A Careful, Honest Comparison
ChondroFiller® vs
Microfracture
Microfracture is a long-established arthroscopic technique for small cartilage defects. ChondroFiller® is a non-surgical scaffold injection that delivers cartilage regeneration without bone-marrow stimulation or arthroscopy. Here is the honest comparison.
Reviewed byProf Paul Lee MBBch, FRCS (Tr & Orth), PhDLast reviewed 1 May 2026Quick Answer
ChondroFiller® supports natural cartilage regeneration without surgery; microfracture is a keyhole operation that stimulates the bone marrow to fill the defect with fibrocartilage. Microfracture has a long evidence base, particularly in younger active patients with small defects, but the repair tissue it produces is fibrocartilage, which can deteriorate after three to five years. ChondroFiller® aims to deliver more hyaline-like tissue and avoids drilling the subchondral bone — but it is the right answer for selected focal defects only. The choice is made at consultation with MRI review.
The Headline Difference
ChondroFiller® vs Microfracture — the key difference
Microfracture works by deliberately damaging the subchondral bone — the surgeon makes small holes through the bone plate so marrow cells leak into the defect and form a clot, which matures into fibrocartilage. ChondroFiller® instead places a sterile collagen scaffold directly into the mapped defect under ultrasound guidance; the patient’s own cells then migrate into the scaffold and form new cartilage matrix over six to twelve months. Different mechanism, different recovery, different repair tissue.
Mechanism of Action
How each treatment works
ChondroFiller® is a sterile type I/III collagen scaffold injected as a liquid directly into a mapped cartilage defect under ultrasound guidance. It sets into a gel that occupies the defect within minutes.
The patient’s own cells then migrate into the scaffold and lay down new cartilage matrix over six to twelve months. The subchondral bone is left alone — ChondroFiller® does not stimulate the marrow or alter the bone plate.
Microfracture is an arthroscopic procedure. The surgeon prepares the cartilage defect and then makes a series of small holes (microfractures) through the subchondral bone plate using an awl or drill.
Bone marrow leaks into the defect and forms a blood clot containing stem cells; over the following months this matures into fibrocartilage — repair tissue rich in type I collagen rather than the type II collagen found in native hyaline cartilage.
How Long Results May Last
Duration and number of injections
Tissue formation over 6–12 months
Good early relief, often declines after 3–5 years
Outcomes for both treatments depend heavily on defect size, location, patient age and whether the underlying joint is otherwise healthy. Published averages should be read as guidance, not a personal promise.
Treatment Course
Number of injections
Typically one injection course, with the box quantity (one, two or three) decided from MRI. ChondroFiller® can be repeated if a separate new defect develops; the original implanted tissue is intended to be durable.
Microfracture is a one-off arthroscopic operation. Revision or conversion to a different cartilage procedure (MACI, autologous chondrocyte implantation, or a scaffold-based treatment) is sometimes needed years later if the fibrocartilage deteriorates.
Safety and Infection
Safety considerations
These are very different procedures with very different risk profiles. ChondroFiller® at London Cartilage Clinic is an ultrasound-guided outpatient injection delivered under full sterile technique with routine IV antibiotic cover. The most serious risk is joint infection, which is rare.
Microfracture is arthroscopic surgery: it carries the standard arthroscopy risks (infection, deep-vein thrombosis, anaesthetic complications) plus surgery-specific issues — subchondral bone overgrowth (intralesional osteophyte formation), bone marrow oedema and a rehabilitation protocol that often includes a period of restricted weight-bearing. See our injection safety and infection-prevention protocol for the ChondroFiller® injection-side detail.
Patient Selection
Who each treatment may suit
Microfracture is most defensible in younger, active patients with small contained cartilage defects (typically under 2 cm²), good bone quality and no significant generalised joint disease. In larger defects, older patients or joints with bone marrow oedema, modern cartilage protocols increasingly favour scaffold-based or cell-based options over microfracture.
ChondroFiller® is appropriate for focal cartilage defects up to roughly 6 cm² with reasonably preserved surrounding cartilage. It is not the right answer for diffuse bone-on-bone arthritis, very large multi-zone defects or unstable subchondral bone. See who is suitable for ChondroFiller?
Cost and Value
What each treatment costs
At London Cartilage Clinic, ChondroFiller® costs from £3,000 for one box, £5,500 for two and £8,000 for three. The price includes consultation, ultrasound-guided injection, IV antibiotic cover and six-week follow-up. See the ChondroFiller® cost guide.
Private microfracture in the UK is typically priced as an arthroscopic knee procedure — from around £6,000 to £9,000 depending on hospital, surgeon and anaesthetic. It is available on the NHS for clinically appropriate cases, though waiting times vary.
The headline numbers are similar; the more important comparison is the trade-off between a non-surgical scaffold and an arthroscopic bone-marrow-stimulation operation, and which one fits the defect on imaging.
Our Honest Take
When we may recommend each
You have a focal cartilage defect on MRI and want a non-surgical pathway.
You want to preserve the subchondral bone plate rather than have it deliberately perforated.
You want a regenerative pathway that targets the defect with a scaffold rather than relying on marrow-stimulation to fill it with fibrocartilage.
A small, contained cartilage defect (typically under 2 cm²) in a young, active patient with otherwise healthy bone.
