After articular cartilage damage has been diagnosed, what factors are indications for microfracture?

The general indications for microfracture are:

• The patient has a full-thickness defect (loss of articular cartilage down to the bone) in either a weightbearing area between the femur and tibia or in an area of contact between the back of the patella and the groove it slides in.
  
• The patient has unstable cartilage covering the underlying bone.
  
• The patient has degenerative changes in a knee that is normally aligned.

Important factors to consider for use of the microfracture procedure are:

• The patient's age (as a relative indication)
• The patient's activity level
• Whether or not the patient has acceptable alignment of the knee. "Knock-kneed" or "bowlegged" patients may not be good cadidates for this procedure.
  

When is microfracture not recommended for a patient?

• the patient's knee is poorly aligned.
• the patient's chondral defect is not all the way through the full thickness of the cartilage.
• the patient is not willing to follow a strict and rigorous rehabilitation protocol.
• the patient is older (generally over 65) and might have difficulty with crutch use and the rehabilitation process.
• the patient has disease-induced arthritis, cartilage disease, or any disease affecting the immune system (e.g. rheumatoid arthritis).