Percutaneous Drilling for Joint Preservation

When cartilage in a joint becomes damaged, worn, or fragmented, it creates friction and inflammation that progressively worsens over time — leading to chronic pain, swelling, and reduced mobility. Because cartilage cannot regenerate on its own, the body needs a targeted stimulus to initiate a healing response. Percutaneous drilling — also known as microfracture — is a minimally invasive joint preservation treatments technique that creates small, controlled perforations in the bone beneath damaged cartilage, triggering the formation of new tissue that can restore a functional cushion within the joint and delay or prevent the need for joint replacement.

Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with more than three decades of specialized experience in arthroscopic and minimally invasive joint surgery. Microfracture drilling is among the most widely used cartilage restoration techniques in professional sports — and as Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, Dr. Glashow has extensive firsthand experience applying this procedure to athletes who depend on rapid, reliable joint recovery to return to competition. A graduate of Cornell University Medical College with fellowship training at the Southern California Orthopedic Institute/UCLA, he has been named a Castle Connolly Top Doctor every year since 2000 and has performed over 15,000 orthopedic procedures at his Upper East Side practice in New York City.

Minimally-Invasive Joint Drilling

When cartilage is damaged from injury or worn thin from friction or inflammation, it can restrict joint movement. Cartilage fragments, uneven cartilage and thin cartilage can result in joint pain and swelling. Percutaneous, or microfracture, joint drilling is a procedure that can remove damaged or fragmented cartilage. Using an arthroscope and endoscopic tools, the joint can be accessed through a tiny incision for minimally-invasive cartilage and joint treatment.

Once the damaged cartilage is removed, percutaneous drilling is used to create perforations in the bone surface where there is lost or damaged cartilage. These small holes in the bone stimulate a healing response that can create new scar tissue to replace lost cartilage. Cartilage scar tissue can cushion the joint and reduce friction, resulting in less inflammation and pain with movement. Percutaneous drilling is performed as an outpatient procedure at our clinic in New York City and requires minimal downtime for recovery.

Explore Microfracture and Joint Preservation Options in New York City

If cartilage damage is causing persistent joint pain and limiting your ability to stay active, percutaneous drilling may offer a minimally invasive path to lasting relief. Dr. Glashow and his orthopedic team evaluate every patient individually — using advanced imaging and a thorough clinical assessment to determine whether microfracture drilling, biologic therapy, or a combination of advanced treatments will deliver the best outcome for your joint health and long-term goals. With more than 30 years of experience treating patients ranging from professional athletes to those simply seeking a pain-free, active life, Dr. Glashow provides the kind of personalized, expert-level care that has made his Upper East Side practice one of the most respected in New York City. Contact our office to schedule your consultation — we offer same-day and next-day appointments, after-hours and weekend availability, and 24/7 emergency access.

Frequently Asked Questions About Percutaneous Drilling for Joint Preservation

What is percutaneous drilling, and how does it differ from microfracture?

The terms are often used interchangeably. Both refer to a minimally invasive arthroscopic technique in which small perforations are made in the bone beneath an area of damaged or lost cartilage. These tiny holes allow blood and marrow elements to reach the joint surface, triggering a natural healing response that produces fibrocartilage — a functional tissue that cushions the joint and reduces bone-on-bone friction. Dr. Glashow uses precision arthroscopic instruments to control the depth and spacing of each perforation for optimal tissue formation.

Who is a good candidate for percutaneous drilling?

This procedure is best suited for patients with localized, full-thickness cartilage defects — typically in a weight-bearing area of the knee — who have not responded adequately to conservative treatments such as physical therapy, anti-inflammatory medications, or activity modification. Ideal candidates tend to be younger or more active patients whose surrounding joint structures are otherwise healthy. Dr. Glashow evaluates each patient’s imaging, symptoms, and activity goals before recommending drilling as part of a broader joint preservation plan.

What does recovery look like after microfracture drilling?

Because the procedure is performed arthroscopically through a small incision on an outpatient basis, initial recovery is relatively quick. Most patients use crutches and limit weight-bearing for four to six weeks to allow the new tissue to form and mature. A guided physical therapy program begins shortly after surgery, with a gradual return to low-impact activities over two to three months. A full return to sports or high-impact exercise typically takes four to six months, depending on the size and location of the defect treated. Dr. Glashow works closely with physical therapists and athletic trainers to tailor the rehabilitation timeline to each patient.

What kind of cartilage does microfracture produce?

The healing response stimulated by percutaneous drilling produces fibrocartilage rather than the original hyaline cartilage. While fibrocartilage is structurally different — it is denser and more fibrous — it creates a functional surface that reduces pain, decreases friction, and improves joint mobility for many patients. For some defects, Dr. Glashow may combine drilling with biologic treatments such as bone marrow concentrate to enhance the quality and durability of the new tissue.

Can percutaneous drilling be combined with other joint preservation treatments?

Yes. Dr. Glashow frequently pairs microfracture drilling with complementary therapies to maximize results. Bone marrow concentrate or amniotic fluid injections can be applied at the time of the procedure to support the healing response, and abrasion arthroplasty may be performed alongside drilling to smooth surrounding cartilage and optimize the overall joint surface. The specific combination depends on the nature and extent of each patient’s cartilage damage.

How long do the results of microfracture drilling last?

Results vary based on the size of the cartilage defect, the patient’s age and activity level, and adherence to the post-operative rehabilitation protocol. Many patients experience significant pain relief and improved joint function that lasts for several years, particularly when the procedure is performed on a well-contained defect and followed by appropriate physical therapy. For patients whose symptoms return over time, Dr. Glashow can discuss additional joint preservation options or, when appropriate, transition to more definitive surgical treatments.