Augmented Marrow Stimulation: Drilling Techniques and Scaffold Options

Marrow stimulation is a commonly used surgical adjunct in the treatment of knee cartilage injuries. While initial studies on traditional microfracture demonstrated favorable short-term results, survivorship and clinical outcomes at medium- and long-term follow-up were subsequently shown to be inferior as compared to cell- and graft-based treatment options. As a result, numerous technical modifications and biologic augmentation approaches have been developed with the goal of improving the efficacy and the durability of marrow stimulation procedures. This chapter presents an overview of the basic and clinical science of marrow stimulation, its evolution over the past 25 years, and preliminary outcomes of treatment augmentation with biologic, scaffold, and cartilage-based approaches.