Microfracture in review: Careful evaluation and patient selection are paramount for treatment of articular cartilage lesions of the knee

Microfracture is a popular treatment option for articular cartilage lesions of the knee due to its cost-effectiveness, minimally invasive approach, and technical simplicity. However, the repair tissue remains limited to fibrocartilage, which is biomechanically inferior to hyaline cartilage. Microfracture requires careful patient selection based on anatomic location, lesion size, patient age, and activity level. Optimal indications are lesions ≤2-3 cm² in high-demand patients under the age of 40 that are less than a year from injury. In addition, post-operative rehabilitation is an important consideration for optimal cartilage repair. Lesion size, location, and concomitant pathology should be assessed when formulating a rehabilitation plan. Separate protocols are established for femoral condylar and patellofemoral lesions. Results for microfracture are predominantly positive, however, long-term durability remains a concern. Studies comparing microfracture to osteochondral autograft transfer and autologous chondrocyte implantation note superior outcomes for these alternative treatments. However, there is still limited long-term data comparing the various cartilage repair techniques. Complications are rare; however, intralesional osseous overgrowth may occur. Augmentation techniques have been developed in order to improve repair tissue quality, including biomaterial scaffolds, growth factors, and stem cells.