Microfracture is a surgical procedure performed to promote the healing of damaged cartilage with the use ofstem cells (progenitor cells of the body). It is considered the best procedure to treat cartilage injuries less than ½ inch or 15 mm. Microfractureis widely used to treat hip and knee injuries, but can also be performed to treat articular cartilage (tissue cushioning two bones) of the ankle joint, damaged due to an ankle sprain or break, which can lead to snapping and locking of the ankle joint, loss of motion and deep ankle pain.
Microfracture may be indicated for the following:
- Ankle sprains or fractures
- Osteochondral lesion of the talus (injury to the cartilaginous layer on the ankle bone)
- Young patients whohavea single injury and healthy subchondral bone(bone underlying the articular cartilage)
The microfracture technique is usually performed as an arthroscopic procedure (arthroscope or instrument consisting of a small camera to view the area of injury) under local, spinal or general anesthesia. Three small incisions are made to insert the arthroscope and other instruments. Any loose or unstable cartilage is removed. Your surgeon will insert a sharp tool known as an awl to make several holes on the surface of the ankle joint. These holes penetrate into the subchondral boneand open up new blood supply to the area. This new blood supply from within the bone marrow, supplies the damaged joint surface with new stem cells to form fibrocartilagewhich fills the damaged area and promotes the formation of new tissue. The incisions will then be covered.
Following the procedure, rehabilitation is critical for the success of the surgery. Your physical therapist will teach you exercises during the rehabilitation program to regain muscle strength, promote healing and gain normal range of motion of the ankle joint.
You can apply ice or ice packs over the ankle to reduce swelling. Whenever possible, elevate your leg higher than the level of your chest to minimize swelling. Your dressing will be removed in 3 days.You can get the incisions wet in the shower, but avoid submerging the wound in the pool or tub. A splint may be applied for the first 3 days after the surgery andyou will have to use crutches regularly for the first 4 weeks to avoid bearing weight on the operated foot.
You may be prescribed medication for relieving pain. Avoid driving until you have been advised to do so by your doctor. Consult your doctor immediately if you experience fever, shortness of breath, sudden pain, or other unexpected symptoms.
Risks and Complications
As with any procedure, microfracture involves some of the following risks and complications:
- Blood clots
- The newly formed cartilage is not as strong as the body’s original cartilage and thus there is a risk of its breakage overtime