Cartilage Repair: Microfracture Surgery Explained

Introduction to Cartilage Repair & Microfracture Surgery

Cartilage damage is a common issue, especially among athletes and older adults, leading to pain, stiffness, and reduced mobility. Unlike other tissues, cartilage has limited self-healing ability due to its lack of blood supply. This is where microfracture surgery comes in—a minimally invasive procedure designed to stimulate cartilage regeneration.

Microfracture surgery is often recommended for patients with localized cartilage defects, particularly in the knee. By creating tiny fractures in the underlying bone, the procedure encourages the growth of new cartilage-like tissue. While not a perfect replacement for natural cartilage, it can significantly reduce pain and improve joint function.

Did You Know? Microfracture surgery was pioneered in the 1980s and has since helped countless athletes, including NBA players, return to their sports.

In this guide, we’ll explore how microfracture surgery works, who it’s best suited for, recovery expectations, and alternative treatments. Whether you're considering this procedure or just researching options, this article will provide the insights you need.

What is Microfracture Surgery? (Procedure Overview)

Microfracture surgery is an arthroscopic procedure used to repair damaged articular cartilage—the smooth, white tissue covering the ends of bones in joints. Unlike total joint replacement, microfracture is a joint-preserving technique that promotes the body’s natural healing response.

During the procedure, a surgeon uses a small tool called an awl to create tiny holes (microfractures) in the bone beneath the damaged cartilage. These holes release bone marrow cells, which contain stem cells and growth factors. Over time, these cells form a "super clot" that develops into fibrocartilage—a scar-like cartilage that helps restore joint function.

Key aspects of microfracture surgery include:

While fibrocartilage isn’t as durable as natural hyaline cartilage, microfracture can delay or even prevent the need for more invasive surgeries like knee replacement.

Who Needs Microfracture Surgery? (Indications & Eligibility)

Microfracture surgery isn’t for everyone. Ideal candidates typically have:

Common patient profiles include:

Note: Smokers, obese patients, or those with advanced arthritis may not be good candidates due to slower healing and higher failure rates.

A thorough evaluation by an orthopedic surgeon—including MRI scans—helps determine if microfracture is the right choice.

How Does Microfracture Surgery Work? (Step-by-Step Process)

Microfracture surgery follows a precise sequence:

  1. Anesthesia: General or regional anesthesia is administered.
  2. Arthroscopic Access: The surgeon makes 2–3 small incisions and inserts a camera (arthroscope).
  3. Debridement: Damaged cartilage is carefully removed, exposing the underlying bone.
  4. Microfracture Creation: Using a specialized awl, the surgeon creates tiny holes (~3–4mm apart) in the bone.
  5. Clot Formation: Bone marrow seeps out, forming a clot that eventually matures into fibrocartilage.
  6. Closure: Incisions are closed with sutures or steri-strips.

The entire procedure takes 30–90 minutes, depending on the defect size. Patients typically leave the hospital the same day with crutches and a customized rehab plan.

Benefits & Success Rates of Microfracture Surgery

When successful, microfracture offers:

Success rates vary based on:

Studies Show: About 75% of patients see significant improvement within 1 year, but results may decline after 5+ years due to fibrocartilage wear.

Risks & Possible Complications

While generally safe, microfracture surgery carries risks like:

To minimize risks:

Discuss your medical history with your surgeon to assess personal risk factors.

Recovery Timeline & Post-Surgery Care

Recovery is phased and requires patience:

Pro Tip: Use a continuous passive motion (CPM) machine early on to improve cartilage formation.

Adhering to your surgeon’s rehab plan is crucial—the new cartilage needs time to mature.

Alternatives to Microfracture Surgery

If microfracture isn’t suitable, consider:

Your surgeon will recommend options based on your age, activity level, and damage extent.

Final Thoughts: Is Microfracture Surgery Right for You?

Microfracture surgery can be a game-changer for the right candidate—offering pain relief and delaying more invasive procedures. However, its success hinges on:

If you’re considering microfracture, consult an experienced orthopedic surgeon to discuss your unique case. With the right approach, you could be back on your feet—and back to doing what you love.