Microfracture surgery is an innovative arthroscopic technique designed to stimulate the growth of new cartilage in areas where articular cartilage has been damaged or lost. Articular cartilage is the smooth, white tissue that covers the ends of bones in joints, allowing frictionless movement and shock absorption. Unlike most body tissues, cartilage has no blood supply and therefore very limited capacity for self-repair. When damaged by injury or disease, cartilage defects can cause pain, swelling, mechanical symptoms, and if left untreated, often progress to debilitating arthritis. Microfracture addresses this problem by creating small perforations in the underlying bone to access the bone marrow compartment, releasing growth factors and stem cells that form a fibrocartilage "super clot" to fill the defect. Dr. Kumar performs microfracture surgery for focal cartilage defects resulting from acute injuries (such as patellar dislocations, ACL tears, or direct trauma), osteochondritis dissecans (where a piece of cartilage and bone separates from the joint surface), or early degenerative changes in young active patients. The procedure is most effective for small to medium-sized defects (typically 1-4 cm²) in the knee, ankle, or shoulder in patients under 40 years old. Candidates must have isolated cartilage lesions without widespread arthritis, stable joint alignment, and realistic expectations about the procedure's limitations. Microfracture works best when the surrounding cartilage is healthy and the joint mechanics are normal. The arthroscopic microfracture procedure begins with thorough debridement of the damaged cartilage back to stable edges, creating a contained defect with vertical walls. Dr. Kumar then carefully removes the calcified cartilage layer at the base of the defect to expose the underlying subchondral bone. Using a specialized awl (pointed instrument), he creates multiple small holes or "microfractures" approximately 3-4mm apart and 3-4mm deep into the bone. These perforations penetrate into the bone marrow space, releasing blood, stem cells, and growth factors that fill the defect and eventually organize into repair tissue. The number of microfractures depends on the size of the defect, but typically ranges from 8-20 perforations for average lesions. Following microfracture surgery, rehabilitation is critically important for optimal outcomes. Patients must strictly avoid weight bearing for 6-8 weeks to allow the "super clot" to organize and mature into fibrocartilage repair tissue without being disrupted. Continuous passive motion (CPM) machines are often used to provide gentle movement that promotes cartilage nutrition and maturation while protecting the healing surface. Physical therapy focuses on maintaining range of motion and strengthening surrounding muscles while respecting weight-bearing restrictions. The repair tissue continues to mature for 12-18 months after surgery, with gradual progression to full activities. At Arthoscenter, Dr. Kumar achieves good to excellent results in 65-80% of carefully selected patients undergoing microfracture surgery. The procedure is most successful in younger patients (under 40) with acute traumatic cartilage lesions smaller than 2 cm². Results are less predictable for larger defects, chronic lesions, and patients with underlying arthritis or malalignment. While the fibrocartilage formed through microfracture is not identical to native hyaline cartilage, it can provide meaningful symptom relief and functional improvement for many years. The minimally invasive arthroscopic approach offers advantages of reduced pain, faster initial healing, and ability to return to activities compared to open cartilage restoration procedures.