Posted by: Debbie | 2010-11-17

Knee microfracture

I am looking for some help with my knee. 3 Years ago I went into surgery to have a part of my meniscus shaved off and when I woke up the surgeon had to remove a piece of a cartilage the size of an old one rand coin and perform micro-fracture.

I was told it could take 2 years before I fully recovered. I did all the required therapy from physio to biokinetics to swimming ad strength building. My knee is still very, very bad though.

I was very active in sports before the injury and have been unable to return to sport since. Basically I dont know where to go to next.

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Our expert says:
Expert ImageOrthopaedic Specialist Forum

Microfracture is a procedure that falls under the category of mesenchymal cell proliferation. The idea is to stimulate marrow cells to form a type of scar cartilage to fill the defect in the chondral cartilage. It therefore produces a covering that never has the same function or structure of the original articular cartilage. In fact the closest we can get is cartilage transplant (autologous chondrocyte implantation) which even this does not restore the cartilage to absolutely normal.
There are unfortunately a number of variables which affect the outcome of the procedure. Firstly is the cause of the lesion. This may be traumatic, a fall or twist, or degenerative which is wear and tear and a precursor of arthritis. Obviously if this is arthritis it is not curable and is a progressive disease which while get worse with time. The technique and immediate rehabilitation( possibly the most important factor) can influence the outcome. Dr Steadman from the USA, who developed the technique, requires each patient to be on continuos motion for 6 hours a day!! In SA we request the patient to do 300 - 600 knee motions a day. Your age plays a role as often over 50 years the body does not have enough mesenchymal cells to make the new scar cartilage.
Local factors like size, thickness, site and chronicity also affect the result as does the mechanical alignment of your leg.
It would be best to see your surgeon again to find out why it is still causing pain. This will normally require another MRI to asses the lesion. A plan going forward can therefore be devised.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

Our users say:
Posted by: Dr JL Crane | 2010-11-30

Dear Debbie

I suggest that you have a MRI scan of your knee, to diagnose the cause of your pain. It could be a re-tear of meniscus, a loose body or a large defect i the cartilage that has not healed. once you have been diagnosed suitable treatement can be initiated and get you back to sport.

Jason Crane

Reply to Dr JL Crane

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