Knee cartilage defect: marrow stimulating techniques

Mirza, Muhammad Z.; Swenson, Richard D.; Lynch, Scott A.

doi:10.1007/s12178-015-9303-x

Cited by 17 publications

(12 citation statements)

References 56 publications

(55 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, these techniques are only focused on the repair/regeneration of the cartilage, while defects greater than 6-8 mm in depth (OC defects) require the addition of a bone graft [18]. Instead, relatively small OC defects, <2 cm 2 , can be treated using microfracture surgery where holes are created in the subchondral bone to access the bone marrow and release stem cells and growth factors (Figure 2A) [17,[67][68][69][70]. While this method can produce new cartilage, histological analysis shows this to be mostly composed of fibrocartilage [70] which lacks the lubricative and load distribution properties typical of the native articular hyaline cartilage [54].…”

Section: Existing Surgical Treatments For Osteochondral Defectsmentioning

confidence: 99%

3D Printed Multiphasic Scaffolds for Osteochondral Repair: Challenges and Opportunities

Doyle

Snow

Duchi

et al. 2021

IJMS

View full text Add to dashboard Cite

Osteochondral (OC) defects are debilitating joint injuries characterized by the loss of full thickness articular cartilage along with the underlying calcified cartilage through to the subchondral bone. While current surgical treatments can provide some relief from pain, none can fully repair all the components of the OC unit and restore its native function. Engineering OC tissue is challenging due to the presence of the three distinct tissue regions. Recent advances in additive manufacturing provide unprecedented control over the internal microstructure of bioscaffolds, the patterning of growth factors and the encapsulation of potentially regenerative cells. These developments are ushering in a new paradigm of ‘multiphasic’ scaffold designs in which the optimal micro-environment for each tissue region is individually crafted. Although the adoption of these techniques provides new opportunities in OC research, it also introduces challenges, such as creating tissue interfaces, integrating multiple fabrication techniques and co-culturing different cells within the same construct. This review captures the considerations and capabilities in developing 3D printed OC scaffolds, including materials, fabrication techniques, mechanical function, biological components and design.

show abstract

Section: Existing Surgical Treatments For Osteochondral Defectsmentioning

confidence: 99%

3D Printed Multiphasic Scaffolds for Osteochondral Repair: Challenges and Opportunities

Doyle

Snow

Duchi

et al. 2021

IJMS

View full text Add to dashboard Cite

show abstract

“…The cartilage tissue formed can fill the defect partially or completely. When the healing tissue was analyzed at 8 weeks, it was observed that it consisted of fibrous tissue (29%), fibro cartilaginous tissue (30%), granulation tissue (12%), bone tissue filling the defect (10%) and hyaline-like cartilage tissue (12%) (1) . The quality of the repaired tissue was still a matter of discussion.…”

Section: Graphmentioning

confidence: 99%

“…On the basis of experimental and clinical studies, the use of continuous passive motion (CPM) of the knee together with a period of non-weight bearing had been widely adopted for the management of chondral defects, especially after microfracture. Salter et al (30) stated that perhaps the most influential investigators to advocate the use of CPM in conjunction with biologic resurfacing procedures, were believing that the quality of chondral repair tissue was markedly improved by the "dynamic compression" that modulated the regenerative potential of chondrocytes (1) .…”

Section: Does Lesion Size Influence Outcome With Microfracture ?mentioning

confidence: 99%

“…If only cartilage is involved in the pathology, the term chondral defect is used. Many synonyms are used, including osteochondritis dissecans, transchondral fracture, flake fracture, talar dome fracture, osteochondral fracture, osteochondral lesion and osteochondral defect (1) . Full-thickness articular cartilage defects only have limited regenerative potential.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assisted Arthrscopic Microfracture Treatment of Osteochondral Lesions of the Knee

