The microfracture technique to treat full thickness articular cartilage defects of the knee

Full thickness defects of the articular cartilage rarely heal spontaneously . While some patients do not develop clinically significant problems from c hondral defects, most eventually develop degenerative changes associated wi th the cartilage damage over time. Techniques to treat chondral defects inc lude abrasion, drilling, tissue autografts, allografts, and cell transplant ation. The senior author has developed a procedure referred to as the "micr ofracture". This technique enhances chondral resurfacing by providing a sui table environment for tissue regeneration and by taking advantage of the bo dy's own healing potential. This technique has now been used in more than 1 400 patients. Specially designed awls are used to make multiple perforation s, or "microfractures" into the subchondral bone plate. The perforations ar e made as close together as necessary, but not so close that one breaks int o another. Consequently, the microfracture holes are approximately three to four millimeters apart (or 3 to 4 holes per square centimeter). Importantl y, the integrity of the subchondral bone plate is maintained. The released marrow elements form a "super clot" which provides an enriched environment for tissue regeneration. Follow up with long term results of more than 8 ye ars have been positive and Very encouraging.