Microfracture surgery is a common method used to repair knee cartilage. A study reported in the March 2015 journal Arthroscopy indicates that the procedure is ineffective, and the author suggests that it’s time to retire knee microfracture surgery.

Knee microfracture is used to create holes in the cartilage. The theory behind this surgery is that drilling small holes in the bone inside a cartilage lesion should release bone-marrow stem cells and stimulate cartilage healing. About 650,000 of these knee procedures are performed each year, but there is controversy about whether this common orthopedic knee procedure works. Research to date on knee-microfracture outcomes has been inconclusive.

The most recent study continues to raise doubts about the efficacy of knee microfracture surgeries and suggests that the procedure should be abandoned. The author of the study looked at many different studies examining knee microfracture and made the following conclusions:

Multiple authors have promoted these procedures [knee microfracture surgeries] as ’helpful,’ but others have confirmed only short-term relief with destruction of the subchondral surface.”

What this conclusion suggests is that poking holes in the cartilage chews up the bone surface under the cartilage (destroys the subchondral surface).

Proponents [of knee microfracture surgery] do not compare their marrow-stimulation results to a control group that had debridement alone.” 

Results of knee microfracture surgery haven’t been tested against debridement (simply cleaning out the knee), a common surgery that was shown ineffective in a 2008 study reported in the New England Journal of Medicine.

The study reported in Arthroscopy brings up some valid questions about how little we know about this invasive surgery.

Microfracture Knee Alternatives: RIP Knee Microfracture? first appeared as a post on the Regenexx blog.