Injuries to the articular cartilage of the knee are increasingly common, especially in athletes. The operative management of these focal chondral lesions continues to be a regenerative challenge. The microfracture (MFx) procedure has become a first-line arthroscopic treatment method for small, symptomatic chondral lesions, and it frequently serves as the standard technique against which other cartilage repair procedures are compared. Over time, outcome studies have defined the weaknesses and limitations of first-generation MFx. The second iteration of MFx seeks to optimize regeneration using the trilogy of cells, scaffolds, and growth factors. As surgeons, we are only as strong as our weakest link.
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