KNEE ARTHRITIS - Bone marrow stimulation :
to microfracture or not to microfracture - - Posted by TCO (TCO), 7 April 2004
One OS wants to debride with a microfracture. One without. (And a third wants to dbride with a lateral 
).
All 3 would take the biopsy for genzyme for later if needed.
Should I microfracture or not?
Posted by Beauzer (Beauzer), 7 April 2004
Hi,
I had microfracture in 1999. While it doesn't last forever, I got 4 years of good wear with little pain out of the op. My OS at the time, though, didn't believe that you need to be NWB, so that was really the deciding factor for me as I couldn't take that much time off. I know, for me, that the fibrocartilage formed from the microfracture really helped with the pain. That being said, it has almost all worn off now and I need a TKR before too long. I think it was definitely worth it. You may want to check out the post-op section as there is an ongoing discussion by some folks who have recently had microfracture
Good luck,
Danielle
Posted by TCO (TCO), 9 April 2004
I think I am going to get it. Bottom line is that I am sick of seeing different docs. I've seen 5 docs and gotten 5 different recommendations.
http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=PF_joint;action=display;num=1081250505;start=0#4
I think I will just get the frigging microfracture. It worries me that we don't know what caused the lesion. And that we aren't fixing what caused it. Also worries me that the microfracture is painful and that it only lasts a few years.
But what the hell can I do? I've seen top guys now. At least Dr. H. and Dr. T are supposed to be big swinging...knee docs. And they still disagreed. Fookers!
Posted by Beauzer (Beauzer), 9 April 2004
Well, try not to get too frustrated. The disagreement just goes to show that the right answers to a difficult problem (cartilage loss) just arent' known yet. Hey, the options today (genzyme, OATS, etc.) weren't even really available when I started having problems back in 1998, and microfracture wasn't widely done either, so that goes to show how fast stuff is changing and being developed. I wish I was going through all this stuff now, maybe then I wouldn't need a TKR at the age of 29!
Stay positive,
Danielle 
Posted by stgiles16 (stgiles16), 13 April 2004
I had my first microfracture in march 03, didnt work , had second one dec 03. Really hope this one worked. They are a painful surgery and take a while to get over, but Danielle is right, things are progressing so fast that maybe by the time this one wears out there will be something new out there instead of TKR. Good Luck
Missy
Posted by TCO (TCO), 11 May 2004
I talked to the docs (3 and 5) about microfractures. They are not so far apart. I guess one is more agressive/optimistic. One more cautious/pessimistic.
Posted by hmaxwell (Heather M.), 11 May 2004
I don't know if it helps at all, but I just came across this document listing the different ways to treat articular cartilage damage and, more importantly, what the indications are for each one. For example, surgeons who perform microfracture have certain patient selection criteria that are listed here, supposedly to help ensure best outcomes.
It's a pretty good list of your surgical options, and the references list is a who's who in knee surgery. Good further reading there if you can slog through the medical journals.
http://www.physsportsmed.com/issues/2001/05_01/laprade.htm
Heather
Updated Sat Nov 21 2009
