Arthroscopic Marrow-Stimulating Procedure for Full-Thickness Knee Cartilage Lesions

Articular cartilage defects remain challenging to treat because cartilage is avascular, sparsely cellular and has limited intrinsic healing potential. If left untreated, these lesions may progress to degenerative osteoarthritis, resulting in persistent pain and functional limitation. Marrow stimulation techniques such as drilling and microfracture are commonly used to promote repair by accessing subchondral bone marrow elements. Although these procedures are simple and widely practiced, their clinical benefits are often limited to the short- to mid-term, and they may disrupt the subchondral bone plate, potentially compromising future cartilage restoration options. Nanofracture represents an evolution of traditional microfracture, using smaller-diameter (1 mm) and deeper (9 mm) perforations to enhance marrow access while minimizing trabecular bone compaction. This article describes an arthroscopic nanofracture technique using a curved guide and depth-controlled wire, allowing precise, evenly spaced perforations and improved access to challenging regions such as the posterior femoral condyles and tibial plateau without added surgical morbidity. By preserving subchondral architecture and ensuring consistent marrow stimulation, nanofracture may improve the biological quality of repair tissue.