Abstract
Microfracture is nonanatomic because microfracture destroys the gross structure and the complex microscopic infrastructure of the subchondral plate, and may promote subchondral cyst formation. In consideration of the destruction of subchondral anatomy, it may be time to abandon the arthroscopic microfracture procedure. However, arthroscopic abrasion arthroplasty results in a positive outcome in 66% of patients, and may still merit consideration as a salvage procedure.
AANA Past President Jack Bert is an arthroscopic expert who has performed knee arthroscopy in high volume for many years and believes the time has come for microfracture to be abandoned.
1
Microfracture is nonanatomic because microfracture destroys the gross structure and the complex microscopic infrastructure of the subchondral plate, and may promote subchondral cyst formation.In 1989, Dr. Bert showed that knee abrasion arthroplasty was not superior to arthroscopic debridement alone.
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Dr. Bert recalls that AANA Past President Lanny Johnson presented 66% satisfactory results of abrasion arthroplasty at AAOS in 1982, and Dr. Clement Sledge stated that, “Only Dr. Johnson could get such good results.”1
However, it turns out that Dr. Sledge was wrong because in the current issue, Sansone et al.3
present 20-year follow-up of abrasion arthroplasty, and show a positive functional outcome in 67.9%, which is remarkably close to Dr. Johnson's 66%.However, 66% positive functional outcome equals 33% poor results, “but for arthritis, a disease with no ‘cure,’ this seems pretty good, albeit not great.”
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Additional research is required to determine if, as published long ago, abrasion arthroplasty is no better than debridement,2
, 5
and a limit of Sansone et al.3
is absence of a control group. But expertly executed abrasion arthroplasty need not destroy the gross structure or the complex microscopic infrastructure of the subchondral plate. Abrasion arthroplasty is a salvage procedure, not a cure; it is minimally invasive and results in a positive outcome in 66% of patients, but it also resulted in increased pain in 20% of Dr. Bert's patients.1
Looking at the evidence, it may not be time to abandon knee abrasion arthroplasty, but Dr. Bert makes a strong argument, and in consideration of the destruction of subchondral anatomy, the time may have come to abandon arthroscopic microfracture.References
- Abandoning microfracture of the knee: Has the time come?.Arthroscopy. 2015; 31 (501-505)
- The arthroscopic treatment of unicompartmental gonarthrosis: A five-year follow-up study of abrasion arthroplasty plus arthroscopic debridement and arthroscopic debridement alone.Arthroscopy. 1989; 5: 25-32
- Long-term results of abrasion arthroplasty for full-thickness cartilage lesions of the medial femoral condyle.Arthroscopy. 2015; 31 (396-403)
- Arthroscopic arthritis options are on the horizon.Arthroscopy. 2015; 31 (389-392)
- Role of arthroscopy in osteoarthritis of the knee.Arthroscopy. 1991; 7: 358-363
Article info
Footnotes
See related article on page 501
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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- Abandoning Microfracture of the Knee: Has the Time Come?ArthroscopyVol. 31Issue 3
- PreviewMarrow stimulation has been performed for more than 45 years beginning with the simple drilling of bony surfaces, burring or “abrading” the sclerotic lesion, and more recently using awls to penetrate eburnated bone to promote blood flow to the bony surface. Multiple authors have promoted these procedures as “helpful,” but others have confirmed only short-term relief with destruction of the subchondral surface. Unfortunately, proponents do not compare their marrow stimulation results to a control group that had debridement alone.
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