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Knee arthroscopy techniques for arthritis

Severe knee arthritis, note the raw bone areas

     In the recent Journal of Bone and Joint Surgery article by Knutson1. , an interesting trial of a really very new technique of cartilage transplantation was compared to a fairly tried and true technique call "microfracture".  Cartilage transplantation has been advocated by several authors as of recent years.  The operation requires two procedures.  One to get some cartilage, which is then mailed off to grow more cells in the lab.  Once enough of the cells are grown, then the cartilage is shipped back to the surgeon in special containers and is transplanted through and open operation into the area of arthritis.  Results are fairly good and there is a lot of excitement about this new idea.  The study by Dr. Knutson compared this really great new technique to the other more commonly done operation that is done in one stage, arthroscopically, as an outpatient.   The operation is called the microfracture technique.  Basically, it is a fairly simply procedure.  The area of arthritis, as long as it is not too large, is "microfractured" with a special instrument.  In other words, the isolated area where there is no white shiny cartilage is perforated with multiple small holes that breaks the bone very slightly and creates bleeding.  Since hyaline cartilage, the shock absorber on the end of the bone, does not have a blood supply and won't heal, then this creation of small bleeding holes stimulates the body to create a fibrous scar tissue on the area of previously raw bone.  This area, when properly rehabilitated, will form some cartilage and act a lot like a windshield patch job does.  It takes some time, and some non-weight bearing on crutches to make the operation work.

     The article is really important because it demonstrates that the fancy new cartilage growing and transplanting two stage super expensive operation has roughly the same results as the much easier and cheaper operation.  It should be noted that there was a slight bias that the cartilage transplantation operation may grow slightly better cartilage than that of the microfracture technique; however, more research and more trials should clear up any differences if there are any. 

     What does this mean to you?   It simply means that you don't have to travel to Bergen, Norway to have a world expert in cartilage transplantation do an operation on you.  Although you would undoubtedly get a great operation by a world renown expert, surgeons all across the world are quite familiar with the microfracture technique and a surgeon near you can likely perform the operation with as great of a success as you can get anywhere.

1. Knutson et al, JBJS, 2004, 86-A, p. 455.

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Last modified03/05/05: