Microfracture (ice-picking)
The patient undergoes an exploratory operation during which small holes are made in the underlying bone using a sharp object (the ’ice pick’). During this process, the bone plate is perforated, releasing bone marrow which fills the original defect. The bone marrow, which contains a mixture of blood and stem cells, will from a permanent filling of the defect in the original defect.
This may be a suitable short-term treatment for injuries covering an area smaller than 1.5 cm². However, recent studies indicate that this treatment does not offer a satisfactory solution for larger injuries in the longer term. A comparative clinical study revealed that the structure of the restored cartilage tissue is of an inferior quality1 as compared to other treatment methods. Studies by Minas and Mithoefer have also indicated that in the long term, bone growth and cartilage thinning will occur, and that the knee may remain stiff or painful2,3.
1 Saris D, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y et al. Characterized Chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 2008 Feb; 36(2):235-46.
2 Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum B. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 2009 Feb 26.
3 Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T. Increased Failure Rate of Autologous Chondrocyte Implantation After Previous Treatment With Bone Marrow Stimulation Techniques. Am J Sports Med 2009 Mar 4
3 Minas T, et al. The American Journal of Sports Medicine, Preview, March 2009.
