Cartilage injuries in the knee are not uncommon in collegiate and professional athletes of all sports, although contact and high-impact activities are particularly high-risk. Unlike most tissues in the body, however, the articular cartilage that lines the surfaces of our joints has no inherent ability to regenerate. We are born with what we have and protecting it is of paramount importance, as progressive cartilage injury and loss can initiate the cascade of degenerative wear and arthritis. Focal cartilage injuries from trauma can affect the femoral, tibial, and patellar surfaces of the knee in isolation or combination. Bipolar or “kissing” defects that make contact on opposing surfaces of a joint are among the most difficult and problematic to treat.

The goal of all cartilage replacement surgery is to achieve complete fill of the defect with repair tissue that is as similar to native cartilage tissue as possible. Microfracture is a marrow stimulation that is among the commonly utilized to treat focal, symptomatic cartilage defects in the knee. In a microfracture surgery, small channels are created by the surgeon which provide access to the bone marrow deep to the cartilage surface. Stem cells can then migrate from the marrow to fill the defect and form an enriched blood clot. The cells then differentiate into a cartilage-like tissue that fills the defect and provides a smooth contact surface.

Success following microfracture surgery has been variable and is influenced by a number of factors, including the severity and size of the defect, number of defects, patient age, compliance, and rehabilitation. A number of professional basketball players, including All-Stars like Amare Stoudemire, Jason Kidd, and Antonio McDyess, have returned following microfracture surgery and continue to play at the highest level. Others, however, such as Anfernee Hardaway or Jamal Mashburn, returned to the NBA but had difficulty achieving their prior level of play.

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