Microfracture is one of the most frequently used cartilage repair techniques especially for athletes looking to get back to sport quickly. It is a based on a simple idea. Repair cells, including stem cells, growth factors and other healing elements are in the bone marrow. By creating channels in the bone underneath the cartilage defect these marrow cells are stimulated to flow into the area to aid in repairing the damage. Previously, an “icepick” style device (microfracture) or long metal wire (k-wire) were used to create access channels to the marrow. In 2012 Arthrosurface introduced Nanofracture, which is a needle like instrument that along with a special handle punctures a channel that is very small (1mm), deep (9mm) and always at a consistent depth. According to a comparative study performed at one of the best Orthopaedic Hospitals in America, The Hospital for Special Surgery in New York, in collaboration with top Cartilage Scientists at Cornell University, researchers found that Nanofracture was better than both the traditional microfracture technique or k-wire instruments. In the Study the smaller diameter instruments (Nanofracture®) were better at getting to the pleuripotential repair cells in the marrow below the cartilage defect and they were substantially less damaging to the underlying bone when compared to either of the microfracture or k-wire instruments.
The authors of the study noted that bone marrow stimulation techniques using bigger diameter instruments resulted in more bone compaction and an abnormal hardening of the tissues around the defect. K-Wire and microfracture techniques also resulted in less open bone marrow channels and reduced marrow access. In addition, larger diameter devices created greater disturbances in bone marrow architecture than the small diameter nanofracture procedure. Based on these findings, the study concluded that the choice of cartilage repair technique should be carefully considered as the newer Nanofracture option showed improved marrow access and less disruption to the underlying bone.