Full-thickness cartilage lesions of the distal femur can cause pain, loss of function, and, ultimately, arthritis. These defects do not heal spontaneously and often require surgical intervention. Although a variety of cartilage- restoring and pain-eliminating procedures have been described, microfracture is a commonly accepted method of treatment with comparable results to other cartilage resto- ration procedures. 13,16 Recently, microfracture surgery has been portrayed in the media as a procedure that can result in rapid performance decline and/or the termination of a professional basketball player’s career. Although most clinical studies report improvement in knee function in 70% to 90% of patients undergoing micro- fracture surgery, 9,10,18 studies examining elite athletes and their ability to return to preinjury performance are lacking. Steadman et al 17 investigated outcomes of micro- fracture surgery in a cohort of National Football League (NFL) players. Although subjective, patient-derived out- comes were improved, performance variables were not reported. The purpose of this study was to describe preoperative and postoperative performance in a series of National Basketball Association (NBA) players who underwent microfracture surgery to treat chondral lesions. Furthermore, we sought to determine preoperative variables that were predictive for a player not returning to NBA competition. Results and Performance After Microfracture in National Basketball Association Athletes Surena Namdari, MD, MMSc, Keith Baldwin, MD, MSPT, MPH, Okechukwu Anakwenze, MD, Min-Jung Park, MD, MMSc, G. Russell Huffman, MD, MPH, and Brian J. Sennett,* MD From the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Background: Microfracture technique is commonly used to treat symptomatic chondral lesions of the knee. Performance outcomes and attrition rates associated with this injury/surgery in National Basketball Association athletes are unclear. Hypothesis: National Basketball Association players undergoing microfracture for symptomatic chondral lesions of the knee will have demonstrable differences in performance compared with preinjury and with matched controls. Study Design: Case control study; Level of evidence, 3. Methods: We evaluated 24 National Basketball Association players who underwent microfracture between 1997 and 2006. Descriptive data and performance data for the first full season preceding and following the index surgery were collected. Data were obtained from 48 matched controls. Univariate/multivariate statistical methods were used to assess change in performance and return to play. Results: Thirty-three percent (8 of 24) of National Basketball Association athletes who underwent microfracture surgery never returned to play in the National Basketball Association. Fourteen players returned to play in the National Basketball Association for >1 season. Within-group comparisons revealed that points scored (P = .008) and minutes played (P = .045) were reduced postoperatively. No performance variables were significantly different when averaged over 40 minutes of play. When compared with controls, cases experienced a significant decline in points per game (P = .013). Multiple regression analysis revealed that cases were 8.15 times less likely to remain in the National Basketball Association than controls (P = .005) after the index year. Conclusion: Players undergoing microfracture for knee chondral injuries are at risk for not returning to the National Basketball Association postoperatively. With the exception of points per game, athletes returning exhibited similar performance postopera- tively compared with matched controls. Keywords: microfracture; chondral defect; knee arthroscopy; National Basketball Association 943 *Address correspondence to Brian J. Sennett, MD, Chief, Sports Medicine, Associate Professor, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 235 South 33rd Street, Weightman Hall, 1st Floor, Philadelphia, PA 19104 (e-mail: brian .sennett@uphs.upenn.edu). No potential conflict of interest declared. The American Journal of Sports Medicine, Vol. 37, No. 5 DOI: 10.1177/0363546508330150 © 2009 American Orthopaedic Society for Sports Medicine