The role of the microfracture technique in the treatment of full-thickness chondral injuries

Microfracture is indicated for both traumatic and degenerative full-thickness chondral defects. The technique is useful for both unipolar and "kissing" (bipolar) lesions in both the primary treatment and revision settings. There are no contraindications to the technique based on the size or location of the lesion, although smaller (<400 mm(2)), acute (<12 weeks from injury) femoral and trochlear lesions have the most predictable results. Relative contraindications to microfracture include chondral defects greater than 5 to 10 mm deep and the presence of a malaligned limb. Clinical studies have shown significant (P<.05) improvement in all functional parameters studied following the use of microfracture for the treatment of full-thickness, traumatic chondral defects. Of note, improvement in symptoms of pain and swelling continue to be seen until 2 years after surgery following microfracture. The microfacture tfchnique is a cost-effective, technically feasible, highly efficacious procedure available to all surgeons who perform arthroscopy of the knee. It is a reasonable first approach to the treatment of chondral defects, because it does not burn any bridges with regard to future procedures such as a mosaic-plasty or autologous chondrocyte transplantation if the microfracture should fail.