore throat.

  • The procedure may not work, and expectations may not be met.

Risks

  • Specific risks include infection, bleeding into the joint, deep vein thrombosis (DVT), pulmonary embolus (PE), persistent pain, complex pain syndrome, swelling at the incision site, anterior knee pain.

  • Some of the complications will need further treatment that may include surgery.

Cost

  • There are significant costs for both the patient and the NHS.

  • Patient: You will need to take time off work, require help during initial stages and visit the hospital, GP surgery and physiotherapist, which may cost in taxis and parking.

  • NHS: Generally a moderately expensive option. However, the cost of treatment, if there’s a complication, will also add to the expense.

What if no treatment is done?

  • Arthritis will continue to deteriorate.

  • Symptoms will get worse; sometimes rapidly.

  • Will have a negative influence on other management options, e.g. surgery, in the future.

References

Steroid Injection Osteotomy