Microfracture Knee Procedures Improve Activity Outcomes

Surgical treatment using microfractures for knee injury repair helps pediatric patients regain function and return to normal activity levels following surgery and rehabilitation.

Researchers at the Steadman Philippon Research Institute (SPRI; Vail, CO, USA) studied 26 patients aged 18 years old and younger who had full-thickness articular cartilage surgery with microfracture between 1992 and 2008. They prospectively collected surgical and outcome data for these patients, working with a minimum two-year follow-up. All patients were diagnosed with a standard knee arthroscopy procedure and then treated with microfracture holes placed three to four millimeters in depth. The patients were evaluated for knee function, including limp, support, stair climbing, squatting, instability, swelling, pain, and locking.

The researchers examined the 21 patients--with an average follow-up time of 5.2 years after surgery--for whom they had data. In all, 11 microfractures were performed in the patellar compartment, 9 were in the lateral femoral condyle, 8 were in the medial femoral condyle, and 1 was in the trochlear groove. The mean Lysholm score was 90 (range of 50-100 points), with a mean Tegner activity level of six (range of 2-10 points) and an average patient satisfaction of nine (range of 1-10 points). There were no complications or injury to the physis. The study was presented at the American Orthopedic Society for Sports Medicine's specialty day, held during February 2011 in San Diego (CA, USA).

"This is a good first step in learning about the overall outcome of this procedure on pediatric patients,” said lead author Richard Steadman, MD, founder of the SPRI. "While we have limited data on this specific population, we have seen this procedure be effective in young athletes, who share similarly active lifestyles. This study confirms what we have already seen in this group.”

Microfracture is an articular cartilage repair technique that works by creating tiny fractures in the underlying bone. The surgery is performed by arthroscopy, after the joint is cleaned of calcified cartilage. Through use of an awl, the surgeon creates tiny fractures in the subchondral bone plate; blood and bone marrow seep out of the fractures, creating a blood super-clot that releases cartilage-building cells. The surgery is quick--taking as short as 30 minutes but sometimes lasting as long as 90 minutes--minimally invasive, and can have a significantly shorter recovery time than an arthroplasty.

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Steadman Philippon Research Institute