Chondral Defects

For patient information following a Microfracture

CHONDRAL DEFECTS MICROFRACTURE

This leaflet has been devised to act as a guide to you, of what to expect following your operation.

Microfracture
During surgery multiple small holes are made in the bone at the bottom of the cartilage defect.
This causes bleeding and a clot is formed in the hole. This clot enables new cells to form a repair cartilage that fills the gap.

After surgery it is important to protect this clot so that new cells can form. This is done by limiting weight bearing. You are allowed to place your foot on the floor, but not to take much weight through the leg for 6-8 weeks, depending on the size of the area involved.
Return to function and sporting activities can vary between individuals but most people notice
significant improvement 6 months after surgery, although full recovery can take up to 2 years.

If this technique is used on the patella you will be put in a knee brace, which restricts your range of movement when walking. You will be able to take weight through the leg as long as it is comfortable.

It is very important (after the operation) to regain full range of movement of both knee bending and straightening. To help achieve this, you will stay in hospital overnight and a machine will help to move the knee for you whilst you are recovering.

If you need further advice please contact the McNicholas Knee Clinic and arrange a consultation

Autologus Chondrocyte Implantation (ACI)

ACI is another method which can be used to treat cartilage defects in the knee, and involves 2 operations:

In the first operation, key hole surgery is used to harvest cartilage calle from the injured knee. These cells are then used to grow many more cells in the laboratory. It usually takes 5 weeks for the cells to multiply sufficiently and, at this stage, the secone operation is performed. This procedure involves a cut on the front of your knee, and the cells grown in the laboratory are replaced at the injury site. A membrane is used to keep the cells in the correct location. This membrane will either be taken from the lining of your own bone (periostium), or a membrane manufactured from porcine collagen (pig connective tissue) in the laboratory.

The following images demonstrate the second stage of ACI treatment for a cartilage injury:

	The chondral defect is debrided to remove all unstable cartiladge Close examination of the debrided chondral defect reveals evidence of the previous unsuccessful microfracture
	The periosteal membrane is harvested and then sutured to the edges of the chondral defect
	Stitching the patch is completed This image illustrates a periosteal patch, but a porcine origin membrane would be used in an identical manner
	The sutured patch is now sealed with fibrin glue Once sealed the patch is tested for water-tightness

Further information is available at www.active-trial.org.uk

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