Microfracture is a surgical procedure where a tiny 'pick' is used to spike holes through damaged joint cartilage into the bone below with a view to stimulating bleeding and formation of new fibrocartilage.

Page updated October 2023 by Dr Sheila Strover (Clinical Editor)


The rounded end of the femur, where the joint cartilage has worn away to show the yellowish bone. You can see the pick holes of microfracture piercing through the base plate of the cartilage.


The pick has a long stem and is driven in via the keyhole by the surgeon from the outside of the joint using a small hammer.


How does microfracture work?

The procedure allows migration of marrow cells into the resultant clot, thus facilitating new fibrocartilage formation to cover the defect. The technique was first proposed by Dr Richard (Dick) Steadman, and is one of a group of procedures now referred to as 'marrow stimulation techniques'. The procedure is losing way to nanofracture using a needling device that creates narrower holes, together with augmentation with other regenerative methods such as the injection of stem cells, microfragmented fat or paste grafts.

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Pain after microfracture

Rehabilitation after microfracture can be a challenge. The procedure is quite painful and the joint surface has to be protected by non weight bearing until fibrocartilage covers the defect.

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Forum discussions

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Peer-reviewed papers

  • Microfracture

    Citation: Steadman JR, Rodkey WG, Briggs KK. Microfracture: Its History and Experience of the Developing Surgeon. Cartilage. 2010 Apr;1(2):78-86. doi: 10.1177/1947603510365533. PMID: 26069538; PMCID: PMC4297044.


    "Patient compliance with rehabilitation, knee alignment, and the depth of the cartilage rim surrounding the lesion are a few of the factors that can affect the outcomes following microfracture."

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Dr Sheila StroverĀ (Editor)
BSc (Hons), MB BCh, MBA

See biography...

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