Question 1

I'm 32 years old and have a cartilage defect in my knee from a football injury 2 years ago. My surgeon recommends microfracture but I've read online that the results don't last—should I just get a knee replacement now instead?

Accepted Answer

At age 32, knee replacement is NOT a good option—you should strongly consider cartilage repair surgery like microfracture before resorting to replacement. Here's why: KNEE REPLACEMENT IN YOUNG PATIENTS: Knee replacements last 15-20 years on average. If you get one at age 32, you'll likely need: Revision #1 at age 50-55, Revision #2 at age 70-75, Possibly Revision #3 at age 85+. Each revision is more difficult, with worse outcomes, more bone loss, and higher complication rates. Many surgeons try to delay first knee replacement until at least 60-65 years to minimize lifetime revisions. MICROFRACTURE ADVANTAGES: Joint-preserving—keeps your own knee, no implant. Relatively simple, low-risk arthroscopic procedure. 70-80% achieve good pain relief and return to activities for 5-10 years. Even if microfracture eventually fails, you can still get knee replacement later—microfracture doesn't 'burn bridges.' REALISTIC EXPECTATIONS FOR MICROFRACTURE: You're right that durability is limited—fibrocartilage formed by microfracture isn't as durable as native cartilage. Studies show: 60-70% still doing well at 5 years, 40-50% at 10 years. However, even 5-10 years of good function is valuable at your age—delays knee replacement to 40-45 years instead of 32, reducing lifetime revisions needed. DECISION FRAMEWORK: If microfracture gives you 10 good years, you'd be 42 years old when/if it fails. Then consider: Revision cartilage procedure (repeat microfracture, ACI, osteochondral graft), Knee replacement at 42-45 years (much better than 32), Continue conservative management if symptoms tolerable. ALTERNATIVE CARTILAGE REPAIRS: If you want potentially more durable option than microfracture, ask surgeon about: Autologous chondrocyte implantation (ACI)—growing your own cartilage cells and reimplanting. More complex, longer rehab, but may have better long-term durability. Osteochondral autograft (OATS)—transplanting plugs of cartilage/bone from non-weight-bearing area. Good for small focal defects. These cost more and have more demanding rehab but may be worth it at your age. BOTTOM LINE: At 32 years old, you should pursue cartilage repair (microfracture or other technique) before considering knee replacement. Even if microfracture only lasts 5-10 years, it's valuable time gained with your own knee, delaying eventual replacement and reducing lifetime surgeries.

Question 2

I had microfracture surgery 4 months ago and I'm frustrated with the slow recovery—I'm still using crutches and can't run yet. My friend had meniscus surgery and was back to sports in 6 weeks. Is my recovery normal or did something go wrong?

Accepted Answer

Your recovery is completely normal for microfracture—this is NOT like meniscus surgery and requires much longer, more restrictive rehab. The frustration you're feeling is common but important to understand why recovery is slow: WHY MICROFRACTURE RECOVERY IS SLOW: Microfracture relies on your body forming new fibrocartilage tissue to fill the defect. This process takes time: Weeks 0-6—Bone marrow stem cells migrate into defect, form 'super clot' that will become fibrocartilage. This tissue is extremely fragile and would be crushed by body weight, hence strict non-weight-bearing. Weeks 6-12—Fibrocartilage beginning to mature but still soft. Gradual weight-bearing introduced as tissue strengthens. Months 3-6—Fibrocartilage continuing to mature and remodel. Can begin low-impact activities but tissue still developing. Months 6-12—Fibrocartilage approaching mature strength. High-impact activities gradually introduced. Premature weight-bearing or impact during weeks 0-12 crushes forming fibrocartilage, causing procedure to fail. Compare to meniscus surgery (removing torn meniscus tissue)—no healing required, immediate weight-bearing, back to activities in 4-8 weeks. Completely different procedures with different biology. EXPECTED TIMELINE AT 4 MONTHS: Weight-bearing—should be off crutches or nearly off by now, walking without limp. Running—NOT yet. Most protocols don't allow running until 5-6 months minimum. Return to sports—9-12 months for high-impact sports (basketball, football). If at 4 months you're still using crutches daily and can't walk comfortably, that may be slightly behind schedule—discuss with surgeon or physiotherapist. But if you're off crutches and just frustrated you can't run yet, you're right on track. KEYS TO SUCCESS: Patience—don't rush return to impact activities. Premature running damages fragile fibrocartilage. Compliance—follow physio program religiously. Quadriceps strength critical for protecting repair. Gradual progression—when cleared to run (5-6+ months), start with walk-run intervals, progress slowly over weeks. Realistic expectations—you may never return to 100% pre-injury level, especially in cutting/pivoting sports. 70-80% achieve good function but some residual limitations common. WHEN TO WORRY: If at 4 months you have: severe ongoing pain, persistent large swelling, inability to straighten knee fully, or not progressing with rehab despite good effort, these warrant urgent surgeon review (may indicate failed repair or other complication). Otherwise, stay patient—most microfracture patients aren't back to full activities until 9-12 months post-op.

Medical Disclaimer

Cartilage Repair Surgery (Microfracture)

📖What is Cartilage Repair Surgery (Microfracture)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention