Microfracture
Introduction
Articular cartilage has limited intrinsic healing capacity; microfracture is one of various different cartilage repair strategies.
Marrow-stimulating techniques such as microfracture rely on perforation of the subchondral plate, allowing pluripotential mesenchymal cells to fill the defect and create a hybrid fibrocartilage repair.
Augmentation of microfracture using biologic acellular scaffolds may retain the mesenchymal cells and growth factors at site of defect.
Patient Selection
Microfracture is often the first-line treatment of full-thickness cartilage lesions (Outerbridge grade IV) because of its success, relative ease, and cost-effectiveness.
When unsuccessful, it does not preclude use of other techniques.
Selection criteria are very specific for a successful outcome.
Indications
Lesion size less than 2 cm2is ideal, not exceeding an area of 4 cm2
Location of lesion
Femoral condylar lesion is favorable.
Patellofemoral compartment lesions are less favorable.
Unipolar lesion, well contained
Intact meniscus
Body mass index less than 30 kg/m2and age younger than 40 years associated with better outcomes
Symptomatic lesion
Contraindications
Bipolar lesions
Diffuse degenerative joint disease
Uncorrected malalignment
Patients unable to comply with or fulfill postoperative protocol
Subchondral bone loss or uncontained lesions such as an osteochondral defect
Body mass index over 30 kg/m2and older age
Longer duration of preoperative symptoms is associated with poorer outcomes.
Significant loss of meniscal tissue
Preoperative Imaging
Radiography
Weight-bearing AP, weight-bearing 45° PA, lateral, and Merchant views to assess for loose bodies, arthritis
Long leg alignment radiographs
Assess for angular deformity
Focal lesion with varus malalignment can be treated with microfracture and high tibial osteotomy.
MRI
Cartilage-specific MRI sequences
Proton density–weighted fast spin-echo imaging with or without fat saturation
T2-weighted fast spin-echo imaging with or without fat saturation
T1-weighted gradient-echo imaging with fat suppression
Assess for concomitant meniscal or ligamentous pathology.
 | Video 14.1 Microfracture: Technique and Pearls. Armando F. Vidal, MD (10 min) |
Procedure
Setup/Patient Positioning
General, spinal, or regional anesthesia
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