Microfracture in decline?

[Mainstreet]

I found this story in the Chicago Tribune about the apparent decline of microfracture. I thought it was interesting because the procedure involves current and past NBA players particularly Amare Stoudemire.

It's best to read the whole article but here are some excerpts.

Now, many doctors are trending away from the surgery. According to data kept by the sports medicine and analytics research team (SMART), 14 players had microfracture surgery between 2003 and 2010, including Stoudemire. For many of the players who underwent microfracture surgery, the procedure hastened the end of their career. Penny Hardaway, Chris Webber, Allan Houston and Ron Harper were never the same. Since 2010, only five players have had it.

A 2018 study found that the failure rate of microfracture surgery was 66 percent, compared with 51 percent in patients that had OAT surgery — a procedure in which cartilage is transplanted from a cadaver or another joint in the body. The study defined failure as scoring less than 65 on the Lysholm scale, which measures a patient’s pain, instability, locking, swelling, limp, stair climbing and squatting. This was one of the first studies to compare the two procedures.

“The problem is, initial results were good, but when you start to carry those results out further, the results deteriorated,” Douoguih said. “The player might be able to play at the one-year or two-year mark, but then at the four-year or five-year mark, things went downhill. And you took a closer look and found that yeah, those players were able to play — they were on the court — but maybe their numbers weren’t quite what they were before. And there were some cases where the player didn’t get back to play.”

While Amare had some success after microfracture, he stresses how difficult it is to recover.

While Stoudemire says he doesn’t harbor anger about his microfracture, he regrets getting the surgery and advises young players who call him asking for advice to avoid it.

“I get calls all the time from players who are recommended (to have) the microfracture,” Stoudemire said. “I just tell them, ‘Listen, man, I was able to bounce back from it, but not everyone can. It’s an excruciating recovery.’ I told the same thing to Chandler Parsons when he was in Dallas. Getting the microfracture is one thing, but the recovery is another. It takes dedication, focus and a lot of perseverance to get over that hump.”

http://www.chicagotribune.com/sport...surgery-amare-stoudemire-20180706-story.html#

 

[GatorAZ]

Interesting to hear Amare talk about the recovery. In Jack McCallum’s book he said Amare didn’t take his rehab very seriously during the 05-06’ season. I remember him coming back for a few games that year. He played great in his first game and everyone was encouraged but he fell off and they eventually shut him down. Micro-fracture and achilles are devastating injuries for athletes.

 

[Mainstreet]

Interesting to hear Amare talk about the recovery. In Jack McCallum’s book he said Amare didn’t take his rehab very seriously during the 05-06’ season. I remember him coming back for a few games that year. He played great in his first game and everyone was encouraged but he fell off and they eventually shut him down. Micro-fracture and achilles are devastating injuries for athletes.

Agreed these injuries are devastating. It was interesting Amare viewed his outcome a success... “And I was one of the only success stories.”

I found the story while following Marc Stein on twitter.

The article was written by Malika Andrews.

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[Hoop Head]

I thought we didn't hear about microfracture surgeries happening nearly as often and it seems like it wasn't a case of not hearing about them so much as they're not happening as often. Everyone is different but it seems like there aren't many successful cases of players recovering close to 100% or where they were before the surgery.

I know Patrick Beverly had it recently and that's one of the reasons some are against trying to acquire him. He hasn't shown he can play at a high level since he had it so it would be a risk to acquire him, especially now that he's over 30.

Amare had it at a time when he was still developing his game and that basically halted his development and capped it off. He became what he was, no better but also not necessarily worse. He got a little smarter but he almost had to because he wasn't capable of being as physically dominant as he was before.

I know he says he doesn't regret it but that's almost expected. Second guessing the surgery over a decade later isn't healthy. He could drive himself crazy with the "what ifs" involved if he did regret it.

I'm curious if there were other options back then. I know microfracture surgery itself was looked at as a somewhat new way to to address issues then but what were the other options available at the time? I don't recall hearing about the cadaver transplant before.

 

[Mainstreet]

I thought we didn't hear about microfracture surgeries happening nearly as often and it seems like it wasn't a case of not hearing about them so much as they're not happening as often. Everyone is different but it seems like there aren't many successful cases of players recovering close to 100% or where they were before the surgery.

I know Patrick Beverly had it recently and that's one of the reasons some are against trying to acquire him. He hasn't shown he can play at a high level since he had it so it would be a risk to acquire him, especially now that he's over 30.

Amare had it at a time when he was still developing his game and that basically halted his development and capped it off. He became what he was, no better but also not necessarily worse. He got a little smarter but he almost had to because he wasn't capable of being as physically dominant as he was before.

I know he says he doesn't regret it but that's almost expected. Second guessing the surgery over a decade later isn't healthy. He could drive himself crazy with the "what ifs" involved if he did regret it.

I'm curious if there were other options back then. I know microfracture surgery itself was looked at as a somewhat new way to to address issues then but what were the other options available at the time? I don't recall hearing about the cadaver transplant before.

It appears OAT surgery is one of the preferred methods now and microfracture is another tool... not the entire cure for such an injury.

 

[Beaver]

I had microfracture surgery in my early 20s. Was terrible being on crutches for three months. Now just an overweight dude with a desk job

 

[jlove]

Ive gone through 2 on my left knee and the recovery sucks and takes forever to get to even 75%. My knee still isn't the same.

 

[Russ Smith]

I found this story in the Chicago Tribune about the apparent decline of microfracture. I thought it was interesting because the procedure involves current and past NBA players particularly Amare Stoudemire.

It's best to read the whole article but here are some excerpts.








