Microfracture and microfracture plus techniques in the knee

Chapter synopsis

Microfracture is a safe, minimally invasive, technically simple, and cost-effective marrow stimulation technique that provides effective short-term functional improvement of small to medium cartilage defects. Appropriate indications, attention to surgical detail, and well-structured rehabilitation help to optimize the outcome from this cartilage repair technique. Shortcomings include limited hyaline repair tissue, variable repair cartilage volume, subchondral bone changes, functional deterioration in some patients, and unclear long-term efficacy. Despite its limitations, microfracture is still the most frequently used cartilage repair technique. Relatively novel, microfracture plus techniques are being increasingly utilized in order to address the above shortcomings, with a growing body of evidence to support favorable outcomes.

Important points

• Indication: Symptomatic cartilage lesions of the femur, patella, and tibia smaller than 2 cm ² .

• Technical steps: Debridement, calcified cartilage removal, systematic microfracture from periphery with use of a spiral pattern, leaving 3–4 mm between individual microfracture holes. Alternatively, micro-drilling using a designated device may be used. Following microfracture, augmentation with substances that promote cartilage restoration may be performed (“microfracture plus”).

• Individualized rehabilitation addresses unique defect characteristics and associated pathology.