A microfracture is when tiny holes are made surgically into a damaged area of cartilage in the knee to stimulate healing.

Cartilage: There are 2 main types –

1. Menisci: Disc shaped fibrous cartilage situated between the femur and tibia. They provide stability, act as shock absorbers, lubrication and allow equal weight distribution.
2. Articular Cartilage: This covers the end of the bones and allows them to move smoothly against each other with less friction. It also helps spread the load applied to the joint.

Damage to the articular cartilage can be caused by trauma which can lead to pain, swelling, locking and giving way. Articular cartilage does not have its own blood supply and therefore has limited capacity to heal.

The holes from the microfracture cause bone marrow to come to the surface and form a clot over the area being treated. The bone marrow contains cells which make new cartilage to cover damaged area. The new cartilage is not as strong as your natural cartilage but it gives a coating to the area which was previously bare.

The procedure is performed during an arthroscopy which is generally done as a day case.

All operations involve an element of risk. Those involved for a microfracture will be discussed with you by Mr Jackson and include:

• Infection (<1%).
• Blood clots also known as a deep vein thrombosis (DVT) and pulmonary embolus (PE) (<1%).
• Numbness of the skin around the wounds and particularly down the inside of the shin (this is usually temporary and occasionally permanent).
• Nerve or vessel damage.

• On admission you will check in at the reception area and be asked to confirm your details for your medical file. A member of the admissions department will accompany you to the day ward waiting area.
• A member of the nursing staff will bring you into the ward. They will complete all the required checks (blood pressure, pulse, etc), allergy status to any medications, medical and surgical history. It is important to give the nurse as much detail as possible regarding your current medical status and if any previous issues with anaesthetics.
• You cannot eat or drink anything for 6 hours prior to surgery so you will generally be fasting from midnight (for a morning operation) or 6am (for an afternoon operation). This includes chewing gum.
• An anaesthetic nurse will complete your anaesthetic checklist on the ward and accompany you to theatre.
• You will meet Mr Jackson and the anaesthetist in the anaesthetic room prior to the operation. The anaesthetist will again ask you all the same questions as the nurse and anaesthetic nurse completed on the ward to ensure all information has been provided.
• Once the surgery has been completed, you will wake up in the recovery room and will return to the ward after a period of time.
• Once post operative checks (blood pressure, pulse, wound, diet) have been completed by the nurse, a physiotherapist will explain exercises that are to be completed at home and provide confidence for using the crutches. A member of the nursing staff will change your dressing id required and provide documentation for discharge. This will include a prescription and wound instructions.
• Mr Jackson and his practice nurse will come speak to you on the ward prior to discharge.

Length of stay is a day case procedure generally 6 hours.

Return to driving is generally recommended once you are off the crutches and feel can safely make an emergency stop.

Flying is not recommended for 6 weeks after surgery (particularly long haul flights of >4 hours) to minimise the risk of a deep vein thrombosis.

Wound is generally closed with steristrips (paper stitches). This will be clarified by nursing staff on discharge. These can be removed 12-14 post operatively. You do NOT need to attend your gp for removal of steristrips.

Showering is not permitted until 24 hours after surgery. Cling film can be used to keep the dressing dry.

Returning to work will be discussed with Mr Jackson at your consultation / after surgery on the ward.

You are required to have someone come collect you after the surgery. The anaesthetic remains in your system for 24 hours and can inhibit your ability to function normally for this period.

• The follow up appointment, is at 2 weeks. You will meet Mr Jackson’s specialist physiotherapist and practice nurse.
• The physiotherapist will examine the movement of the knee and provide guidance on the next stages of rehab.
• The practice nurse will assess the wound, pain management and provide reassurance in relation to any queries.
• At your 2 week appointment, the subsequent consultation with Mr Jackson will be arranged.