Microfracture represents as a first-line approach to manage minor articular cartilage defects of the knee joint and to produce satisfying functional improvement and pain relief at the mid-term and consequently, evident from a systematic review of the contemporary literature conducted by Patrick Orth and colleagues of Saarland University, Homburg, Germany.

Cochrane Library databases, PubMed, and ScienceDirect from 2013 to 2018 were searched for clinical trials on microfracture therapy and study design, patient demographics, and pre-, intra-, and postoperative findings were derived. PRISMA guidelines were implemented. Modified Coleman Methodology Score (CMS) was used to assess the methodological quality of the included studies and generate aggregated data.

A total of 18 studies (1830 defects) were analyzed. Eight out them were cohort studies without a comparison group. Due to the lack of control groups and structural repair tissue evaluation, low patient numbers, inhomogeneity in outcome parameters, and short follow-up periods, the quality of the overall study was moderate. The treatment was implemented at 43.4 ± 68.0 months of symptom duration. The failure rates of the procedure at five years and ten years were found to be were 11–27%and 6–32%, respectively. Ten studies went through imaging analysis, reported second-look arthroscopies twice and showed well-integrated fibrocartilaginous repair tissue. A further high-quality and standardized study designs will clarify optimal indications for the microfracture regarding cartilage repair strategies in better ways.