Clinical Relevance of Chondral Lesions in the Treatment of the ACL-Deficient Knee: Microfracture Technique
Anterior cruciate ligament (ACL) injuries and chondral defects are commonly associated. These chondral injuries can occur simultaneously with the ACL injury or remotely as a secondary injury from instability in the ACL-deficient knee. The literature does not provide clear direction in the management of this combination of injuries. If a chondral injury is encountered at the time of ACL treatment, we recommend that it be treated either concurrently or separately in a staged procedure. Despite a number of procedures described in the literature for chondral defects, our procedure of choice is microfracture. Microfracture is an economical, straightforward technique with a proven track record. The steps of the procedure and the associated rehabilitation process are critically related to one another, and all steps must be followed as described. The goal is to provide the optimal environment for the body’s own progenitor cells to make the reparative tissue in the defect. Over a course of 30 years, our experience with microfracture has developed and evolved through both basic science and clinical research. We have shown excellent results in treating patients with microfracture when the technique and rehabilitation are followed rigorously.
KeywordsAnterior Cruciate Ligament Anterior Cruciate Ligament Reconstruction Anterior Cruciate Ligament Injury Chondral Lesion Continuous Passive Motion
- 11.Lewis PB, Nho SJ, Colton AE, et al. Overview and first-line treatment. In: Cole BJ, Busam ML, editors. Surgical management of articular cartilage defects in the knee. Chicago: AAOS; 2009.Google Scholar
- 17.Rodrigo JJ, Steadman JR, Silliman JF, et al. Improvement of full-thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion. Am J Knee Surg. 1994;7:109–16.Google Scholar
- 18.Røtterud JH, Risberg MA, Engebretsen L, et al. Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2–5 years follow-up. Knee Surg Sports Traumatol Arthrosc. 2011. doi: 10.1007/s00167-011-1739-y [Epub ahead of print].