The Knee Surgeon

Articular Cartilage Treatment / Early Arthritis

Microfracture is a surgical technique used to treat articular cartilage defects in joints. It is most commonly employed for small to medium-sized defects and is often performed arthroscopically, which involves using small incisions and a tiny camera (arthroscope) to guide the procedure. Here’s how microfracture works:

  1. Using a specialized tools the surgeon creates multiple small holes (microfractures) in the underlying bone that lies beneath the damaged cartilage. These holes are strategically spaced to encourage blood flow from the bone marrow to the damaged area.
  1. As the bone is exposed, bleeding occurs from the microfractures. This bleeding creates a blood clot in the area of the defect. The clot forms a scaffold for the development of new tissue.

Over time, the blood clot is gradually replaced by a type of tissue called fibrocartilage. Fibrocartilage is not the same as the original hyaline cartilage that covers joint surfaces, but it can provide some degree of cushioning and joint function.

After the surgery, a period of protected or non weight-bearing and physical therapy is typically recommended to allow the newly formed tissue to mature and integrate with the surrounding joint structures.

While microfracture can be effective for small cartilage defects, there are some limitations and potential drawbacks to consider:

The fibrocartilage that forms after microfracture is not as durable or long-lasting as the original hyaline cartilage. It may wear down more quickly, potentially requiring additional interventions in the future.

  • Microfracture is best suited for small defects, typically less than 2 cm in diameter. Larger defects may not respond as well to this technique.
  • Patients often need to adhere to strict weight-bearing restrictions during the initial phases of recovery to prevent excessive stress on the healing tissue.

Microfracture is generally more effective in younger patients, as their bodies are more capable of producing healing tissue in response to the microfracture technique.

  • Long-term follow-up is important to monitor the health of the repaired area and to address any potential issues that may arise.