Augmentation Strategies following the Microfracture Technique for Repair of Focal Chondral Defects

Abstract

The operative management of focal chondral lesions continues to be problematic for the treating orthopedic surgeon secondary to the limited regenerative capacity of articular cartilage. Although many treatment options are currently available, none fulfills the criteria for an ideal repair solution, including a hyaline repair tissue that completely fills the defect and integrates well with the surrounding normal cartilage. The microfracture technique is an often-utilized, first-line treatment modality for chondral lesions within the knee, resulting in the formation of a fibrocartilaginous repair tissue with inferior biochemical and biomechanical properties compared to normal hyaline cartilage. Although symptomatic improvement has been shown in the short term, concerns about the durability and longevity of the fibrocartilaginous repair have been raised. In response, a number of strategies and techniques for augmentation of the first-generation microfracture procedure have been introduced in an effort to improve repair tissue characteristics and reduce long-term deterioration. Recent experimental approaches utilize modern tissue-engineering technologies including local supplementation of chondrogenic growth factors, hyaluronic acid, or cytokine modulation. Other second-generation microfracture-based techniques use different types of scaffold-guided in situ chondroinduction. The current article presents a comprehensive overview of both the experimental and early clinical results of these developing microfracture augmentation techniques.

Current Concepts for Rehabilitation and Return to Sport After Knee Articular Cartilage Repair in the Athlete

“…Second-generation techniques that aim to augment the repair tissue quality and quantity after microfracture have recently been developed. 173 This technique is recommended primarily for smaller cartilage defects of up to 2 to 4 cm 2 in size. Postsurgical rehabilitation must consider that cartilage repair after microfracture occurs in 3 biologic phases: the clot formation phase, repair cartilage formation phase, and cartilage maturation phase.…”

Effects of the Combination of Microfracture and Self-Assembling Peptide Filling on the Repair of a Clinically Relevant Trochlear Defect in an Equine Model

“…Microfracture repair tissue tends to be more fibrocartilaginous, with inferior biochemical and biomechanical properties compared with normal hyaline cartilage 2,6,7 . Therefore, the investigation of alternatives and augments to microfracture continues to be an important area of study.…”

“…Noncellular matrices have been investigated as augments to microfracture 4,6 . Of these, self-assembling peptides represent an attractive option for designing matrices that encourage cellular recruitment.…”

Microfracture of the Knee: Are The Results Achieved In Clinical Practice Statistically Comparable to Those Presented in Controlled Studies?

“…For this reason and due to its minimally invasive nature, technical ease, limited surgical morbidity, low costs and because it does not prevent the application of other cartilage repair procedures that may be needed in the future, microfracture has gained popularity over the past two decades [8][9][10]. It is now a common first-line treatment for patients with cartilage defects of the knee [11,12].…”