A patient already booked for arthroscopy for another reason (loose body, meniscal repair) where the small defect can be addressed at the same time.
Where surgery is the agreed plan and the surgeon judges marrow-stimulation to be the most appropriate cartilage step.
When Each Is The Wrong Answer
When we would not recommend each
Diffuse bone-on-bone arthritis with no preserved cartilage rim for the scaffold to anchor to.
Significant subchondral bone oedema or instability — the bone needs to be a stable base for new tissue.
Very large or multi-zone defects where a surgical pathway (Liquid Cartilage™ or autologous chondrocyte implantation) is the better answer.
Larger defects (typically over 2–4 cm²), older patients or anyone with established bone marrow oedema — modern evidence increasingly favours scaffold- or cell-based options here.
Patients who want to avoid arthroscopy when a reasonable non-surgical alternative (ChondroFiller® injection) exists.
Patients who cannot tolerate a period of restricted weight-bearing as part of microfracture rehabilitation.
The Bottom Line
In summary
Microfracture is a legitimate cartilage-repair option with decades of clinical experience and a place in the modern surgical toolkit. ChondroFiller® offers a different approach: a scaffold-based, non-surgical pathway that preserves the subchondral bone and aims for more hyaline-like repair tissue. The right answer depends on defect size, location and the rest of the joint picture on MRI. We will tell you honestly when surgery is the better answer.
ChondroFiller® vs Microfracture
Frequently asked questions
Is ChondroFiller® better than microfracture?
Better is the wrong word — they are different tools. Microfracture has decades of evidence and a clear role in small defects in young active patients. ChondroFiller® aims to produce more hyaline-like tissue without drilling the subchondral bone, and is delivered as an injection rather than a surgery. The right answer depends on the defect and the patient.
Why does microfracture produce fibrocartilage and not hyaline cartilage?
The repair tissue that forms after microfracture comes from a marrow clot, and its natural maturation pathway produces fibrocartilage — a tissue rich in type I collagen, mechanically inferior to native hyaline cartilage (type II collagen). Hyaline cartilage is what scaffold- and cell-based techniques like ChondroFiller®, MACI and ACI are trying to recreate.
I have already had microfracture and it has failed. Can I have ChondroFiller®?
Sometimes yes. Where the failed microfracture has left a contained defect with reasonable surrounding cartilage and a stable subchondral bone plate, ChondroFiller® is sometimes a reasonable next step. Where the bone plate is irregular or there is significant marrow oedema, a different procedure may be needed. We review the MRI before deciding.
Does ChondroFiller® avoid the recovery time of microfracture?
The injection itself is outpatient and most patients return to normal day-to-day activity within days. The tissue formation phase takes six to twelve months, during which we generally recommend graded loading rather than restricted weight-bearing. Microfracture typically requires a more prescriptive rehabilitation protocol because the subchondral bone has been perforated.
Is microfracture available on the NHS?
Yes, microfracture is available on the NHS for clinically appropriate cartilage defects, though waiting times and surgeon preference vary. ChondroFiller® is not routinely funded by the NHS in the UK and is a private treatment at this time.
Which has stronger evidence?
Microfracture has the longer publication history but the strength of that evidence has softened in recent years, particularly for defects larger than 2 cm². ChondroFiller® has published outcome data (IKDC, Harris Hip Score, MOCART MRI) and over 19,000 cases of clinical use. See the ChondroFiller® clinical evidence page.
Book a ChondroFiller® Assessment – London
Natural cartilage regeneration starts with the right defect, the right operator, and the right plan.
Learn More about ChondroFiller
Deep dive into our clinical resources and patient guides.
Cost in the UK
ChondroFiller® cost in the UK from £3,000, what is included and why prices vary.
Suitability
Who is suitable for ChondroFiller® as an injection, and who may need caution.
Clinical Evidence
IKDC, Harris Hip Score and MOCART MRI outcomes for ChondroFiller® cartilage regeneration.
Self-Assessment
Five-question ChondroFiller® pathway self-assessment for Prevention, Regeneration, Combination, or Support.
In London
Private ChondroFiller® cartilage repair at our Harley Street clinic.
Liquid Cartilage™ Surgery
Our proprietary keyhole-surgery technique combining ChondroFiller® with MSC co-delivery in a single procedure, for larger or more complex cartilage defects. £9,800.
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ChondroFiller vs Microfracture
ChondroFiller® regeneration compared to microfracture surgery for cartilage defects.
ChondroFiller vs MACI
ChondroFiller® scaffold compared to matrix-induced autologous chondrocyte implantation.
ChondroFiller vs ACI
ChondroFiller® scaffold compared to the original autologous chondrocyte implantation technique.
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ChondroFiller® cartilage regeneration compared to platelet-rich plasma injection.
ChondroFiller vs Stem Cells
ChondroFiller® compared to stem cell and biologic regenerative treatments.
ChondroFiller vs Knee Replacement
Where ChondroFiller® may help preserve the joint and where replacement is the right answer.
ChondroFiller® Injection
Cartilage Regeneration Overview
ChondroFiller® is a registered trademark of Meidrix Biomedicals GmbH. London Cartilage Clinic is not affiliated with or endorsed by Meidrix Biomedicals.