Do Microfractures Work?

Abstract

It has been observed that injuries, which involve only a part of the joint cartilage thickness, show a partial healing ability, but some healing potential is present in the case of injuries that affect the subchondral osseous tissue. The methods of treatment for chondral defects are nonsurgical: pharmacological chondroprotection (nutraceuticals containing chondroitin sulphate and glucosamine sulphate), viscosupplementation, PRP and cytokine modulation. The surgical options include palliative approaches, marrow stimulation, and cell-based regeneration techniques. The microfracturing technique has started to be used in the ’80s using equine models. The basic principle of microfracturing is to stimulate cartilage repair, not regeneration. It represents the first line of therapy for cartilage defects that affect its full thickness. The advantages of microfracturing are: it is a minimally invasive procedure, technical simplicity, decreased surgical morbidity, and low costs, thus making it a common procedure. However, microfracturing is not a bulletproof technique. There is a high rate of treatment failure after 5 years. Constant decline of the outcome during the 5-year follow-up after surgery is also described. Lesion size represents a better predictor regarding outcome, compared to age. The best results are obtained in young patients, small lesions and low-demand patients. Microfractures can be augmented using BMAC (bone marrow aspirate concentrate) containing 0-0.1% progenitor cells. The matrix aids in the improvement of microfractures, and it also increases the stability of the blood clot, acting as a barrier that avoids the fibroblast invasion of the graft. There is still a place for microfractures in chondral defects. Better results can be achieved with an improved technique, an optimized rehabilitation, and adding several augmentation techniques.