Microfracture surgery

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Left knee-joint from behind, showing interior ligaments. (Lateral meniscus and medial meniscus are cartilage.)

Microfracture surgery is an orthopedic surgical technique used to restore damaged knee cartilage, the material that helps cushion bones at the joints. It is frequently performed on professional athletes and is becoming increasingly common for all types of patients.

1 Development
2 Procedure
3 Recovery
4 Athletes who have undergone the surgery
5 References
6 External links

[edit] Development

The surgery was developed in the late 1980s and early 1990s by Dr. Richard Steadman of the Steadman-Hawkins clinic in Vail, Colorado. Steadman slowly refined the procedure through research (including tests on horses)^[1]. After Steadman experienced success with the surgery, professional athletes started taking notice. Originally, the surgery was called "controversial" by many sportswriters, due to a lack of studies on the long-term effects and the fact that an unsuccessful surgery could end an athlete's career.^[2] However, Steadman and other researchers have proven that compared to other treatments, the procedure is safe and effective, even in the long term.^[3] Because microfracture surgery is quick (taking around 30 minutes), less invasive than previous types of knee surgery, and has a high rate of success, it has quickly become a common procedure for orthopedic surgeons. Dr. Steadman has also adapted the surgery into a treatment to help reattach torn ligaments (a technique he calls the "healing response") that he successfully used on alpine skiier Bode Miller.^[4] Possible applications in the hip and ankle joints have also been speculated on.^[5]

[edit] Procedure

The surgeon makes a tiny, quarter-inch incision on the affected knee and inserts a long thin scope (arthroscope). This scope allows the surgeon to work directly on the joint area. First, any calcified cartilage is removed. Then, the surgeon uses an ice pick-like tool called an awl to punch very small holes (“microfractures”) in the bone near the defective cartilage. Blood and bone marrow (which contains stem cells) seep out of the holes, creating a blood clot that releases cartilage-building cells. The fractures are treated as an injury by the body, which is why it results in new, replacement cartilage.^[6]

Microfracture surgery can help a patient prevent a partial or total knee replacement. It is also used to treat pain in the knee from cartilage injuries, as well as early arthritis of the knee, lesions on the kneecap, degenerative chondral lesions of the knee, and traumatic injuries to the cartilage. It does have limitations, and is less effective in treating older patients, overweight patients, or cartilage damage that is larger than 2.5 cm.^[6]

[edit] Recovery

Current studies have shown a success rate of 75 to 80 percent among patients 45 years of age or younger, even among professional athletes.^[3]^[5] With the help of physical therapy, patients can often return to sports (or other intense activities) in about 4 months. However, this is a best-case scenario and depends on the severity of the cartilage damage (and any other conditions existing in the knee). Normal patients and professional athletes who play at the highest level however are quite different, as Chris Webber, who underwent the surgery, has stated that a full recovery in 4 months is nearly impossible. Webber returned to the NBA eight months after his surgery but did not feel "like himself" until a few years later.^[7]

[edit] Athletes who have undergone the surgery

There have been many notable professional athletes who have undergone the procedure. The list includes many NBA players such as Chris Webber, Allan Houston, Penny Hardaway, Zach Randolph, Jamal Mashburn, Darius Miles, Kenyon Martin and Jason Kidd. Many NFL players (including Bruce Smith and Stephen Davis) have also needed the surgery.

In October 2005, young star Amare Stoudemire of the Phoenix Suns underwent one of the highest-profile microfracture surgeries to date. He returned to the court in March 2006 and initially appeared to have made a full recovery, but subsequently started feeling stiffness in both knees (his right knee had been overcompensating for the injured left knee). He and the team doctor decided he needed more time to rehab and will not return until the 2006-2007 season.^[8]

The technique is also gaining renown in other parts of the world. English Premier League star Michael Owen came to the U.S. in September 2006 to receive the surgery from Dr. Steadman.^[9]

Partially because of the high level of stress placed on the knees by these athletes, the surgery is not a panacea and results have been mixed. Houston, Mashburn, and Hardaway's careers all effectively ended after they underwent the surgery. Martin has only been able to play sporadically in the 2005-06 NBA season. However, some players such as Kidd and Randolph have been able to return at or near their pre-surgery form. Denver Nuggets forward Kenyon Martin will be the first professional sports player to attempt a comeback in the 2007-2008 season from microfracture surgery on both knees.