Chondral Resurfacing of Articular Cartilage Defects in the Knee with the Microfracture Technique

Abstract

Microfracture repair of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of two years. The best short-term results are observed with good fill grade, low body-mass index, and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade is associated with limited short-term durability.

Drilling and microfracture lead to different bone structure and necrosis during bone‐marrow stimulation for cartilage repair

“…Although bleeding is often seen clinically in MF when the pressure of circulating arthroscopic fluid is reduced, 11,12,15 we found overt bleeding at the time of surgery in only one out of four MF holes in our study. Nonetheless, 24 h later, all holes will filled with a blood clot suggesting continual bleeding or perhaps additional fracturing from weight bearing postsurgically.…”

“…Drilling, first introduced by Pridie in 1959, 3 was prevalent for decades 4,6 prior to MF becoming advocated in the 1990s. 5,[7][8][9][10][11][12][13] Both of these procedures aim at recruiting bone marrow elements to repair cartilage defects. 14,15 MF uses an arthroscopic awl to penetrate the subchondral plate, and is thought to be superior to Pridie drilling, 5,10,11,16 which employs a hand-driven or motorized drill that may produce heat necrosis in the bone-a hypothesis that has never been tested.…”

“…14,15 MF uses an arthroscopic awl to penetrate the subchondral plate, and is thought to be superior to Pridie drilling, 5,10,11,16 which employs a hand-driven or motorized drill that may produce heat necrosis in the bone-a hypothesis that has never been tested. The MF technique represents a first-line treatment option for full-thickness cartilage defects in the knee 12,17 showing a decrease in pain and improved knee function after 1-or 2-year follow-up. [7][8][9][10][11]18 Recent clinical data has also provided evidence that outcomes after MF are similar to those of autologous chondrocyte implantation.…”

“…20 Bone remodeling can proceed along with the induction of chondrogenisis that resembles endochondral ossification, to form new bone in deeper zones and fibrous or fibrocartilaginous tissues in the more superficial chondral region. 10,14,15,21 A number of studies using bone marrow stimulation have been carried out to improve cartilage repair by modifying the perforation technique, 12 combining with periosteal grafts, 22 hybrid implants, [23][24][25] scaffolds, 26 or other surgical methods. 27 However, to our knowledge, no previous study has specifically investigated the characteristics of the acute fractures themselves, such as hole shape, extent of hematoma, extent of bone damage, morphology of fractured bone and bone marrow, and osteocyte necrosis.…”

Buffered Platelet-Rich Plasma Enhances Mesenchymal Stem Cell Proliferation and Chondrogenic Differentiation

“…Filling of the defect after microfracture has been correlated with clinical outcome. 20 If PRP improves filling via increased stem cell proliferation or differentiation, better clinical outcomes would be anticipated. A clinical study using buffered PRP to augment microfracture surgery is presently being designed to test this hypothesis.…”