While Amare had some success after microfracture, he stresses how difficult it is to recover.



http://www.chicagotribune.com/sport...surgery-amare-stoudemire-20180706-story.html#

I had that discussion with the surgeon who did my patellar tendon surgery in Sept just because I was curious and she said the same thing. At the time microfracture was the best in practice, it no longer is this OAT is now considered best in practice.

Both the ladies who helped in my physical therapy said the same thing they rarely have patients now who have had microfractures and they both said the recovery process and time is brutal.

By the time someone's knee gets to the point where they really need a surgery like that, the outcome is probably not going to be great anyways but the amount of rehab and the pain involved really reduces the recovery rate. When you're in PT for a few months like I was, you meet lots of people recovering from lots of different surgeries and it becomes very obvious that there are many elements, what sort of surgery they had, how good the surgeon was, but at a certain point by far the biggest factor is the person who is recovering. How hard they work, do they follow instructions etc. I saw people get worse because they weren't working hard, I saw people get worse because they were doing stuff "on the side" that they weren't supposed to be doing(one woman was riding her bike 5 miles a day on non PT days).

It's easier for athletes because their rehab is so much more controlled and supervised but it still puts a great deal of emphasis on them and how seriously they take it.

Glad they have something better now.

 

[devilalum]

I had a pretty severely torn meniscus and a doctor told me I needed surgery to repair it.
I did some research and found a study with a large group of subjects. Half had surgery and rehab. The other half just did the rehab without the surgery. After 6 months the group that rehabbed only had more success than the group that had the surgery. This was 15 years go and I am still completely pain free. I do however work out almost every day. IMO the best way to keep your body pain free is to use it.

 

[Ouchie-Z-Clown]

I had a pretty severely torn meniscus and a doctor told me I needed surgery to repair it.
I did some research and found a study with a large group of subjects. Half had surgery and rehab. The other half just did the rehab without the surgery. After 6 months the group that rehabbed only had more success than the group that had the surgery. This was 15 years go and I am still completely pain free. I do however work out almost every day. IMO the best way to keep your body pain free is to use it.

That’s the importance of finding a good, reputable doctor that doesn’t have a reputation for cutting. My father, an orthopod, always said “don’t cut unless you have no other choice.” Even though surgery would have always made him more $$$, a LOT more $$$.

 

[Mainstreet]

Ive gone through 2 on my left knee and the recovery sucks and takes forever to get to even 75%. My knee still isn't the same.

I'm sorry to hear that. I have a knee that has really deteriorated but the surgeon did not feel microfracture was an option. He said stem cell treatment was on the horizon. Of course the question is when.

 

[Mainstreet]

That’s the importance of finding a good, reputable doctor that doesn’t have a reputation for cutting. My father, an orthopod, always said “don’t cut unless you have no other choice.” Even though surgery would have always made him more $$$, a LOT more $$$.

I finally found a orthopedic surgeon who is not locked into cutting. He truly is a blessing. Before I found him the surgeons were like... no bother me unless you want to have surgery.

 

[jlove]

I'm sorry to hear that. I have a knee that has really deteriorated but the surgeon did not feel microfracture was an option. He said stem cell treatment was on the horizon. Of course the question is when.

I've been hearing sometime 2019/2020

 

[Mainstreet]

I've been hearing sometime 2019/2020

Awesome. I'm trying to hang on.

 

[jlove]

Me too

 

[AZCrazy]

I wonder what the future of stem cell regenerative procedures holds for this and other orthopedic problems. Joints are always the weak link.

 

[Covert Rain]

I wonder what the future of stem cell regenerative procedures holds for this and other orthopedic problems. Joints are always the weak link.

This. Microfracture or transplant isn't the future. It's going to be using stem cells to regrow damaged tissues etc.

 

[Errntknght]

This. Microfracture or transplant isn't the future. It's going to be using stem cells to regrow damaged tissues etc.

I think microfracture is a form of stem cell treatment - the holes they drill into the bone allow stem cells to diffuse into the area from marrow. When the cartilage is originally formed their is a matrix of strong fibers in which cartilage cells grow but there is no new matrix for the new cells. My guess is the transplant is done to furnish a reused matrix. Certain fibrous forms are only created at a certain stage of life. Elastin is one such Iit is similar to the matrix) and however much we have when that time ends is all we'll ever have. Some time in the furture we may discover a way around that.

 

[BillsCarnage]

I had a pretty severely torn meniscus and a doctor told me I needed surgery to repair it.
I did some research and found a study with a large group of subjects. Half had surgery and rehab. The other half just did the rehab without the surgery. After 6 months the group that rehabbed only had more success than the group that had the surgery. This was 15 years go and I am still completely pain free. I do however work out almost every day.

I lost about 50% of my medial meniscus when I tore my ACL last year. No pain, but the grinding does concern me with long term wear. There was a a lot of tenderness during rehab on that area, but no real bad pain.

IMO the best way to keep your body pain free is to use it.

Ain't that the truth. I get some plantar fasciitis flare up every so often and it's amazing what a walk around the block will do to help.

 

[boisesuns]

Hopefully with all our knee and foot troubles, we'll be back to regular posting on the board when the suns get good again.

 

[SunsFanFirst]

Stem cell treatments are already out there (really ramped up in the last 6-7 years). Its how athletes are returning so much faster from blown ACL’s. That said they have barely scratched the potential imo. Treatments are expensive and until there is research/proof supporting the new techniques/applications being tried insurance companies are not going to cover it. That said, the results in boney, ligamentous, rotator cuff, foot injuries, etc have been awesome.