Denwood Hayley, Hauer Tyler M, Berube Megan, Kelley Mary Grace, Cook Abigail, Lin Hang, Cong Ting
Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA.
UHN Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
Ann Jt. 2025 Jul 15;10:26. doi: 10.21037/aoj-24-69. eCollection 2025.
The microfracture procedure, introduced in 1994 by Dr. Steadman, involves creating small perforations in the subchondral bone plate to stimulate cartilage regeneration through fibrocartilage formation. Early studies demonstrated its efficacy in improving patient-reported outcomes for small osteochondral defects, particularly in young, active patients. However, its popularity has declined due to poor long-term outcomes and limited indications. Emerging alternatives, such as autologous chondrocyte implantation (ACI) and osteochondral allograft/autograft transplantation (OAT), show superior long-term results. Antegrade procedures like microfracture and drilling aim to release marrow elements to facilitate cartilage repair, but evidence for their efficacy is limited. These techniques can damage subchondral structures, triggering inflammatory and mechanical changes, including subchondral cysts, osteophytes, and reduced bone mineral density. Retrograde drilling, which avoids subchondral plate violation, emerges as a potential solution, promoting revascularization while preserving structural integrity. Despite promising results in subchondral fracture fixation and avascular necrosis, clinical studies are needed to confirm its efficacy for cartilage repair. The key challenge lies in balancing sufficient marrow stimulation with subchondral plate preservation to maintain long-term joint functionality. Future research should focus on understanding the interplay between subchondral plate integrity and cartilage repair durability. Comparative clinical trials are essential to validate retrograde drilling and other evolving techniques as viable alternatives to traditional microfracture and drilling procedures.
微骨折手术由斯特德曼医生于1994年引入，该手术通过在软骨下骨板上制造小穿孔，以刺激纤维软骨形成来促进软骨再生。早期研究表明，对于小面积骨软骨损伤，尤其是年轻、活跃的患者，该手术在改善患者报告的预后方面具有疗效。然而，由于长期效果不佳和适应症有限，其受欢迎程度已有所下降。新兴的替代方法，如自体软骨细胞植入（ACI）和骨软骨异体/自体移植（OAT），显示出更好的长期效果。像微骨折和钻孔这样的顺行手术旨在释放骨髓成分以促进软骨修复，但其疗效证据有限。这些技术可能会损伤软骨下结构，引发炎症和力学变化，包括软骨下囊肿、骨赘以及骨矿物质密度降低。逆行钻孔避免了对软骨下骨板的破坏，成为一种潜在的解决方案，在保留结构完整性的同时促进血管再生。尽管在软骨下骨折固定和缺血性坏死方面取得了有前景的结果，但仍需要临床研究来证实其对软骨修复的疗效。关键挑战在于在充分刺激骨髓与保留软骨下骨板之间取得平衡，以维持关节的长期功能。未来的研究应专注于理解软骨下骨板完整性与软骨修复耐久性之间的相互作用。比较临床试验对于验证逆行钻孔和其他不断发展的技术作为传统微骨折和钻孔手术的可行替代方法至关重要。
