Microfracture surgery is a minimally invasive orthopedic procedure designed to repair damaged cartilage in joints, most commonly the knee. Developed in the 1980s, this technique stimulates the body's natural healing process to create new cartilage in areas where it has worn away.
This procedure is particularly beneficial for active individuals and athletes who experience joint pain due to cartilage defects. By creating tiny fractures in the underlying bone, the surgery prompts stem cells to form new fibrocartilage, which helps restore joint function and reduce pain.
While microfracture isn't a permanent solution for severe arthritis, it can provide significant relief and delay the need for more extensive joint replacement surgeries in many patients.
Microfracture surgery is typically recommended for patients with specific types of joint cartilage damage. The most common candidates are those with:
Patients often experience symptoms like persistent joint pain, swelling, locking, or catching sensations during movement. These symptoms typically don't improve with conservative treatments like physical therapy, anti-inflammatory medications, or cortisone injections.
The procedure is particularly common among younger patients (under 40-50 years old) who want to maintain an active lifestyle and delay more invasive procedures like joint replacement.
Microfracture surgery is performed arthroscopically, meaning it's done through small incisions using a camera and specialized instruments. Here's what typically happens during the procedure:
These small holes allow bone marrow cells and blood to form a clot over the area. Over time, this clot transforms into fibrocartilage - a repair tissue that helps cover the defect. The entire procedure usually takes 30-90 minutes, depending on the size and number of lesions being treated.
Because it's minimally invasive, patients typically experience less postoperative pain and faster recovery compared to open joint surgeries.
Proper preparation can significantly impact your surgery's success and recovery. Here's what to expect:
Medical Evaluation: Your surgeon will order imaging tests (X-rays, MRI) to assess the joint damage. You may need blood work and a physical exam to ensure you're healthy enough for surgery.
Prehabilitation: Many doctors recommend "prehab" - physical therapy before surgery to strengthen surrounding muscles and improve joint mobility. This can make rehabilitation easier post-surgery.
Home Preparation: You'll need to arrange for help at home, especially during the first week after surgery. Prepare your living space by removing tripping hazards and setting up a comfortable recovery area with pillows for elevation.
Medication Adjustments: Your doctor may advise stopping certain medications (like blood thinners) before surgery. Always follow their specific instructions regarding medications and fasting before the procedure.
Recovery from microfracture surgery is a gradual process that requires patience and commitment to rehabilitation. Here's a general timeline:
First 1-2 Weeks: The joint must be protected to allow the blood clot to form properly. You'll likely use crutches to keep weight off the joint and may wear a brace for stabilization.
Weeks 2-6: You'll begin gentle range-of-motion exercises and may start partial weight-bearing as tolerated. Physical therapy focuses on maintaining joint mobility without stressing the healing area.
Months 2-6: As healing progresses, therapy intensifies to rebuild strength and proprioception. Most patients can return to low-impact activities around 3-4 months, with full recovery taking 6-12 months depending on the joint and lesion size.
Adhering to your rehabilitation program is crucial for optimal results. Rushing the process can damage the new cartilage formation and compromise your outcome.
While microfracture surgery is generally safe, like any procedure, it carries some risks:
Factors that increase complication risks include smoking, poor nutrition, non-compliance with weight-bearing restrictions, and pre-existing health conditions like diabetes. Your surgeon will discuss your specific risks and precautions to minimize them.
Contact your doctor immediately if you experience fever, increasing pain, redness, or unusual swelling after surgery, as these may indicate complications.
Microfracture surgery has shown good to excellent results in about 75-80% of properly selected patients. Success depends on several factors:
Studies show that microfracture can provide significant pain relief and functional improvement for 5-10 years in many cases. However, the fibrocartilage formed isn't identical to original hyaline cartilage and may wear down over time.
For athletes, return-to-sport rates vary by sport and level. Many professional athletes have successfully returned to competition after microfracture, though high-impact sports may accelerate cartilage wear.
Long-term outcomes improve when patients maintain a healthy weight, follow an appropriate exercise regimen, and avoid activities that overload the joint.
Depending on your specific condition, other treatment options may be considered:
Non-surgical options: Physical therapy, viscosupplementation injections, platelet-rich plasma (PRP) therapy, or stem cell injections may help some patients delay or avoid surgery.
Other surgical options:
Your orthopedic surgeon will recommend the most appropriate option based on your age, activity level, lesion characteristics, and overall joint health.
How long does microfracture surgery take?
The procedure itself typically takes 30-90 minutes, depending on the number and size of lesions being treated. With preoperative preparation and recovery time, you'll likely spend several hours at the surgical facility.
Will I need general anesthesia?
Microfracture can be performed under general anesthesia or regional anesthesia (like a spinal block). Your anesthesia team will recommend the best option based on your health and preferences.
How long until I can walk normally after microfracture?
Most patients use crutches for 4-8 weeks to protect the healing cartilage. Full weight-bearing typically resumes by 6-8 weeks, with normal gait returning as strength improves during rehabilitation.
Can microfracture surgery be repeated if it fails?
While possible, repeat microfracture often has diminishing returns. Alternative procedures like OATS or ACI may be more effective for failed microfracture cases.
Does insurance cover microfracture surgery?
Most health insurance plans cover microfracture when medically necessary, but you should verify coverage with your provider as out-of-pocket costs vary by plan.