The treatment using microfracture tools is usually completed as part of arthroscopy or minimally invasive surgery, without the need for special or unique surgical incisions.

• Place the tip of the penetrator with a nail puller into the proximal cavity of the manual instrument.
• Position the distal end of the assembled microfracture tool at a target point approximately 2 mm away from the cartilage wall.
• Use a light hammer to strike the near‑end handle of the penetrator to a depth of 9 mm. Remove the penetrator after reaching the target depth.
• Reposition the penetrator to create additional holes at approximately 2 mm intervals. Use a spiral pattern to evenly perforate the subchondral bone plate until sufficient microfractures are formed.