ACI vs. Microfracture, Revisited

I originally wrote this post, which garnered a good deal of attention, about these two procedures.

I said that if forced to choose between the two, I’d rather have the less-invasive (and less-expensive) microfracture, which may even be more effective. In the comments section, several people disagreed. One commenter said that, over the long-term, ACI (or autologous chondrocyte implantation) leads to a better result.

Uh, maybe not.

This study (published in August in the reputable Journal of Bone and Joint Surgery) looked at large lesions treated with either ACI or microfracture. The 80 subjects were evaluated after 15 years (a suitably long timeframe, I think all would agree).

Check out the highlights:

* There were 17 failures in the ACI group compared with 13 for those who had microfractures.

* Total knee replacements: six in the ACI group, three in the microfracture.

* X-ray evidence of early osteoarthritis: 57 percent in the ACI group vs. 48 percent in the microfracture.

Luckily I don’t have to choose between either. But if I did, I think I’d stick with my original answer.

Knee Pain and the Weather

Here’s a rather in-depth article about the relationship between pain and weather. The authors pored over a lot of different studies to reach their conclusions. Which are ...

That the link betwen the two is unclear. Actually, to be more accurate, it appears rather weak.

They looked at a number of painful physical conditions, from arthritis to migraine pain. I’m going to stick with the osteoarthritis end of things, as that’s what those of you with bad knees care most about.

Why should the weather influence perceptions of knee pain in the first place? Some theories:

* When bad weather moves in and barometric pressure drops, the surrounding air pushes on the joint with less force, allowing tissues to expand and causing uncomfortable pressure.

* Or, an alternative theory is changes in barometric pressure “may augment cytokine pathways.” More cytokine activity may damage host cells.

* A combo of rain, cold temperatures, and low pressure may cause pain by increasing swelling in the joint.

I encourage you to read the whole article, if you want more. I’m going to jump to the conclusion and in particular this line.

Studies that typically report the strongest correlation between meteorological phenomena and onset of pain are often poorly designed, utilizing self-report mail surveys and small sample sizes, not blinding participants to the research hypotheses, or relying on subjective memory recall.

Okay, that’s not hopeful if you’re trying to prove a connection between weather and pain. Still, the authors note that the issue is far from settled. At the least, certain individuals could be more sensitive to changes in the weather.

I’m not sure myself. I did think my knees were a bit crankier in Hong Kong when a big storm was nearing. And weather effects on one level make sense to me: the lousier the weather, the more likely you are to be unhappy, and there is a definite link between depression and pain.

What about everyone out there? Do changes in the weather affect how your knees feel?