- Microfracture can access difficult to reach areas of the articular surface and provides controlled depth penetration limiting unnecessary damage. (7)
- Clinical studies have shown significant (P<0.05) improvement in all parameters measuring function monitored after the use of microfracture for the treatment of full-thickness traumatic chondral defects. (7)
- Microfracture knee surgery is successful with acute and chronic full-thinkness chondral defects. The procedure can be used as the primary treatment but also in a revision setting. (7)
- It is useful with unipolar and bipolar lesions. In addition to not being limited by the type of lesion, the size or location of the lesion does not offer any issues. In a study of 100 patients with focal, full-thickness defects treated using microfracture by Dr. Richard Steadman, there was no statistical difference in the outcome of the patient based upon the location or the size of the lesion. (7)
- This procedure is safe, cost effective, has technical simplicity, and an extremely low patient morbidity rate. (7)
- The technical advantages of microfracture are that the integrity and shape of the subchondral bone are reserved and the use of the awl eliminates the possibility of thermal necrosis. Another advantage of the 30, 45, 90 degree angled awls is that it can reach lesions in all areas of the knee's articular surface except for the patella. To microfracture the patella, a small arthrotomy is needed. (1, 7, 13)
Disadvantages
- Critics of microfracture knee surgery argue that the repair tissue generated is mostly fibrous in nature and has poor durability. However, the tissue demonstrates improved symptoms and joint function at long-term follow-ups. Long term studies are beginning to quiet the critics as functional performance is still occurring many years after the procedure. One example of such durability is a linebacker who completed 13 seasons in the NFL after microfracture treated his medial femoral condyle lesion. (7, 12, 23)
- Microfracture requires a longer and harder postoperative management schedule than other repair procedures. If the surgeon believes the patient would not be able to follow the rehabilitation requirements the procedure will be withheld. (1, 7)
- The failures of the procedure may not reflect the effectiveness of the specific technique as much as it does reflect the challenge of joint-sparing arthroscopic surgery in degenerative knees. (13)
Microfracture procedure
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