Skkorpion said:
The AZ Republic had a wonderful article on this about two years ago and two of their points were these, if I recall:
1. Many of the European sports clinics had quit doing microfracture surgeries because the success rates were so low.
2. No AZ pro player in any of the major sports has ever had the surgery and recovered to play well again.
And finally, our MLB, Mitchell had a butchered microfracture done at Oklahoma. Notice how none of the reporters even bothers to mention him anymore.
I don't know for certain but everything on Mitchell pre draft said the same thing, tore his ACL, had surgery, wasn't as fast after the surgery, that's why he fell during the draft. I have never heard he had microfracture, but they do seem to keep that quiet, I just recently found out Dijon had it and I'm a huge UCLA fan.
Most of the guys who had microfracture were essentially last chance guys anyways for years. That's why I think it'll be interesting to watch the 3 young guys and see if they get better results. I know Zach Randolph of Portland had it done and came back this year, wasn't 100% but he doesn't look like he's done either.
Here's a Q and A with Steadman from 2000 where he describes the procedure, interesting and it describes some of the improvements they've made. For example he says they no longer drill the holes, they use an awl now. He's also got some new collagen mensiscus implant that's supposed to make it possible for people who lose some or all of their meniscus to see great results.
Knee1: You developed the technique known as microfracture, could you describe it?
Dr. Steadman: Microfracture is a technique that involves making multiple fractures in the joint surface to stimulate regeneration of articular cartilage in a defective area. The procedure is used if we identify a full thickness cartilage defect on the knee joint surface. One of the major requirements for the procedure is that the patients have good joint alignment. If a patient has bowleg, knock-knee or a similar condition that puts excessive pressure on the side of the knee where we are trying to regenerate the cartilage, then it may be necessary to do an osteotomy to change the angle of the bone. However, most athletes do not have that problem, as osteotomies are more popular in patients over forty-five years old.
The current procedure involves creating a bed from which the cartilage can grow. Preparation of the bed involves removal of the deepest layer of cartilage, which consists of the calcified cartilage layer. Research in horses has shown that preparing the bed in this manner enhances cartilage regeneration. In addition to preparing the bed, it is also extremely important that a stable edge is created around the defective area. Flaps of cartilage over the defect tend to discourage new cartilage from forming.
After creating the stable edge, we make multiple fractures in the bone using a curved awl. The awl allows us to break the subchondral bone but leaves the subchondral plate in tact. Most people involved in cartilage research feel that the subchondral plate is an important part of the functioning of articular cartilage and so it is better to leave the plate in place. By using an awl with different curves, we can come in with a 90-degree angle; an orientation that gives us our best chance for regeneration. By making these tiny fractures, we allow stem cells (undifferentiated cells that can form any tissue) and growth factors from the bone marrow to be released and coat the bone surface. These stem cells then regenerate the defective area of cartilage.
In the past, we used to drill these holes rather than using an awl. Drilling was ineffective for several reasons. First, it didn’t allow us to fracture the bone at the correct angle; the curve on the awls corrected this angle problem. Second, the drilling left a smooth, polished surface that didn’t promote sufficient adherence of the new cartilage to the bone. Using the awls, we get a rough surface to which the cartilage more effectively adheres.
Knee1: How did you develop this procedure?
Dr. Steadman: Microfracture is actually a combination of other procedures that have been done in the past, and I identified some mechanical aspects that we could do that I thought would enhance procedures that already used bone marrow to form new cartilage. At first, it was just a technique to make little fractures in the joint surface to make the joint think that it had been recently injured. As we progressed with our research, we felt that we had to improve on the need for a long rehabilitation time. Research in horses showed that this tissue takes at least eight weeks to become firm tissue that can stand up to stress. Over the 16 or 17 years that I have been doing the procedure, we have enhanced the technique through what we have learned through research. Today, we have a procedure that is about 85 percent successful in returning patients to their normal or near normal level of functioning.
Knee1: What type of rehabilitation is involved with the microfracture technique?
Dr. Steadman: For a long time we have known that cartilage needs time to mature before it is ready for heavy, impact activity. As a result, patients are on crutches for eight weeks after the procedure. However, we also believe that the new cartilage benefits from smooth motion. It is our feeling that the mechanical stimulation that we get through smooth motion gives the stem cells a message that aids in the overall signal causing the stem cells to form cartilage. Therefore, we try to create situations where we have very little impact on the new-forming cartilage, but a lot of smooth motion. This includes stationary bicycle and deep-water exercise.
