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If I have the surgeon do a microfracture procedure on my knee, how will I know if it takes?

Microfracture repair of defects (holes) in the joint surface has become a popular way to treat significant damage to the articular cartilage of the knee. The procedure involves several steps. First, the surgeon removes any ragged edges along the tear. This is called debridement. Then the layer of calcified (hard) cartilage is removed to expose the subchondral bone. Subchondral just means the bone is right below the articular cartilage -- like subflooring in a house. Next, the surgeon takes a special tool and forms tiny holes (microfracture) in the subchondral surface. Microfracture works by stimulating a bleeding and healing response. Blood from inside the bone marrow seeps up through the holes and fills the hole or defect in the cartilage with a clot. The articular cartilage doesn't have much of its own blood supply or an ability to heal itself. That's why the surgeon tries to help it along with techniques like microfracture. There are other methods used to stimulate healing but microfracture has become popular with good short-term results. Results can be measured in a wide range of ways. For the patient, improvement in symptoms such as decreased pain and swelling and improved function are usually important. Some patients may refer to their level of athletic activity and ability to perform strenuous work as the primary measures of results. There are some well-known testing tools that the surgeon and/or physical therapist might use to compare knee function from before surgery to after surgery. For example, there is the well-known Western Ontario and McMaster Universities (WOMAC) index, the Cincinnati knee score and the Tegner activity scale. Other testing measures often used include the Baumgaertner score, Japanese Orthopaedic Association knee score, and the Knee injury and osteoarthritis outcome score (KOOS). In fact, there are more than a dozen different scales that can be used to measure knee function. The key is to choose one that most closely reflects the type of results you want and use it consistently over time to assess outcomes. The surgeon may use MRIs or even a second-look arthroscopic exam to measure the fill in volume. This is a visual means of looking at the surgical site and seeing how well the defect has filled in and smoothed over. The need for further surgery is another measure surgeons use to indicate a failed response to microfracture treatment. Without these methods of viewing the healing site, studies show that functional improvement is actually a good indication of how well the defect has filled in. The better the patient function, the more likely a good fill in grade has occurred. So long as nothing disturbs the clot that forms with this treatment, you can expect to have good quality of repair cartilage and a successful result.


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