Arthroscopic debridement and microfracture (marrow stimulation)

Jack Farr, MD

Using the familiar arthroscopic approach (typically under local anesthetic), surgeons locate the damaged chondral tissue and trim away or stabilize the area. This prevents the damaged tissue from flaking off, which is often responsible for swelling, joint lining irritation, and pain. This "clean up" is called a chondroplasty. When the injury is less than 1cm (3/8 inch) in diameter, in certain circumstances, it has a lower probability of progressing. For lesions that chondroplasty alone will have a poor probability of helping, the body can be stimulated to produce repair tissue. This repair tissue develops from cells which migrate to the area through small holes made in the bone by abrasion, drilling, or more recently, by using a small pick to create microfractures. This can be thought of as repairing "potholes" in a road. It may not last as long as a normal road, but it is often successful in eliminating symptoms in many patients. Studies suggest this repaired cartilage is fibrocartilage-like (scar cartilage), which is less resistant to wear than normal joint articular (hyaline) cartilage. In the future, a variety of means (for example, local growth factors, pulsed electrical current, or gene regulation) may be used to enhance the marrow stimulation cartilage to a more hyaline-like quality.

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