Micro fracture is a ground breaking technique. The concept is that by creating an injury to the area, you can get it to heal. This concept has been used in medicine to promote wound healing for ages. In the case of a knee cartilage lesion, it involves poking holes into the bare bone and allowing the bone marrow on the other side to seep through and form a clot in the hole. Because allot of trauma is done to the bone, the patient needs to keep weight off of the area for 6-12 weeks. This morning I present an unusual study case. This is a 54 year old woman who was initially entered into one of our studies in early 2008, but who eventually got micro fracture of a very large hole in the cartilage on the medial side of her knee. Since our initial focus of treatment was her smaller lateral side lesion (where she had more symptoms) and she had the larger medial lesion operated, we felt the follow-up images might one day provide an interesting comparison of the results of the two procedures in the same knee.
The patient is an avid horsewoman who had increasing knee pain over the past few years before our treatment. She now is about a year out from treatment, reporting 70% improvement. The medial micro fracture side is shown above. Note the red dashed circles on the left show a significant break in the grey cartilage layer. Note that in general, this is improved in the post operative right sided yellow dashed circles.
It’s important to note the irregular contour of the bone on the bottom “AFTER” image (3rd down on the right above). The cortex is the outer hard part of the bone that appears as a dark black line. Below is a blow up of this micro fracture area before and after the surgery. Note that before the surgery, the cortex line is straight with problem cartilage (white areas in the grey cartilage). After micro fracture surgery, this cortex bone line is irregular with what appears to be fill in cartilage.
The good news is that the bright area in the bone under the micro fracture lesion is better, meaning that the micro fracture produced some fill in of the cartilage which helped it reduce forces on the bone and the bone now has less swelling.
The image below is the Regenexx-C procedure treated side (lateral compartment). This area shows good fill in of the breaks in the cartilage (white areas on the left in the red dashed circles that are more grey in color and uniform in appearance in the after images-yellow dashed circles).
The upshot. Both sides seemed to have accomplished their goals based on the patients report and the changes in the images over 13 months. The micro fracture side shows some irregularity in the bone likely due to the trauma of poking holes in the bone. My personal opinion is that micro fracture is a great procedure that works very well in some of these larger lesions in younger patients. It’s a brilliant advance over arthroscopic debridement (surgeries where cartilage is simply “cleaned up” by cutting it out). I think that in the future we may see stem cells placed in the joint after micro fracture surgery to aid healing and we’ll also see many non-surgical, stem cell based, injection options like the Regenexx-C procedure.
This patient was treated with the Regenexx-C (cultured stem cell injections).