Abandoning microfracture of the knee: has the time come?

Marrow stimulation has been performed for more than 45 years beginning with the simple drilling of bony surfaces, burring or "abrading" the sclerotic lesion, and more recently using awls to penetrate eburnated bone to promote blood flow to the bony surface. Multiple authors have promoted these procedures as "helpful," but others have confirmed only short-term relief with destruction of the subchondral surface. Unfortunately, proponents do not compare their marrow stimulation results to a control group that had debridement alone. A recent study confirmed that microfracture (MF) is equivalent to debridement and does not affect the subchondral bone, which therefore does not reduce the success rates of future surgery subsequent to MF. This brief review summarizes some of the factual data showing that marrow stimulation may not offer any improvement over debridement alone and that, in fact, MF results in significant destruction to the subchondral bone.