Bone Marrow Stimulation

Bone marrow stimulation, also known as microfracture surgery, is an arthroscopic procedure performed to repair damaged ankle cartilage. Cartilage is necessary for cushioning the area, and allows for smooth, painless movement. When the cartilage is damaged, a person may experience considerable pain upon running or walking. Bone marrow stimulation works by creating tiny fractures in the underlying bone, through which blood and bone marrow begin to form. This results in the development of something known as a super clot, which contains growth factors that will lead to the development of new cartilage.

Bone marrow stimulation, or microfracture surgery, is most commonly performed on athletes who may have suffered cartilage injuries or damage to the ankle while participating in sports. The procedure is also frequently performed on the knee, and is usually highly effective for relieving pain and swelling in the affected joint.

Candidates for Bone Marrow Stimulation

Ideal candidates for bone marrow stimulation are typically younger, active adults with a focal cartilage  injury or lesion. A microfracture procedure for the ankle is not typically recommended for older adults who have extremely damaged cartilage.

Bone Marrow Stimulation Procedure

Bone marrow stimulation is a surgical technique used for repairing damaged cartilage in the ankle area. The operation is minimally invasive as it is typically performed via arthroscopic means. Arthroscopy uses tiny incisions to insert a probe-like camera and surgical instruments. These small incisions allow for more precise movement and reduce the risk of infection and other complications of surgery. Arthroscopy can be especially effective in treating joint conditions.

Bone marrow stimulation is performed while the patient is under anesthesia. The procedure requires two small incisions on the ankle. Through one incision, the arthroscope is inserted, which is connected to a small camera that will display an image on a monitor. This is this image that provides the surgeon with a clear view of the inner ankle during the procedure.

A small surgical tool called an awl will be inserted through another incision into the damaged area of the ankle. It is used to create small holes, known as microfractures, in the underlying subchondral bone. Microfractures help release the cells that produce healthy articular cartilage, creating a healing effect that restores the damaged ankle. The number of holes created will vary depending on the size and location of the lesion and extent of the damage. Most patients require between two and five small holes. At times, this technique is combined with platelet rich plasma or bone marrow aspiration. Once the microfracture has been performed, the arthroscope will be removed and the incisions are sutured. The surgery usually lasts for 30 to 45 minutes.

Recovery from Bone Marrow Stimulation

Following a bone marrow stimulation procedure, patients are usually allowed to return home the same day. Patients may be prescribed medications to alleviate pain after the surgery. During the recovery process, the ankle joint requires the protection with splint for two weeks . Placing weight or added pressure on the ankle should be avoided initially.

In most cases, patients will need to undergo  physical therapy to help restore function and strength to the ankle. The recovery process following bone marrow stimulation is usually lengthy, and it may be up to six months before a person is able to return to sports or other intense activities.

Results of Bone Marrow Stimulation

While bone marrow stimulation usually yields positive results for patients, some cases may require a second bone marrow stimulation procedure or more extensive surgery if the newly created cartilage breaks down or becomes damaged once again. This may occur within one to two years after the initial procedure. For most patients, however, bone marrow stimulation can provide effective, long-term pain relief.


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