An overview of microfracture Surgery

by KakashiNar

Microfracture surgery is an articular cartilage repair surgical technique that works by creating smal fractures in the area where the damaged cartilage is.

Microfracture surgery is one of the many articular cartilage repair techniques available to orthopedic surgeons today. The operation is typically carried out for the treatment of small cartilage defects.

Microfracture is best known for being cheap (1-3.000 $), minimally invasive and efficient.

The main idea behind the procedure is to create very small (micro) holes (fractures) in the underlying bone, thus the microfracture name. The operation allows the creation of new cartilage in the area where the cartilage defect was. This new cartilage is not the same as the one we are originally born with (called hyaline cartilage), but instead is called fibrocartilage.

Most microfracture operations are carried out in knees, although some doctors have started recently to perform it on other joints, like the ankle and elbow.

Why is the operation carried out ?

Microfracture is performed on patients who have suffered an injury to the cartilage which in turn created a “hole” or a dead region on the cartilaginous tissue. Overtime, these defects may grow bigger leading to osteoarthritis. Unfortunately, there is no real cure for osteoarthritis, only knee replacement which lasts for a maximum of two decades and is considered a last resort solution..

How is a cartilage defect caused ?

A cartilage defect may be caused either after a trauma  (e.g a car accident or a bad fall), or it may the accumulative result of many small damages occurring in the patient’s life (wear and tear).

What is hyaline cartilage ?

As mentioned before, microfracture doesn’t lead to the creation of hyaline cartilage but instead the formation of fibrocartilage. Hyaline cartilage is a firm, rubbery substance that coats the end of our bones creating a thick and smooth layer so that our joints can bend without: 

  • Catching and clicking
  • Friction
  • Pain

Knee anatomy

Knee anatomy
Knee anatomy

What is microfracture ?

A microfracture is one amongst the many surgical techniques that a doctor can choose to treat a cartilage defect. Usually, it is performed as a “first line of defense” solution, and if it fails another technique may be applied, like autologous chondrocyte implantation (ACI).

As we explained before, during a microfracture the doctor makes tiny holes, using a special awl. These holes allow stem cells and bone marrow to reach the damaged area and help it regenerate with new fibrocartilage.  

During the procedure, the doctor first clears off any loose pieces of cartilage, debris and calcified cartilage that is still in the defect area, leaving only the healthy tissue. Then, he  makes small holes or punctures in the bone, with an average diameter of 1-2 millimeters. The bigger the defect area, the more of these holes are created.

How long does microfracture recovery take ?

The answer will disappoint you, especially if you are about to have this kind of surgery. It will take quite a long time since the material entering through the holes requires a lot of time to fully mature into fibrocartilage .

In general, recovery time depends on many factors including:

  • Your age
  • The size of the defect
  • How fit you were prior to the operation
  • Your overall expectations

Most patients have to use crutches during the first two months and are required to both follow and intensive rehab protocol and to stay non-weight bearing. It will take at least 4 more months before you are allowed to return fully to your previous level activity, including sports.


Most patients do well after a microfracture, as long as they have followed their rehab protocol correctly. It is estimated that about 60 to 70 % manage to fully return to their previous level of activity. The rest, either have to re-receive the operation – or some other cartilage repair surgery – or to make some minor adjustments, e.g. to avoid high impact sports like running and football.

Useful Links

For more information on microfracture please visit

Don't hesitate to leave a comment if you have any questions !

Video from a microfracture

Updated: 08/16/2013, KakashiNar
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