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Injuries and Medical Advice

Cartilage Regrowth

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What do you know about “micro fracture” technique? The surgeon said I had no cartilage left in my ankle, so he drilled small holes—“micro fractures”—in the bone to get scar-tissue cartilage to grow. Seems like a miracle procedure.

—DR

Yeah … no! Miracles supposedly happen, but this is not one. The micro-fracture technique causes small amounts of deliberate damage to areas of eroded cartilage to stimulate re-growth. The surgeon drills a bunch of wee little holes into the bone where the synovial cartilage (the shiny material on the joint surface) has worn away. This creates a “super-clot” from which a layer of new cartilage grows.

If beautiful shiny cartilage were to appear, you might consider this a miracle. Unfortunately what you get is a version of cartilage not sporting the same qualities as that of the younger you. If synovial cartilage is a Ferrari, you now have a motorized scooter—it’ll work and get you places, but it will not be the exhilarating ride you once had.

Results are variable, depending not only on where the joint is—knee, hip, ankle—but where on the surface the technique is used and over how much area. Ankles, I’m guessing, comprising a smaller joint surface with incrementally more load, would do less well than larger joints. Most studies I’ve seen are on knees, and there are insufficient studies looking at ankles to make anything but an intuitive call.

[Also Read The Curse of Lumpy: Dupuytren’s Disease]

Although the new cartilage has less resilience than the old version, with failure rates up around 30 percent at 10 years, you just bought yourself some sacred time. At a stage when your grandfather was hanging up his laced boots for a pair of slippers, you are now heading back to the cliff for yet more fun stuff.

Be fully cognizant, however, that this cartilage also has a lifespan, one that is less forgiving of chronic impact load than the original. Taking up running, or continuing to run (especially on hard surfaces) would be a bad idea. Keep it moderate in this regard, but otherwise, hey, knock yourself out.


This article appeared in Rock and Ice issue 260 (November 2019).