Microfracture Augmentation Options for Cartilage Repair

Historically, microfracture was a commonly utilized procedure for treating small focal chondral defects of the knee. However, studies have demonstrated that microfracture lacks long-term durability. Despite this, microfracture remains the most commonly performed cartilage repair treatment due to its technical ease, cost-effectiveness, and the ability to be performed as a one-stage procedure. Over the last decade, novel techniques for augmenting microfracture to improve long-term outcomes have emerged. These approaches fall into two main categories: scaffolds and orthobiologics. The goal of both of these augmentations is to improve cartilage fill and durability, thereby improving long-term outcomes. Scaffolds provide a structure for cell proliferation and can be applied with a sealant to inhibit extravasation of bone marrow elements into the joint after marrow stimulation. The goal of orthobiologics is to increase the availability of cytokines and cells necessary for cartilage development. This chapter will explore the current landscape of microfracture augmentation with a focus on scaffold and orthobiologic augmentation.