Shaheen¹,

El-Sayed²,

Mankoula³

2017

Egyptian Journal of Hospital Medicine

View full text Add to dashboard Cite

Background: chondral injuries in the knee are a common source of pain and morbidity. Treatment of symptomatic chondral defects is challenging due to the limited healing capacity of articular cartilage. Microfracture is the most common surgical technique used to treat chondral defects in the knee and utilizes marrow stimulation to generate a fibrocartilage repair. Microfracture has demonstrated good short-term postoperative outcomes. Long-term outcomes following microfracture are variable, with loss of improvement attributed to the poor mechanical qualities of the fibrous repair tissue. Aim of the work: this prospective study with a 12 months follow-up was conducted to determine the efficacy of microfracture in the postoperative follow-up. We prospectively followed up these patients preoperatively and postopertively, clinically and radiologically. The final diagnosis was confirmed during arthroscopy. Patients and Methods: thirty symptomatic patients with articular cartilage defects of the knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twelve months with a combination of validated outcome scores, subjective clinical rating and cartilage-sensitive magnetic resonance imaging. Results: at the time of the latest follow-up, knee function was rated good to excellent for twenty patients (60%), fair for four patients (13%) and poor for eight (26%). A lower body-mass index correlated with higher scores for the activities of daily living, with the worst results for patients with a body-mass index of >30 kg/m2. Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in 15 knees demonstrated good healing in tissue fill of eight patients (54%), moderate fill in four (29%) and poor fill in three patients (17%). The fill grade was correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twelve months. Conclusions: microfracture healing of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of one year. The best short-term results were 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 was associated with limited short-term durability.

show abstract

“…8 , 9 More recently, a microdrill (PowerPick; Arthrex, Naples, FL) has been introduced as a technical alternative to more traditional awl and hammer techniques. 10 , 11 Histologic examinations of bone after treatment with a microdrill demonstrate decreased bony compaction and preservation of “bony channels” to marrow stroma relative to a traditional mallet and awl. 12 However, the impact of technique variations on outcomes has yet to be determined, 13 , 14 , 15 although based on histologic changes, improved outcomes may be expected.…”

mentioning

confidence: 99%

Microdrilling Demonstrates Superior Patient-Reported Outcomes and Lower Revision Rates Than Traditional Microfracture: A Matched Cohort Analysis

Beletsky

Naveen

Tauro

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

View full text Add to dashboard Cite

The purpose of this study was to compare patient-reported outcomes and revision rates between the standard microfracture awl versus the microdrilling technique. Methods: Microfracture patients were queried from a singleinstitution database between 2001 and 2016. Patient-reported outcome measure data were collected at preoperative and 6-and 12-month time points, inclusive of the International Knee Documentation Committee (IKDC) score, Short Form 12 (SF12) Physical Component Score (PCS) and Mental Component Score, and all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. A matching algorithm based on previous procedures, lesion size, and demographic factors created 2 technique-based cohorts. Outcomes including revision rates and both statistically and clinically significant differences (i.e., the minimally clinically important difference [MCID]) between awl and microdrill cohorts were compared using univariate statistics. Results: A total of 68 patients (aged 32.0 AE 13.1 years, 48.5% female, body mass index 26.7 AE 5.3 kg/m 2 ), with 34 patients in each group, were included after the match. At 6 months, the microdrilling group demonstrated significantly greater levels of improvement than the awl group on the IKDC, SF12 PCS, and KOOS Pain, Symptom, Sport, and Quality of Life (P < .04), although differences at 1 year were only maintained on the SF12 PCS instrument (P < .001). With respect to MCID achievement, the microdrilling group demonstrated greater achievement rates at 6 months on the IKDC, KOOS Pain, and KOOS Sport (P < .04). The awl group demonstrated a higher rate of revision surgery (P ¼ .02) within 3 years of follow-up and a greater likelihood to require multiple subsequent procedures (41.1% vs 17.6%, P ¼ .03). Conclusions: Microdrilling demonstrated superior outcomes relative to traditional microfracture awl techniques with respect to patient-reported outcomes at 6 months and revision rates within 3 years of followup. In addition, clinically meaningful differences were evident at 6 months in the microdrilling group. Level of Evidence: Level III, retrospective comparative study.

show abstract

Knee cartilage defect: marrow stimulating techniques

Cited by 17 publications

References 56 publications

3D Printed Multiphasic Scaffolds for Osteochondral Repair: Challenges and Opportunities

3D Printed Multiphasic Scaffolds for Osteochondral Repair: Challenges and Opportunities

Assisted Arthrscopic Microfracture Treatment of Osteochondral Lesions of the Knee

Microdrilling Demonstrates Superior Patient-Reported Outcomes and Lower Revision Rates Than Traditional Microfracture: A Matched Cohort Analysis

Contact Info

Product

Resources

About