Micro-fracture - Current Evidence, is There a Role for it?

Description

This transcript is a detailed presentation by Paul Jermin, a knee surgeon specializing in cartilage regeneration at Oswestry Orthopaedic Hospital, focusing on the microfracture technique for treating cartilage defects. He discusses the historical background of microfracture, popularized in the 1970s by Richard Steadman's team in Colorado, and the developments in its application over the years. Jermin highlights the technique's advantages—including its simplicity and low cost—but also addresses significant issues such as its long-term efficacy, with many patients experiencing deterioration in outcomes after two years.



He explains how microfracture works, describing the methodology of creating holes in subchondral bone to promote cartilage repair through bone marrow stem cells. Jermin reviews the related literature, noting inconsistencies in findings and emphasizing the challenges of interpreting results due to variations in study designs and patient populations.



Throughout the talk, Jermin offers a critique of the microfracture approach, mentioning its lack of production of true hyaline cartilage and the potential for long-term complications like subchondral bone hypertrophy. He expresses skepticism about its effectiveness in larger lesion sizes and reflects on adopting alternative methods such as Autologous Chondrocyte Implantation (ACI) and osteochondral allografts, particularly for patients with significant defects. Jermin concludes by recommending a careful assessment of treatment options based on individual case presentations while acknowledging the limitations and variability in the evidence surrounding microfracture.

DOI: 10.1302/3114-210645

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