As we await for the bright lights to begin Round 2 of the 2016 NFL Draft, the big looming medical question on the minds of the football fans is: Will UCLA’s star linebacker Myles Jack’s knee injury negatively impact his career in the NFL and will he need microfracture surgery? Everyone agrees that his knee was the reason he remains un-drafted after the 1st round.

The issue needing clarity relates to the potential need for a microfracture surgery on Myles’ injured right knee. The whispers regarding such a procedure quickly became screams when Myles himself reported that he may require microfracture in the future.

Jack has not played since his September 2015 knee injury that required a repair, not simply a trim, of the lateral meniscus cartilage in his right knee. A meniscus injury is not unusual in football but two key elements make his particular injury concerning to NFL teams.

His injury involves the lateral or outside meniscus. This lateral “compartment” bears more weight than the medial or inner compartment, therefore, it is often more symptomatic when injured. A repaired meniscus is less common for football players compared to the typical “trimming” of a torn meniscus. Only a small area of the meniscus cartilage actually has a blood supply so that is the only part of the tissues that actually has the potential to heal. Repairing the meniscus is wonderful, in theory, because it preserves the all-important meniscus. With that being said, if the repaired cartilage fails to heal or is reinjured, the results are concerning.

Pothole in a Joint…Needing Microfracture Surgery

Unrelated to the meniscus cartilage, the articular cartilage at the ends of bones that come into contact with each other to form the knee joint is smooth and solid. The slick surface of the articular cartilage protects it’s underlying bone, which has both a blood supply and nerves.

When the articular cartilage is damaged, from a high-force trauma or over time with arthritic changes, the articular cartilage can break away exposing the bone to the joint surface. Unprotected and exposed bone in a joint is painful. It often bleeds into the joint resulting in a chronically painful and swollen knee.

A defect in the articular cartilage and bone is similar to having a small pothole in the road. The remainder of the road is fine and you can still drive your car over the hole. Both the size and location of that pothole will ultimately determine how deep and impactful that pothole becomes.

Only when excessive pain and/or impaired function of the joint cannot be controlled by standard physical therapy techniques, will a microfracture procedure be considered as an option. Microfracture surgery is an aggressive procedure and its rehabilitation is extensive. In other words, no one rushes into a microfracture procedure until it is absolutely necessary because the recovery is long and the outcome is undoubtably cloudy.

What is Microfracture Surgery?

Don’t confuse the simplicity of the procedure with the complexity of the healing steps following a microfracture surgery. The surgical procedure is almost barbaric in nature. It consists of picking and drilling into the exposed bone in the base of the articular cartilage “pothole” with one simple objective: promote the bone to bleed to stimulate a healing response.

The healing, stated in very simple terms, consists of the production of a different type of cartilage to fill in the existing hole in the articular cartilage. This new filler is mostly fibrocartilage, similar to the cartilage in your external ears and the tip of your nose. It is not as strong or as smooth as the original articular cartilage. If given ample time and the appropriate physical therapy care, the new pothole filler serves a valuable role. It can improve both the mechanics and the symptoms of the injured knee.

Recovery From NFL Knee Surgery

A common myth with microfracture surgery is a lengthly recovery but the athletes will recovery 100%. I’ve rehabbed dozens of NFL players following microfracture surgery and I can tell you that the first part of that myth is true. The athletes are not allowed to put any weight on the injured leg for 6 to 12 weeks. The rehab protocol is slow and methodical for good reason: the healing of that pothole is #1 factor related to a healthy knee 6 months after the surgery.

As for the outcome, it ranges greatly based on the size of the athlete, the extent of the lesion and the length of time since the initial injury. With that being said, with the players that I have been fortunate enough to rehab following microfracture surgery I have never had a player tell me that he was ever greater than 90% of his pre-injury abilities.

In closing, knee microfracture surgery is a proven technique to improve the function of a damaged joint for high-level athletes like NFL players. It is not an option for every knee injury nor is the decision to perform the procedure ever rushed into. Lastly, when the surgery is performed, the recovery is long and the end results are optimistic yet always in question.