Microfracture Knee Alternatives: RIP Knee Microfracture?

Knee microfracture surgery is a common method used for cartilage repair. But does it work? A recent study says that microfracture knee alternatives should be used because the procedure is ineffective and should be abandoned.

Knee microfracture is used for potholes in the cartilage. The theory is that poking or drilling small holes in the bone inside a cartilage lesion should release bone marrow stem cells and stimulate cartilage healing. About 650,000 of these “repairative” knee procedures are performed each year. But does this common orthopedic knee procedure work? Well, nobody really knows with anything approaching high levels of evidence. I’ve blogged before that if anything, the existing research shows that knee microfracture outcomes are underwhelming.

The new study in the journal Arthroscopy continues the doubts over microfracture by suggesting that the procedure should be abandoned. In particular, the new paper looked at many different studies that have been performed on microfracture and concluded:

1. Multiple authors have promoted these procedures as “helpful,” but others have confirmed only short-term relief with destruction of the subchondral surface. Huh? The last bit means that poking of holes destroys the area beneath the cartilage. We’ve seen our share of these cases, with an MRI years later still showing an irregular chewed up bone surface from the surgery.

2. Proponents do not compare their marrow stimulation results to a control group that had debridement alone. Meaning microfracture hasn’t been tested versus just “cleaning out the knee (debridement)” to see if it works any better than that common surgery (which has been shown in a big study not to work). A recent study confirmed that microfracture (MF) is equivalent to debridement and does not affect the subchondral bone.

The upshot? This author from the University of Minnesota believes that it’s time to retire microfracture surgery. He certainly brings up some valid points about how little we know about whether this invasive surgery is effective. We’ve also witnessed the destruction of the bone surface that this procedure can cause.

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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile