- Articular cartilage injuries are a challenge to treat, poor at healing, and are an important cause of permanent disability due to the high mechanical joint stress in athletes. They are challenging to treat because of the poor capacity of the articular cartilage to heal itself. The extreme mechanical joint stress comes from repetitive joint impact, rapid deceleration, and frequent pivoting. All of these stresses are detrimental to articular cartilage repair and lead to increased risk of osteoarthritis. Unfortunately, injuries to the articular cartilage of the knee are common sports aliments. (15, 19, 23)
- The microfracture technique is often used to safely and effectively treat traumatic chondral lesions of the load-bearing areas of the knee in athletes. Microfracture has become the main option for athletes suffering from articular cartilage lesions due to its technical simplicity, limited invasiveness, low associated morbidity, and short postoperative rehabilitation. The media has portrayed the procedure as one that can result in rapid decrease in performance and termination of professional athletes' careers. Instead of the procedure being the cause of many careers to end, it is in fact the injury itself that is ending careers. Microfracture has been successful in preserving careers of players with articular cartilage injuries. (15, 17, 19)
- A study published in 2009 found that after a reasonable absence (5-7 months) from activity professional football and rugby players were able to return to their normal sports activity without risking contracts or careers. Twenty four players with isolated full-thickness articular cartilage defects on the weight bearing surface of femoral condyles were treated with microfracture. Healing assessment occurred at 3, 6, 12, 18 months by subjective and objective functional evaluation. The results showed that 83.3% of the players return to full training in an average of 6.2 months and all returned within 18 months. The functional and MRI scores of all subjects improved over the 18 month study. The point of maximal improvement of function occurred between 6 to 12 months. This study should not be used to assess the effects of microfracture on recreational athletes. Recreational athletes do not have the same amount of motivation or the fine facilities that were available to the professionals. (19)
Figure 6: MRI Score Progress
Shows the degree of healing according to MRI evaluation in 6 month periods. The most complete healing occurs at 18 months, although there are no subjects that have no significant healing after 12 months. This study shows that the worst case scenario is that the healing in incomplete.
Permission granted by Masoud Riyami (19)