Microfracture or cartilage transplant: which one suits my knee?

The main options side by side

• Marrow stimulation, including microfracture: small holes in the bone release marrow cells that form repair tissue; done arthroscopically, usually for small defects; the repair tissue is fibrocartilage, which is less durable than original cartilage
• Osteochondral autograft transfer (OATS, mosaicplasty): plugs of your own cartilage and bone are moved from a less loaded area; suited to small and medium defects, and useful when the bone is involved
• Osteochondral allograft: a matched piece of donor bone and cartilage fills a larger or deeper defect
• Cell-based repair, such as ACI or MACI: your own cartilage cells are grown in a laboratory and implanted, usually in two operations, for larger defects
• Scaffold-augmented techniques: a membrane or matrix is added to marrow stimulation to improve the repair tissue

What decides the choice

Size is the starting point, but not the only factor. The location (thigh bone or behind the kneecap), whether the bone under the cartilage is damaged or cystic, your age, how active you want to be, and whether ligaments, meniscus and alignment also need treatment all shape the recommendation. A smaller defect in a young athlete may be treated differently from the same defect in a less active adult.

Availability is not the same everywhere

Some techniques depend on resources outside the operating theatre. Donor allografts need a licensed tissue bank and safe transport. Cell-based methods need an approved laboratory process and regulatory approval, and the products available differ between countries. Dr. Gelber will tell you honestly which options can be offered in Doha for your knee and, where relevant, what the alternatives are.

Making the decision together

At Aman Hospital the decision usually follows an examination, an MRI, alignment X-rays and sometimes a diagnostic arthroscopy. You should leave the consultation knowing why one technique is recommended over another, how long recovery will take, and what the realistic outcome is.