Microfracture

Written by Dr Sheila Strover on March 14, 2025

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.

Photograph of the articular surface of the femur after a microfracture procedure, showing the small pick holes in the joint surface
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.
Illustration of the front of the knee, with microfracture being performed by a pick.
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 in popularity 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.

"....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...."

Christoph Erggelet et al

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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.

"....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..."

J Richard Steadman et al

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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.

"....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....."

Christoph Erggelet et al

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A-Z Keywords -

Flowchart -

Dr Sheila Strover - 2018 - Arthritis flowchart

Primer -

Dr Sheila Strover - 2016 - Part 5 of a Primer on Osteoarthritis Management Options - Surgical cartilage repair for knee osteoarthritis

Course -

Dr Karen Hambly - 2008 - Course on Articular Cartilage Repair

eBook -

Dr Sheila Strover - Knee arthritis interventions when you are too young for a total knee replacement

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