Microfracture surgery: what to know before choosing it

What to ask before microfracture surgery

Ask how wide and deep the damaged area is. Its size helps the surgeon decide whether this operation fits.

Ask about the meniscus, the firm pad between knee bones that spreads force. Torn padding or loose ligaments can put extra pressure on the new tissue.

A bowed or knock-kneed leg can also send too much weight through one side. The exam and a standing X-ray can show whether your joint sits evenly.

The small skin cuts may heal before the deeper repair is strong. Follow the surgeon's limits for walking, bending and strength work.

Opening the bone can leave it changed beneath the new tissue. It doesn't ban later surgery, but a cell repair may fail more often afterward.

What to do if soreness remains after earlier care

Bring the old operation note when you've had work inside the joint. It tells the next doctor exactly what was changed.

For soreness that remains, QC Kinetix offers joint preservation, or non-surgical clinic care using your blood or marrow. A medical provider is the Chandler clinician who examines your joint and performs the care.

The visit may include PRP, made by drawing your blood and spinning it to keep the platelet-rich part. Concentrated PRP uses more of that prepared part before the clinician returns it to the sore area.

This care is intended for soreness and easier daily movement. It can't decide whether another cartilage operation is needed.

Get a surgical exam for sudden lost motion or a joint that locks. Seek that exam soon when the joint won't straighten.

Sources

1. A meta-analysis of 29 second-look arthroscopy studies covering 586 ankles found cartilage-quality success of 57% (95% CI 48-65%) after bone marrow stimulation, versus 86% after fragment fixation, 91% after osteochondral transplantation and 80% after cartilage implantation techniques. Marrow stimulation was significantly worse than all three when someone actually looked inside the joint afterwards.

   Vreeken JT, et al. — Second-Look Arthroscopy Shows Inferior Cartilage after Bone Marrow Stimulation Compared with Other Operative Techniques for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis.. Cartilage, 2026. DOI: 10.1177/19476035241227332.

2. Among 321 consecutive patients treated with autologous chondrocyte implantation (522 defects), defects previously treated with a marrow stimulation technique failed at 26% versus 8% in defects with no prior penetration of the subchondral bone - a threefold higher failure rate. The order in which procedures are done changes what the later ones can achieve.

   Minas T, et al. — Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques.. Am J Sports Med, 2009. DOI: 10.1177/0363546508330137.

3. In a prospective multicentre randomised trial, 47 patients with focal knee cartilage lesions (mean defect 3.6 cm2) received microfracture alone or microfracture covered with a type I/III collagen membrane (AMIC). All arms improved for the first two years, after which the microfracture group deteriorated progressively while both AMIC arms stayed stable to five years, with more complete MRI defect filling in the AMIC groups.

   Volz M, et al. — A randomized controlled trial demonstrating sustained benefit of Autologous Matrix-Induced Chondrogenesis over microfracture at five years.. Int Orthop, 2017. DOI: 10.1007/s00264-016-3391-0.

4. The same 47-patient randomised trial reported at ten years: all three arms improved over the first two years, then the microfracture group deteriorated significantly while both AMIC arms remained stable. MOCART imaging scores, however, were comparable between the groups - the clinical divergence was not visible on the scan.

   Volz M, et al. — A randomized controlled trial demonstrating sustained benefit of autologous matrix-induced chondrogenesis (AMIC(®)) over microfracture: 10-year follow-up.. Eur J Orthop Surg Traumatol, 2024. DOI: 10.1007/s00590-024-03948-0.

5. A systematic review of autologous matrix-induced chondrogenesis found 28 clinical articles - 12 knee studies (245 patients), 12 ankle (214) and 4 hip (308) - with suboptimal study design in the majority (modified Coleman scores 55-58). Only one level-1 study compared AMIC with microfracture in the knee, no trial compared AMIC with microfracture in the ankle, and no study compared AMIC with matrix-assisted chondrocyte implantation anywhere.

   Gao L, et al. — Autologous Matrix-Induced Chondrogenesis: A Systematic Review of the Clinical Evidence.. Am J Sports Med, 2019. DOI: 10.1177/0363546517740575.