microfratture

Microfratture, also known as microfracture, is an arthroscopic surgical technique used to treat focal articular cartilage defects. It aims to stimulate the growth of repair tissue by creating small perforations in the subchondral bone beneath the damaged cartilage, allowing bone marrow elements to access the defect.

During the procedure, damaged cartilage is debrided to create stable edges. Using an awl or similar instrument, small holes are made in the underlying subchondral bone at regular intervals. Blood and marrow cells enter the defect and form a clot that differentiates into fibrocartilage, which fills the defect.

Indications include symptomatic focal chondral defects of the knee (and to a lesser extent the ankle and hip) in younger patients with adequate joint stability and no advanced osteoarthritis. Contraindications include large or diffuse cartilage loss, malalignment, ligament instability, generalized osteoarthritis, and poor general health or smoking.

Postoperative rehabilitation emphasizes protection of the repair with bracing and gradual return of motion, followed by staged weight-bearing. Non-weight bearing or limited weight bearing is usually required for several weeks, with progressive range of motion, then a gradual return to activity over several months. Return to high-impact activities is typically limited for some time.

Outcomes are generally favorable for small defects and younger patients, with improvements in pain and function reported within months. However, the repair tissue is fibrocartilage, which is less durable than native hyaline cartilage, and long-term durability can be limited. Results decline with larger defects or older age, and many patients may require additional cartilage restoration procedures.

History: Microfratture was developed and refined in the 1990s and popularized by the work of Richard Steadman and colleagues.