Knee > Osteochondral Defect > Treatments

   Arthroscopic Microfracture Drilling

The decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a knee brace, crutches, ice packs or coolers, or a continuous passive motion (CPM) machine. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Most insurance companies require a second opinion before agreeing to reimburse a patient for a surgical procedure. Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

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   What to ask the doctor

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At most medical centers, you will go to "patient admissions" to check in for your arthroscopic surgery for osteochondral defect. If your surgery is going to be inpatient, there may be a separate department, so be sure to ask your doctor. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.

   Since you will most likely be able to go home within a few hours of surgery, and because the anesthetic and pain medications may make you drowsy, arrange for someone to drive you home when you are released.

   Wear a loose pair of shorts or sweatpants with a zipper or buttons on the side that will fit comfortably over a knee brace when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

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   ABC’s of anesthesia

   What to take to the hospital

Arthroscopic microfracture usually takes about 30 to 45 minutes to perform and is normally done on an outpatient basis.

   You will either be put under general anesthesia or be numbed from the waist down with a spinal anesthesia. Physicians insert an arthroscopic awl through tiny incisions. The awl looks like a screwdriver with a pointed end.

   Any frayed cartilage is smoothed over and ground down. To stimulate blood blow, tiny perforations are made in the bone beneath the osteochondral defect, about four to five millimeters apart.

   Incisions are stitched and you are sent to the recovery room.

After surgery for osteochondral defect, you usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and spinal anesthesia may take about two hours to wear off. When you awaken in the recovery room, your knee is usually wrapped in gauze, bandaged, and covered with an ice pack. Patients generally feel a moderate amount of pain, depending on the size of their osteochondral defect. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return and a prescription for pain medicine. You may have significant pain initially and you should take the pain medicine as directed. Remember that it is easier to keep pain suppressed than it is to treat pain once it becomes present. When you feel the pain coming on, take another pill, as long as it is within the time limit on the bottle. You should try to move your feet while you are in the recovery room to improve circulation. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. Physicians generally suggest that you walk with crutches, keeping all weight off your injured leg, for about six to eight weeks. Your knee is usually immobilized in a stiff brace for a short period of time, which varies based on the size of the osteochondral defect. Most patients leave the hospital after two or three hours. As soon as you are fully awakened, you are usually allowed to go home. You will probably be unable to drive a car, so be sure to have arranged a ride home.

Most people spend about seven days at home after their knees are drilled to repair osteochondral defect. Your knee may be partially immobilized in a removable, hinged brace, which may be locked to allow the knee to only bend and straighten a few degrees. This can make movement around the house difficult. Doctors strongly recommend that you avoid any movement that twists your knee. For example, getting your foot stuck under a table leg and twisting around can cause severe pain. Here is what you can expect:

   You will likely feel pain or discomfort for the first few days, and you will be given a combination of pain medications as needed. Many patients may be given a narcotic painkiller and an anti-inflammatory.

   There may be some minor drainage on the bandage since fluid may have accumulated during the surgery. Expect some blood to show through the bandage during the first 24 hours.

   As much as possible, you should keep your knee elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows under your ankle. Icing your knee for 20 or 30 minutes a few times a day during the first two days after arthroscopy also will reduce pain.

   Wait until you can stand comfortably for 10 or 15 minutes at a time before you take a shower. You can probably shower the day after arthroscopy.

   The dressing on your knee is usually removed one day after arthroscopy, during the first follow-up visit. Crutches or a cane may be needed for six to eight weeks.

   Physicians generally recommend that you avoid putting all your weight on the injured knee for about six weeks.

   As soon as possible after surgery, you should begin passive motion exercises either with a physical therapist or using a CPM machine while in bed. Your doctor can arrange to get you a CPM machine for use at home, which helps flex and extend the leg and prevents the joint from becoming stiff due to inactivity.

   For two or three weeks after surgery, you may experience night sweats and a fever of up to 101. Your physician may suggest acetaminophen, coughing, and deep breathing to get over this. This is common and should not alarm you.

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Physicians generally suggest that you progress through rehabilitation slowly after surgery for osteochondral defect. A blood clot that forms around the osteochondral defect needs to stay intact. Too much movement after surgery may hinder the healing process. Your physical therapist can help you learn the proper combination of rest, gentle movement to stimulate blood flow and healing, and light exercises. It is important not to twist or bend in ways that may grind cartilage together until your physician is certain the osteochondral defect has healed. After the osteochondral defect has healed, physical therapy generally helps return healthy young athletes to sports at full strength. Arthritis may complicate the rehab process, especially for older athletes, but the physical therapy program generally recommended by physicians can be broken into three basic phases for everyone:

ON WEIGHT BEARING - UP TO SIX WEEKS

Let the osteochondral defect heal. To restore movement and basic coordination, your physical therapist will help you begin moving your knee and teach you an exercise program to perform on your own.

RESTORING RANGE OF MOTION - ONE TO THREE MONTHS

Rehab progresses into stretching and strengthening exercises that focus on the quadriceps and hamstrings Ð the main stabilizing muscles for your knee. Physicians suggest you gradually increase the amount of weight as your leg muscles get stronger. Strengthening exercises require dedication because results often take weeks and pain may recur.

RETURNING TO ACTIVITIES - THREE TO SIX MONTHS

The focus of rehab turns to increasing your coordination. After a few months of rehab, physical therapy can become activity oriented as you regain the ability to perform complicated movements, using stationary bikes, elliptical machines, and cross-country skiing machines. Once the muscles of your injured leg are about 90 percent as strong as the uninjured leg, you can usually return to activities.

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   Knee strengthening exercises: Cartilage injuries

Adequate leg muscle strength is the best way to keep the bones in your knees from grinding into each other and prevent recurrence of osteochondral defect. Physicians usually suggest that you continue strength training even after your knee has been rehabilitated. Have your physician periodically check your knee. Weight control is also important. One extra pound of body weight translates into three or four pounds of weight across your knee every time you take a step. Lightening the load on your knees helps them to last longer. After an osteochondral defect, you may be at risk of suffering arthritis later in life. Depending on how well your knee heals, you may want to consider cutting back or avoiding repetitive-impact activities, like long-distance running, and contact sports, like football. Many of the exercises and activities that are popular for fitness put stress on your knees. To prevent osteochondral defects it is important to learn knee-sparing exercise techniques by dividing your activities into three components:

   Daily Living - The average person takes between 12,000 and 15,000 steps a day, with each step exerting a force between two and five times your body weight on your knees. After a knee injury, take it easy on your knees during the day whenever possible to save them for activities and exercise. Avoid stairs when there is an elevator, take the shortest path when walking, and consider wearing athletic shoes designed to absorb shock rather than hard-soled shoes.

   Muscle strengthening and conditioning - Activities themselves are not a substitute for conditioning. Your need for special conditioning to prepare for activities increases with age. The best strengthening programs are low-impact and non-weight-bearing, like stationary bikes and certain weightlifting programs, so that the knees do not have to absorb shock.

   Recreation - Sports that require twisting and quick direction changes put great strain on your knee. To prevent injury, stick to light, non-impact activities for your recreation after arthroscopic fragment fixation. If you decide to return to sports like football and basketball, a physician should carefully examine your knee to make sure you have a proper coating of cartilage over your bones.

If pain recurs after rehab, physicians usually suggest you stop your activities and return for a check-up. Pain could be a sign that the fragment has not healed properly. Large osteochondral defects may make it difficult for some people to return to competitive athletic activity.