Microfracture surgery

  Microfracture surgery is an orthopedic surgical technique that can help restore knee cartilage by creating tiny fractures in the adjacent bones, causing new cartilage to develop. It can be used to treat both degenerative knee problems as well as cartilage injuries, and has gained a high profile in the sports world in recent years; numerous professional athletes including members of the NBA, NFL and NHL (most notably Greg Oden and Amare Stoudemire) have undergone the procedure.

The surgery is quick (taking around 30 minutes), minimally invasive, and has significantly shorter recovery times than an arthroplasty (knee replacement). Combined with a high rate of success, these factors have caused orthopedic surgeons to use the procedure with increasing frequency.

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Development

The surgery was developed in the late 1980s and early 1990s by Dr. Richard Steadman of the Steadman-Hawkins clinic in Vail, Colorado. Steadman slowly refined the procedure through research (including tests on horses)^[1]. After Steadman experienced success with the surgery, professional athletes started taking notice. Originally, the surgery was called "controversial" by many sportswriters, due to a lack of studies on the long-term effects and the fact that an unsuccessful surgery could end an athlete's career.^[2] However, Steadman and other researchers have proven that compared to other treatments, the procedure is safe and effective, even in the long term.^[3] Dr. Steadman has also adapted the surgery into a treatment to help reattach torn ligaments (a technique he calls the "healing response") that he successfully used on alpine skiier Bode Miller.^[4] Possible applications in the hip and ankle joints have also been speculated on.^[5]

Procedure

The surgery is performed through an arthroscopy. The surgeon first removes any calcified cartilage. Tiny fractures are then created in the adjacent bones through the use of an awl. Blood and bone marrow (which contains stem cells) seep out of the fractures, creating a blood clot that releases cartilage-building cells. The microfractures are treated as an injury by the body, which is why the surgery results in new, replacement cartilage.^[6] The procedure does have limitations, and is less effective in treating older patients, overweight patients, or cartilage damage that is larger than 2.5 cm.^[6]

Recovery

Current studies have shown a success rate of 75 to 80 percent among patients 45 years of age or younger, even among professional athletes.^[3][5] With the help of physical therapy, patients can often return to sports (or other intense activities) in about 4 months. However, this is a best-case scenario and depends on the severity of the cartilage damage (and any other conditions existing in the knee). Normal patients and professional athletes who play at the highest level however are quite different, as Chris Webber, who underwent the surgery, has stated that a full recovery in 4 months is nearly impossible. Webber returned to the NBA eight months after his surgery but has never been the same since.^[7]

Use in professional sports

There have been many notable professional athletes who have undergone the procedure. Partially because of the high level of stress placed on the knees by these athletes, the surgery is not a panacea and results have been mixed. Many players' careers effectively end despite the surgery. Some players such as Jason Kidd, Steve Yzerman, John Stockton and Zach Randolph [2] have been able to return at or near their pre-surgery form while players Brian Grant, Antonio McDyess, Chris Webber, Allan Houston and Penny Hardaway never regained their old form. Others such as Jamal Mashburn and Terrell Brandon never recovered and retired. Kenyon Martin has had 2 microfracture surgeries. Portland Trailblazers rookie Greg Oden underwent the procedure in early September 2007 and will miss the entire 2007-2008 NBA season. As Oden was only 19 at the time of the surgery, doctors are confident that he will return to full or near-full strength by the 2008-2009 season. ^[8]

In October 2005, young star Amare Stoudemire of the NBA's Phoenix Suns underwent one of the highest-profile microfracture surgeries to date. He returned to the court in March 2006 and initially appeared to have made a full recovery, but subsequently started feeling stiffness in both knees (his right knee had been overcompensating for the injured left knee). He and the team doctor decided he needed more time to rehab and he did not return until the 2006-2007 NBA season.^[9] During the 2006-2007 season, Stoudemire returned to form, averaging 20.4 points and 9.6 rebounds per game while playing in all 82 regular season games and the 2007 NBA All-Star Game. His recent success has brought positive publicity to the procedure, further distancing it from a previous reputation as a possible "career death sentence" in the sports world although he was one of the youngest of the aforementioned players to undergo the surgery. ^[10]

References