Microfracture techniques in the treatment of osteochondral injuries

In our quest to relieve musculoskeletal pain and suffering with its attendant loss of function, orthopaedists have made numerous attempts to restore the integrity of articular cartilage. Open surgical debridement with drilling of the defect had many advocates in the 1950s.(21) Clinical results were variable and not well documented. Many other means of achieving a resurfacing of the "exposed bone" of full-thickness chondral defects have been proposed over the years since. Periosteal and perichondral flaps,(18) cultured chondrocytes,(5) osteochondral allografts,(10) osteochondral autografts,(3, 19) total or partial joint replacements, fibrin clot stimulation,(20) growth factors,(13) osteotomy with or without any of the above,(7, 17) synthetic implants,(8) electrical stimulation,(6) and arthroscopic drilling, abrasion, and microfracture all have their advocates.(1, 9) The important factors to consider when assessing any method include patient morbidity (e.g., pain, stiffness, blood loss, time off work, cosmesis), reproducibility of results, surgical time, cost, technical difficulty, and current clinical data supporting each method.