1. Microfracture for chondral defects of the knee Mr S. Kaleel, MRCS; Mr Z.Ahmad, MRCS; Mr S. Daivajna, MRCS; Mr C. Servant, FRCS Department of Orthopaedics, Ipswich Hospital, Ipswich, Suffolk, United Kingdom. Microfracture for chondral defects of the knee Mr S. Kaleel, MRCS; Mr Z.Ahmad, MRCS; Mr S. Daivajna, MRCS; Mr C. Servant, FRCS Department of Orthopaedics, Ipswich Hospital, Ipswich, Suffolk, United Kingdom. Ipswich NHS Trust Introduction Chondral regeneration can occur when provided an appropriate environment for tissue regeneration. Microfracture of the bone releases pluripotent mesenchymal stem cells from the subchondral bone marrow leading to fibrocartilage formation (Steadman) Indications for microfracture treatment(Knutsen) –Full thickness loss of articular cartilage –Unstable cartilage overlying sub-chondral bone –Degenerative joint disease with normal alignment Contraindications (Knutsen): –Malalignment/Instability –Partial thickness loss –Reciprocal lesions –Patient unable or unwilling to comply with rehabilitation –Systemic Inflammatory Arthritis –Clotting disorder Study Aim ● To evaluate the outcome of microfracture treatment for chondral defects. Patients and Methods The patients were prospectively collected are those who were diagnosed with chondral defects between 2005- 2009 Single surgeon series: A total of 41 patients (27 Male: 14 females) with age range of 16-73 had microfracture performed on their knees. We collected the mechanism of injury, compartment involved, BMI, time since injury, compartment, size of injury, and Tegner/Lysholm Scores.  Method: 1.Make curretage of area to remove unstable cartilage. 2.Clear subchondral bone(Fig. 1) 3.Bone is perforated with tapered tool 3mm in diameter and in depth. (Fig. 2) 4.Resulting clot will result in fibrocartilagenous repair.(Fig. 3) Results Age-Tegner Score Age-Lysholm Score Traumatic group: 23 patients 15 femoral compartment 8 patella compartment Age Range: 16 to 58 Degenerative Group: 18 patients 8 femoral compartment 10 patella compartment Age Range: 20-73 Conclusion: Microfracture : Tegner Score stays the same in under 40 year age group. Lysholm improves by 30pts to 73 in younger age group. Lysholm improves in pts with less than BMI 30 in both tibiofemoral group and patello femoral group. Gives symptom relief for chondral defects Is more effective in younger patients and for traumatic lesions References: Steadman 2003 Arthroscopy: Outcomes of Microfracture for Traumatic Chondral Defects of the Knee in under 45 year old patients Knutsen RCT JBJS 2004,2007 ACI vs Microfracture 2yr & 5 yr results Mithoefer: Prospective Cohort; JBJS 2005 The Microfracture Technique for the Treatment of Articular Cartilage Lesions in the Knee. A prospective cohort study. 5. Recovery Protocol: PFJ Protocol: Cyclical exercise Brace - locked to allow 0 - 30° FWB within brace Strength training within range set by brace After 8 wks, wean out of brace Closed chain exercises Return to full activity at 4 months Tibiofemoral protocol: Cyclical exercise Cyclical exercise Toe-touch weight-bearing for 6-8 wks Toe-touch weight-bearing for 6-8 wks Cycling – from 1 to 2 weeks Cycling – from 1 to 2 weeks Deep Water Exercise – from 1 to 2 weeks Deep Water Exercise – from 1 to 2 weeks After 8 wks, FWB and active ROM After 8 wks, FWB and active ROM No cutting, turning or jumping for 3-4 months No cutting, turning or jumping for 3-4 months Distribution of defect: Compartment Treated: Distribution of BMI: Figure 1Figure 2Figure 3