Orthopedics Hip & Knee Surgical Procedures Microfracture Surgery for Cartilage Damage By Jonathan Cluett, MD Jonathan Cluett, MD LinkedIn Twitter Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial process Updated on July 21, 2022 Medically reviewed by Stuart Hershman, MD Medically reviewed by Stuart Hershman, MD LinkedIn Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction. Learn about our Medical Expert Board Print Microfracture surgery is a treatment option that can help repair areas of damaged cartilage. If you have a small area of cartilage damage (not widespread arthritis), microfracture surgery may help stimulate new cartilage growth. While it is most commonly performed for knee joint problems, it can also be used effectively for problems in other joints in the body. It has also been used for treatment in other joints including the hip, ankle, shoulder, elbow, and other joints. LEONELLO CALVETTI / Getty Images What Is Microfracture Surgery? A microfracture procedure creates small holes in the bone. The surface layer of bone, called the subchondral bone, is hard and lacks good blood flow. By penetrating this hard layer, a microfracture allows the deeper, more vascular bone to access the surface of the joint. This deeper bone has a rich blood supply, and the cells can get to the surface layer to stimulate cartilage growth. How Does it Work? This procedure allows blood and stem cells to form a clot in the area of the cartilage defect. These cells have the ability to form a cartilage layer within the defect. In this way, the body is able to repair the damaged area of cartilage by stimulating blood flow to the defect. Can Stem Cells Replace Lost Cartilage? Who Is a Good Candidate for Microfracture Surgery? There are some factors that can determine whether you are likely to experience a good outcome from having microfracture surgery. Good Candidate Limited areas of cartilage damage Has pain and swelling due to cartilage damage Physically active but cannot participate in sport because of the damage Not a Good Candidate Has widespread arthritis Has joint misalignment or instability Is inactive Has inflammatory arthritis (such as rheumatoid arthritis) Is unwilling to participate in rehabilitation Alternatives Microfracture surgery is generally considered the first-line treatment for cartilage damage in the knee joint. Before deciding to have microfracture surgery, you and your surgeon will discuss other treatments for cartilage defects, such as cartilage transfer and cartilage implantation. The success of these surgical options has been shown to be no better than microfracture, while the risks and costs of microfracture are dramatically less. Some of these other surgical options are generally done for athletes who have failed to improve after microfracture surgery. Cartilage Regeneration and Osteoarthritis Procedure A microfracture can be performed as part of arthroscopic knee surgery. Other joints can be treated similarly, also by arthroscopic surgery. During the procedure: First, the area undergoing microfracture is prepared by removing any loose or damaged cartilage.The area undergoing microfracture should be less than about 2 centimeters in diameter and have good, healthy surrounding cartilage.A small, sharp pick (awl) is used to create the small microfracture holes in the bone.The number of microfractures created depends on the size of the joint being treated. Most people with a 1- to 2-centimeter area of damage require five to 15 small microfracture holes in the bone. Recovery and Rehabilitation One of the keys to successful treatment is appropriate rehabilitation following microfracture surgery. Rehabilitation must protect the area treated by microfracture while maintaining the strength and motion of the knee joint. Most people need to use crutches after surgery. Often, a knee brace will be recommended. And in some situations, a motion machine to bend the knee may be used. Microfracture surgery of the knee is a safe procedure with minimal risks. Persistent pain despite surgical intervention is the main concern. Other more severe complications, such as infection, blood clots, and swelling, are uncommon. Outcomes and Limitations Microfracture can be an excellent procedure, providing substantial pain relief. One of the concerns with microfracture is that it does not stimulate the growth of normal joint cartilage. There are many types of cartilage, and one of these (hyaline cartilage) is normally found on the joint surface. Microfracture stimulates the growth of another type of cartilage commonly found in scar tissue (called fibrocartilage). Unlike hyaline cartilage, fibrocartilage does not have the same strength and resiliency as cartilage normally found in a joint. Therefore, there is a chance that the cartilage stimulated by a microfracture procedure will not stand up over time. Interesting Facts About Cartilage Because microfracture stimulates a less resilient form of cartilage, the long-term results are often unsatisfactory. Over time, people who undergo this procedure may end up experiencing significant progression of arthritis. A Word From Verywell Microfracture surgery is popular because it is safe, relatively easy to perform, and comparatively inexpensive to other cartilage stimulation surgical procedures. In general, people who undergo microfracture surgery do reasonably well in the short to mid-term. There are questions, however, about the durability of microfracture repair, and most surgeons agree that the cartilage that heals within a microfracture defect is not nearly as durable as normal cartilage. 4 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Steadman JR, Rodkey WG, Briggs KK. Microfracture: Its History and Experience of the Developing Surgeon. Cartilage. 2010;1(2):78-86. doi:10.1177/1947603510365533 Kraeutler MJ, Belk JW, Purcell JM, McCarty EC. Microfracture versus autologous chondrocyte implantation for articular cartilage lesions in the knee: A systematic review of 5-year outcomes. Am J Sports Med. 2018;46(4):995-999. doi:10.1177/0363546517701912 Strauss EJ, Barker JU, Kercher JS, Cole BJ, Mithoefer K. Augmentation strategies following the microfracture technique for repair of focal chondral defects. Cartilage. 2010;1(2):145-152. doi:10.1177/1947603510366718 Niemeyer P, Schubert T, Grebe M, Hoburg A. Treatment costs of matrix-associated autologous chondrocyte implantation compared with microfracture: Results of a matched-pair claims data analysis on the treatment of cartilage knee defects in Germany. Orthop J Sports Med. 2019;7(12):2325967119886583. doi:10.1177/2325967119886583 Additional Reading AMATuan RS, Chen AF, Klatt BA. Cartilage regeneration. J Am Acad Orthop Surg. 2013;21(5):303–311. doi:10.5435/JAAOS-21-05-303 Niemeyer P, Schubert T, Grebe M, Hoburg A. Matrix-associated chondrocyte implantation is associated with fewer reoperations than microfracture: Results of a population-representative, matched-pair claims data analysis for cartilage defects of the knee. Orthop J Sports Med. 2019;7(10):2325967119877847. doi:10.1177/2325967119877847 By Jonathan Cluett, MD Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit