Microfracture and Microfracture Plus of the Knee Joint

Area of Science:

• Orthopedics
• Regenerative Medicine
• Biomaterials Science

Background:

• Microfracture (MF) is a common treatment for knee cartilage defects.
• MF stimulates regeneration but produces suboptimal fibrocartilage, leading to clinical decline.
• Microfracture plus (MFplus) combines MF with scaffolds and orthobiologics to enhance cartilage repair.

Purpose of the Study:

• To conduct a scoping review of Microfracture (MF) and Microfracture plus (MFplus) techniques.
• To evaluate clinical, MRI, and histologic outcomes of MF and MFplus.
• To assess the efficacy of various scaffolds and orthobiologics used in MFplus.

Main Methods:

• Scoping review methodology.
• Inclusion of studies reporting clinical, MRI, and histologic outcomes for MF and MFplus.
• Examination of techniques involving porcine collagen membranes, hyaluronic acid matrices, platelet-rich plasma, bone marrow aspirate concentrate, and adipose tissue-derived stromal cells.

Main Results:

• Microfracture alone yields fibrocartilage inferior to native hyaline cartilage.
• MFplus techniques show potential for improved cartilage regeneration.
• Specific scaffolds and orthobiologics demonstrate varying degrees of efficacy in preliminary studies.

Conclusions:

• While MF is a foundational technique, its long-term outcomes are limited by fibrocartilage quality.
• MFplus represents a promising advancement in cartilage defect treatment.
• Further research is needed to optimize MFplus protocols and long-term clinical effectiveness.