The words “microfracture surgery” rank among the scariest in sports medicine ever since Dr. Richard Steadman began performing the procedure several decades ago. Microfracture surgery has altered the careers of multiple professional athletes, particularly in the NBA. The most infamous example of microfracture occurred in 2005 when All-Star forward Amar’e Stoudemire underwent the procedure while a member of the Phoenix Suns. Given that the same knee prevented the Knicks from receiving insurance on Stoudemire’s $100 million contract, it was easy to understand the panic amongst Texas Rangers fans when it was revealed pitcher Derek Holland recently underwent microfracture surgery on his left knee.
Holland initially injured the knee when he was tripped by his pet dog Wrigley. Rangers team surgeon Dr. Keith Meister performed the arthroscopic procedure late last week and the team later confirmed microfracture was needed. However it should be noted that not all microfracture surgeries are equal.
Microfracture is a technique and not a specific surgery like Tommy John surgery. It generally carried out when damage has been sustained to the articular cartilage of the knee but it can be performed on other joints including the ankle. In the case of Stoudemire the injured cartilage was located on the proximal surface of one of the two lower two leg bones. However, occasionally the procedure will also be carried out on the kneecap when the cartilage surrounding an athlete’s kneecap, the patella, is damaged. This appears to be what happened in Holland’s fall.
When performing the microfracture technique, the surgeon begins by cleaning and prepares the cartilage near and at the injury site. Then tiny cracks or “microfractures” are created in the bone with a surgical tool called an awl. In response to the surgeon-created fractures, the body natural defense mechanisms begin to create a marrow-filled blood clot to begin fixing the damaged cartilage. After time, the damage is repaired and replaced with new cartilage. While the replacement cartilage is not as strong and durable as the original cartilage, it is effective enough to allow a return to activity.
The average recovery time for the surgery depends on the location of the procedure and the size of the area repaired. If a repair is done to a weight-bearing bone like the tibia or fibula the athlete will likely not return to play for at least six to eight months with rehab and recovery often extending longer. If a patellar repair is carried out, the recovery time may be slightly reduced and an athlete can return four months later. However it may take six months for a complete return and a brace will likely be worn for the majority of those six months.
Microfracture has become a common place in professional sports with a majority of the cases coming from the NBA. Stoudemire, Jason Kidd, Anfernee Hardaway, Kenyon Martin, and Greg Oden are just a few of the players to have undergone the procedure. In the NFL the list includes Reggie Bush, Anthony Spencer, and receiver Marques Colston. Like Holland, Colston required the surgery in both kneecaps and didn’t miss anytime recovering from both procedures in less than six months.
The results in baseball have been mixed as Grady Sizemore, Brian Giles, and Victor Martinez all had varying amounts of success following microfracture. Yet it’s hard to base Holland’s recovery time on these examples as comparing pitchers and positional players is difficult. Even using former Ranger pitcher Scott Feldman’s eight month recovery from the procedure as a gauge for Holland is problematic as Feldman’s repair was to his femur. The projected six months provided by Texas seems like a realistic estimation with a slight chance of an early return especially with one of the best medical staffs in baseball at his disposal. Keep in mind Holland will need time to get his shoulder prepared even if he receives early clearance on his knee. Still the facts suggest that Holland will be back this season despite the left-hander being linked to one of the more feared surgeries in professional sports.