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Harvard Study Shows Micro-Fracture Knee Surgery Increases Arthritis Pain
By Dr. Paul Anderson M.D. Sports and Pain Medicine Expert
For a while elite professional atheltes were getting micro fracture surgery for chronic knee pain and arthritis. NBA stars Penny Hardaway, Terrell Brandon, Chris Webber, Jamal Mashburn, Allan Houston and Tracy McGrady all had micro-fracture knee surgery and the results were terrible - all players were forced into early retirement.
I had micro-fracture knee surgery as well and it has been a poor result for my knee arthritis. Whatever you do for your knee arthritis pain, do not get microfracture surgery for any reason. Here's the Harvard Medical School study.
Radiological evaluation of knee cartilage after microfracture treatment: A long-term follow-up study.
Von Keudell A, Atzwanger J, Forstner R, Resch H, Hoffelner T, Mayer M. Recent literature revealed good short-term results after microfracturing (MFX) of isolated focal cartilage defects in the knee joint. Study purpose was a long-term evaluation of patients who received MFX through a multimodal approach, correlating clinical scores and morphological pre- and postoperative MRI-scans.
MATERIALS AND METHODS:
Between 2000 and 2007 158 patients were treated with MFX for focal femoral or tibial defects at our department. Patients with instabilities, secondary surgical intervention, patellofemoral lesions, a plica mediopatellaris or more than one cartilage defect site and age >55 were excluded. 15 patients were included. Minimum postoperative follow-up (FU) was 18 months (18-78m). Mean age at surgery was 45 years (27-54), mean FU-interval 48 months (18-78m). Male to female ratio was 9:6. For clinical assessment the Knee Osteoarthritis Outcome Score (KOOS) and Lysholm Score were used, radiological evaluation was performed with radiographs and 3Tesla-MRI.
RESULTS:
Clinical knee function was rated good to excellent in 1 patient, fair in 2 and poor in 10 patients. 2/15 patients received full knee replacement due to insufficient cartilage repair through MFX during FU period. Evaluation of pre- and postoperative MRI showed good cartilage repair tissue in 1 (7.7%), moderate repair in 2 (15.4%) and poor fill in 10 patients (76.9%). In these 10 patients the defect size increased. Average defect size preoperatively was 187mm(2) (range 12-800mm(2)) and postoperatively 294mm(2) (40-800mm(2)). The Knee Osteoarthritis Score-Pain averaged 60 (39-94), Knee Osteoarthritis Symptoms 60.6 (21-100), ADL 69 (21-91), Sports 35.7 (5-60) and QUL 37.2 (6-81). The average Lysholm Score was 73.9 (58-94). 10 patients showed a varus leg axis deviation (Ø 5.9°), 3 had a neutral alignment. The alignment correlated positively with Knee Osteoarthritis Outcome Score and especially with the Lysholm Score.
CONCLUSION:
Our study demonstrated that microfracture as a knee treatment option for cartilage defect ( arthritis) in the kneedid not show the anticipated clinical and radiological long-term results. In 12 of 15 patients the cartilage defect size had increased after MFX, in 2 patients indicating total knee replacement. Especially those with a leg malalignment >5° in varus were more prone to suffer from an increase in defect size. In our cohort the clinical scores correlated with the radiological findings.
