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Canadian Orthopedic Surgeons Differ Greatly in Their Approach to Microfracture Knee Surgery

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Canadian Orthopedic Surgeons Differ Greatly in Their Approach to Microfracture Knee Surgery Canadian orthopedic surgeons differ greatly in their approach to microfracture knee surgery What is this research about? What did the researchers do? Cartilage is the flexible connective tissue that The researchers reviewed studies on micro- separates bones in joints, providing a nearly fracture knee surgery before 2011 to identify frictionless surface. Accidents and aging can all factors that were associated with better sur- damage the stability of the knee, which results gery results. Patient factors included age, body- in increased friction and further breakdown of mass index, location of injury, and pre-surgery the cartilage. Defects in the cartilage surface physical activity level. Surgery factors included can be difficult to treat since cartilage has a the surgical tools used, post-surgery exercise poor capacity for self-repair and regeneration. limitations, and whether or not the calcified In a treatment method called microfracture (hardened) cartilage was removed. On the ba- surgery, an orthopedic surgeon drills small sis of these factors, a survey was created and holes into the bone marrow beneath the carti- sent by email to all members of the Canadian lage, which encourages stem cells to fill the Orthopedic Association (COA), which asked gap in cartilage. Stem cells have the ability to how they decided which patients should have become any cell in the body, including chon- microfracture surgery, and how they per- droblasts (cartilage cells). Microfracture sur- formed this surgery. gery is easy to perform, inexpensive, and elim- inates the need for a second surgery. Unfortu- nately, with microfracture the original smooth, articular cartilage is replaced by What you need to know: denser and tougher fibrocartilage scar tissue. Since the number of stem cells in bone mar- Canadian orthopedic surgeons varied greatly in row decreases with age, microfracture sur- terms of how patients were selected for micro- gery may also be less effective in older adults. fracture surgery of the knee, which surgical tech- niques were used, and what post-surgery pro- Little research has been done to compare how grams were prescribed. Sport medicine surgeons microfracture is performed by different sur- were more likely than non-sports medicine sur- geons. geons to use practices supported by current evi- dence. Project supported by: A program of the OMAFRA-U of G Partnership. What did the researchers find? About the University of Guelph Of 299 completed surveys, 131 surgeons re- researcher: ported regularly performing microfracture of the knee. 41% of surgeons had no upper age Mark Hurtig is a Professor in the Department of limit, while 34% only performed surgery on Clinical Studies in the Ontario Veterinary Col- patients less than 50 years of age. 88% of lege at the University of Guelph. Email: surgeons had no upper body-mass index lim- [email protected]. it. Although the technique is known to im- rticle citation: prove results of the surgery, 31% of sur- A geons did not remove the calcified cartilage Theodoropoulos, J., Dwyer, T., Whelan, D., before creating holes in the bone. After sur- Marks, P., Hurtig, M., & Sharma, P. (2012). Mi- gery, only 11% used a continuous passive crofracture for knee chondral defects: a survey motion (CPM) physical therapy machine, and of surgical practice among Canadian orthope- 39% did not limit weight-bearing activities dic surgeons. Knee Surgery, Sports, Traumatol- such as standing and walking. Sports medi- ogy, Arthroscopy. [In press] DOI: 10.1007/ cine surgeons were more likely to follow rec- s00167-012-1925-6 ommended surgical practices. Cite this work: How can you use this research? University of Guelph, Institute for Community Orthopedic surgeons can use this research Engaged Scholarship (2013). Canadian ortho- to better their understanding of the factors pedic surgeons differ greatly in their approach relating to patient selection, surgical tech- to microfracture knee surgery. Retrieved from: nique, and post-surgery care that influence http://hdl.handle.net/10214/6534 the success of microfracture surgery. Stand- ardization is needed. This summary is a project of the Institute for Medical scientists can further this research Community Engaged Scholarship (ICES) at the by identifying which patients are best suited University of Guelph, with project partners: for microfracture surgery, as well as which the Catalyst Centre, SPARK Program at the surgical techniques and post-surgery care University of Guelph, and the Knowledge Mo- programs lead to the best results. This infor- bilization Unit at York University. This project mation can be used to make best-practice rec- is part of the Pan-Canadian Research Impact ommendations to surgeons. Network. http://www.csahs.uoguelph.ca/pps/clear_research Keywords: Knee, cartilage, microfracture surgery, chon- dral defect, chondral injury, orthopedics This work is licensed under the Creative Commons Attribution-NoDerivs 3.0 Unported .
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