Microfractures
What is it and why?
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The removal of damaged cartilage elements that cause pain or locking through arthroscopy (key-hole surgery) through the knee.
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It is only appropriate in a small number of situations.
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Any significant symptoms from damaged meniscus (shock absorbing) cartilage may improve from this.
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Some select cases of severe isolated arthritis may also benefit from this. Usually for a young adult with a single surface injury or damage.
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This is not recommended for obtaining diagnosis or for ‘washing out’ damaged joints.
- Applicable stages 4 & 5
- Best stages 4 & 5
- Cost Low cost
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Home/self-help
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Hospital
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Daycase procedure
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Inpatient procedure
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Local anaesthetic
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General anaesthetic
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Regional block / Spina
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Pain
Can be severe
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Mobility
Crutches 6+ weeks
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Daily activities
Affected for 2+ weeks
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Driving
No - 3+ months
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Leisure activities
Affected 2+ weeks
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Light exercise
Affected 8+ weeks
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Heavy exercise
Affected 3+ months
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Light work
No more than usual
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Heavy work
Affected 3+ months
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Intimate
Affected 4+ weeks
Overview
What does it involve?
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This is done under general anaesthetic as a day-case procedure.
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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
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The procedure is performed under general anaesthesia
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You may need to use crutches and remain non-weight bearing for up to six weeks
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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
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Some physiotherapy may also be required
Benefits
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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.
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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
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These measures will not cure arthritis.
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However, they can help manage pain levels and improve activities of daily living (ADL).
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Microfracture may delay the deterioration of arthritis.
Limitations and side effects
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In the initial stages, some report exacerbation of pain, though this is usually short-lived.
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Increase activity gradually a few days after receiving the injection.
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Minor side effects include swelling, superficial infection, side effects from the anaesthetic, inflammation from where the cannula was placed or a sore throat.
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The procedure may not work, and expectations may not be met.
Risks
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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.
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Some of the complications will need further treatment that may include surgery.
Cost
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There are significant costs for both the patient and the NHS.
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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.
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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?
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Arthritis will continue to deteriorate.
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Symptoms will get worse; sometimes rapidly.
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Will have a negative influence on other management options, e.g. surgery, in the future.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297050/ (rehabilitation after microfracture)
https://www.thesteadmanclinic.com/patient-education/knee/microfracture-technique
http://journals.sagepub.com/doi/full/10.1177/2325967117753572 (mid-term outcome after microfracture)
https://orthoinfo.aaos.org/en/treatment/articular-cartilage-restoration/ (all cartilage replenishment treatment)
https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/ (degenerate meniscal tear)