Knee arthroscopy and microfracture of osteochondral defect
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Microfracture is a form of cartilage repair that was popularised in the 1980s by Richard Steadman in Colorado, USA. It is not overly technically demanding and has shown good functional outcomes for small (<2cm2) lesions. Original data from the 1980s suggested its use for larger lesions (up to 4cm2). More recent evidence such as NICE guidance and alternative treatments, such as autologous chondrocyte implantation (ACI), have narrowed the indications of microfracture based on size.
It is a straightforward procedure to undertake in one sitting and worthwhile for appropriate sized lesions. However it must be appreciated that microfracture creates repair-type fibrocartilage rather than hyaline cartilage, which is inferior in terms of biomechanics and longevity.
Modern cartilage regeneration techniques are also available and garnering good evidence, especially for larger lesions. Autologous cartilage implantation (ACI) for example is a much more costly, 2-stage procedure. The size of the lesion therefore is critical in the decision making process as the results of ACI can be impaired by previous failed regenerative procedures including microfracture.
Author :Mr Andrew Pearse FRCS (Tr & Orth)
Institution: The Worcestershire Acute Hospitals NHS Trust, UK.
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Question 1 of 12
Which one size of defect is suitable for microfracture according to 2017 NICE guidance?CorrectIncorrect
Question 2 of 12
Patients with an osteochondral defect may present with all the following symptoms EXCEPT which one ?:CorrectIncorrect
Question 3 of 12
Which one imaging technique is the mainstay of pre-operattive preparation for microfracture?CorrectIncorrect
Question 4 of 12
Which one of the following is a good indicator of prognostic outcome?CorrectIncorrect
Question 5 of 12
The scalpel blade used for making the arthroscopy portal is usually which one of the following?CorrectIncorrect
Question 6 of 12
The microfracture awls come in varying angles. Which one of the following should NOT be used with a mallet?CorrectIncorrect
Question 7 of 12
The blunt ended introducer is kept in situ when sweeping into the supra-patellar pouch for which one of the following reasons ?CorrectIncorrect
Question 8 of 12
Direct vision of the creation of a crania-caudal (vertical) orientated anteromedial portal helps avoid damage to which one of the following structures?CorrectIncorrect
Question 9 of 12
The microfracture puncture holes are spaced out to avoid fracturing into one another. This distance should be which one of the following ?CorrectIncorrect
Question 10 of 12
Which one of the following should be avoided early in the rehab programme (<2 weeks)?CorrectIncorrect
Question 11 of 12
The advantage of microfracture over autologous cartilage implantation techniques are all the following EXCEPT which one ?:CorrectIncorrect
Question 12 of 12
Research has shown that microfracture is significant more beneficial in which one type of lesion?CorrectIncorrect