Microfracture techniques in the treatment of osteochondral injuries.

Although many methods currently are available to treat articular cartilage lesions in the knee, microfracture has many inherent advantages. No other technique has been studied in the athletic population, and, in fact, most other procedures have been studied in the arthritic knee or in a mixed population of patients. Blevins et al have shown microfracture to be an effective tool in the treatment of chondral defects in both recreational and high-level athletes with mean follow-up of 3.7 years. Furthermore, microfracture is minimally invasive because it is arthroscopic through standard portals in most cases. The subchondral plate is preserved, unlike in other techniques, improving load-bearing characteristics following healing. No heat necrosis or polishing is introduced into the subchondral bone and marrow with microfracture. The depth of penetration and location of puncture is controlled readily with the various awl angles. Surgical equipment and supply costs are minimal, without the need for expensive cell cultures or nonstandard equipment. No harvest site morbidity is present, unlike osteochondral, perichondral, periosteal, or chondral autograft procedures. Microfracture is not overly demanding technically, but emphasis must be placed on meticulous handling of the subchondral plate and surrounding healthy cartilage and adequate débridement of unhealthy cartilage. Finally, a good surgical technique is only as good as its rehabilitation. Strictly emphasizing the need for compliance with weightbearing restrictions and the use of CPM is essential to successful patient rehabilitation.