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 May 2024 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.
What is the principle behind microfracture?
Microfracture allows migration of marrow cells - which have the potential to reproduce and differentiate - into the resultant clot, thus facilitating new fibrocartilage formation to cover the defect.
The procedure is losing way to nanofracture - which uses 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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Quote from peer-reviewed paper:
"....The quality of cartilage repair following microfracture is variable and inconsistent...Younger patients have better clinical outcomes....patients with lesions of the femoral condyle have the best clinical improvements....smaller lesions have better clinical improvement...."
Citation: Erggelet C, Vavken P. Microfracture for the treatment of cartilage defects in the knee joint - A golden standard? J Clin Orthop Trauma. 2016 Jul-Sep;7(3):145-52. doi: 10.1016/j.jcot.2016.06.015. Epub 2016 Jun 28. PMID: 27489408; PMCID: PMC4949407.
Rehabilitation 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.
This means several weeks on crutches.
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Quote from peer-reviewed paper:
"....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..."
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.
How effective is microfracture as a cartilage repair procedure?
Microfracture gives variable results.
Because of the long period of essential non-weight-bearing patients can get very frustrated, and accidents may happen to damage the fragile fibrocartilage.
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Quote from peer-reviewed paper:
"....Clinical outcomes improve with microfracture for the most part, but in some studies these effects are not sustained. The quality of cartilage repair following microfracture is variable and inconsistent due to unknown reasons....."
Citation: Erggelet C, Vavken P. Microfracture for the treatment of cartilage defects in the knee joint - A golden standard? J Clin Orthop Trauma. 2016 Jul-Sep;7(3):145-52. doi: 10.1016/j.jcot.2016.06.015. Epub 2016 Jun 28. PMID: 27489408; PMCID: PMC4949407.
Forum discussions
- Trochlear Groove Microfracture
Experienced forum members discuss the first few weeks of rehabilitation after microfracture surgery.
- Hugh's microfracture diary
Talking about reasons for talking rehab slowly after microfracture..
- 16.5 Months Later - I am happy and active
A discussion about progress a year and a half after microfracture.
- I accidentally stepped on my foot 4 weeks after microfractures surgery..
An anxious patient is concerned about weight-bearing after microfracture.
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See also -
2016 - Surgical cartilage repair for knee osteoarthritis - part of a Primer on Osteoarthritis management options - by Dr Sheila Strover (Clinical Editor)
2008 - Course -
eBook - Knee arthritis interventions when you are too young for a total knee replacement
Written by Dr Sheila Strover (Clinical Editor) and free to download.