Articular cartilage is the cushion or joint surface that exists in every joint in your body. When damaged, it is very poor at repairing itself and often will progress to arthritis. This is why we, as orthopaedic surgeons, are constantly trying to perfect ways to restore this important tissue.
At present, there is no perfect or consistent way to try to regenerate or re-grow joint surfaces. It's kind of like trying to re-grow hair. Sometimes it works, sometimes it doesn't - and it's never really predictable. One also does not know how long it will last.
Of all of the cartilage regeneration surgical techniques, microfracture is probably the most common. It is certainly the one that you read about the most in the sports page when top athletes damage their joint surface or articular cartilage resulting in "chondral defects." These defects are similar to "pot holes" that happen the streets - although those are much easier to fix.
Microfracture surgery is also pretty easy from a technical standpoint, and is minimally invasive, performed as an outpatient, with minimal discomfort from the patient's standpoint. The harder part is the recovery, especially the first four to six weeks.
Unlike most of the sports medicine type surgeries that we perform today, in which we try to accelerate or speed up the recovery process, with microfracture we need to move slowly - putting the "brakes" on the patient for the first few months.
The new joint surface that is trying to re-grow is quite fragile, like a newborn baby, and needs to be treated with utmost care and respect if it is to transform to a full, solid, durable joint surface.
Patients and athletes are not permitted to run or do any higher impact activities for approximately four to six months. Return to sports is usually at the six to nine month mark. The entire healing process, including "remodeling" of the joint surface (an ongoing process where better end better tissue is made) can take two years. You can see why patients can easily get impatient.
So, if you are considering microfracture surgery, and you want the best possible long-term result for your knee, then you must be a patient patient. We live in a "quick fix" society, and not many of us want to be inconvenienced for a long time. This is one instance where the wait is well worth it, especially if your knee is given a second chance.
The good news is that the future of joint repair and its associated technology is quite bright. Newer techniques are being developed in which the repair process can not only be enhanced but also accelerated. Research is being done in which cell therapies and genetic engineering will speed up the recovery and also build a better new joint surface. Until these newer technologies are ready for prime time, we can only ask you to be patient- especially if you are having a microfracture procedure.
