I also happened to mention that, in support of microfracture, it’s the less extensive surgery that the NBA pros -- who could afford any kind of procedure -- choose.
So recently, along comes this article featuring the NBA’s Greg Oden, a superstar talent felled at a young age by a pair of bad knees, that claims that doctors are moving away from microfracture to fix cartilage defects in NBA players. Among the alternatives, besides ACI: OATS (osteochondral autograft transfer, for small tears), platelet-rich plasma therapy and the Orthokine procedures that Kobe Bryant popularized that are similar to platelet-rich plasma therapy.
It’s certainly true that one or even all of these treatments may be superior to the old-fashioned microfracture, but a few points:
* The knees of NBA players take an epic amount of abuse. It’s important to appreciate that from the outset. It’s not just the jumping and running, but also the diving for loose balls, colliding with opponents in the normal course of play, making quick shifts in direction, etc.
* With that in mind, when someone writes, “the history of microfracture, especially among NBA players, has been dotted with success stories ... and failures,” I wouldn’t take that as necessarily an indictment. I’d be surprised if any knee operation ever had a 100 percent success rate, or even close to it, for such a subject population: too-tall men who bang their knees really hard every two or three days.
* The article tells us the problem is that the microfracture process (in which holes are drilled in bone, which creates bleeding that results in a new layer of cartilage) leads to rubbery fibrocartilage, not the good sort of hyaline articular cartilage. True, but interestingly enough, that fibrocartilage after a while can begin to take on characteristics of normal cartilage. In a study published in Arthroscopy in April 2006, researchers who took biopsies to inspect the cartilage that was formed after a microfracture observed that "this healed tissue is a combination, or hybrid, of fibrocartilage and hyaline-like cartilage."
So is fibrocartilage more of an intermediary state on the way to some form of cartilage that, if not normal, is at least much more normal in function and characteristics? Or what does fibrous cartilage created by a microfracture look like after 20 years, in a well-cared-for knee?
I don’t know. But I suspect that the answer may surprise some people who are critical of the procedure.