Articular cartilage is white, with the bone exposed |
Outerbridge articular cartilage classification |
There is no standard and uniform approach to managing articular cartilage injuries in the knee. Left untreated it can progress to significant joint destruction. The patient may then need a total knee replacement in the worse case scenario.
Treatment options include microfracture, arthoscopic drilling, mosaicplasty and chondrocyte transplantation to restore the joint surface.
A microfracture technique is where the surgeon performs key hole surgery to cause bleeding on the bone surface to promote healing (picture below). It is performed by the surgeon puncturing holes in the subchondral bone layer to allow bleeding to occur. After the blood clots and heals, a layer of fibrocartilage is formed. This technique was first made popular more than 20 years ago by Dr Richard Steadman from Vail, Colorado who has since retired.
Most surgeons here do not usually suggest use of the CPM machine after performing the microfracture technique which I feel is critical in order for optimal healing to occur in the articular cartilage.
Lots of patience and consistency are required by the patient and physiotherapist to slowly regain functional range of movement and strength before any return to sport work can be done.
Fortunately, articular cartilage injuries are my area of interest having had them myself (and requiring 3 knee surgeries) and my postgraduate research was in this area.
I'll write more about mosaicplasty and and the chondrocyte transplantation procedure in the next post. Stay tuned.
References
Hurst JM, Steadman JR et al (2010). Rehabilitation Following Microfracture For Chondral Injury In The Knee. Clin Sports Med. 29(2): 257-265. DOI: 10.1016/j.csm.2009012.009.
Steadmann JR, Rodkey WG et al (1997). Microfracture Technique For Full-thickness Chondral Defects. Oper Tech Orthop. 7:300-304.
Here's what the surgeons use to cause bleeding in the bone |
No comments:
Post a Comment