Enhanced Marrow Stimulation Techniques for Cartilage Repair

Representing the most popular marrow stimulation technique, microfracture surgery has been established as a gold standard for the treatment of articular cartilage defects. Enhanced marrow stimulation techniques for the treatment of cartilage defects promise faster rehabilitation owing to increased initial stability of the regenerating tissue; better tissue quality, allowing for early compression, and shear stress, promoting chondrogenesis; the benefits of a single-stage procedure compared with a chondrocyte transplantation; and multiple future options to increase outcome quality, for example, with growth factor augmentation or drug release. A variety of different techniques and materials are available for arthroscopic and open surgery. To date, power and follow-up of published studies indicate stable fixation techniques but show no significant benefit over microfracture alone, which might change after 5 years when the results of microfracture seem to show degradation. The evidence for the effectiveness of the microfracture procedure alone is largely derived from case series and few randomized trials. Clinical outcomes improve with microfracture for the most part, but according to some studies, these effects are not sustained. The quality of cartilage repair following microfracture is variable and inconsistent for unknown reasons. Younger patients have better clinical outcomes and quality of cartilage repair than older patients do. The necessity of long postoperative continuous passive motion and restricted weight bearing is widely accepted but not completely supported by the evidence in the literature. Maybe a new approach to clinical evidence might be necessary. International registries should be able to create comprehensive data sets at significant lower costs and administrative hurdles, thereby promoting safe and quick implementation of new developments in the field of cartilage repair.