Steadman et al. describe the complete surgical technique and postoperative rehabilitation protocol for microfracture of full-thickness chondral defects of the knee. The paper covers indications, contraindications, step-by-step operative technique, and two distinct rehabilitation protocols based on lesion location. The series spans more than 1800 patients treated by the technique's originator.
Microfracture is still the most common first-line procedure for focal full-thickness chondral defects in young, active patients — and it only works if technique and rehab are executed correctly.
Two steps are most commonly shortchanged: incomplete removal of the calcified cartilage layer (which blocks marrow cell contact with the defect bed) and failure to tailor rehabilitation to lesion location. These are not minor details. They determine whether the repair tissue forms at all.
When you treat a patellofemoral chondral defect with microfracture, the rehab is not the same as for a femoral condyle lesion. The brace must be locked at 0–20° for 8 weeks. Unrestricted flexion places shear force on the maturing clot at precisely the contact zone you are trying to protect.
Apply the greater than 5° varus/valgus threshold as a relative contraindication before offering microfracture. If alignment is outside this range, correcting the mechanical axis first is not optional. It is the reason the procedure will succeed or fail.
This paper is the technical and conceptual reference point for every subsequent cartilage repair comparison. ACI, OATS, and adjuncts like BioCartilage are all benchmarked against what Steadman defined here.
Steadman et al. describe the complete surgical technique and postoperative rehabilitation protocol for microfracture of full-thickness chondral defects of the knee. The paper covers indications, contraindications, step-by-step operative technique, and two distinct rehabilitation protocols based on lesion location. The series spans more than 1800 patients treated by the technique's originator.
Microfracture is still the most common first-line procedure for focal full-thickness chondral defects in young, active patients — and it only works if technique and rehab are executed correctly.
Two steps are most commonly shortchanged: incomplete removal of the calcified cartilage layer (which blocks marrow cell contact with the defect bed) and failure to tailor rehabilitation to lesion location. These are not minor details. They determine whether the repair tissue forms at all.
When you treat a patellofemoral chondral defect with microfracture, the rehab is not the same as for a femoral condyle lesion. The brace must be locked at 0–20° for 8 weeks. Unrestricted flexion places shear force on the maturing clot at precisely the contact zone you are trying to protect.
Apply the greater than 5° varus/valgus threshold as a relative contraindication before offering microfracture. If alignment is outside this range, correcting the mechanical axis first is not optional. It is the reason the procedure will succeed or fail.
This paper is the technical and conceptual reference point for every subsequent cartilage repair comparison. ACI, OATS, and adjuncts like BioCartilage are all benchmarked against what Steadman defined here.