No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Abstract

Background Débridement and bone marrow stimulation is an effective treatment option for patients with talar osteochondral defects. However, whether surgical factors affect the success of microfracture treatment of talar osteochondral defects is not well characterized. Questions/purposes We hypothesized (1) holes that reach deeper into the bone marrow-filled trabecular bone allow for more hyaline-like repair; and (2) a larger number of holes with a smaller diameter result in more solid integration of the repair tissue, less need for new bone formation, and higher fill of the defect. Methods Talar osteochondral defects that were 6 mm in diameter were drilled bilaterally in 16 goats (32 samples). In eight goats, one defect was treated by drilling six 0.45-mm diameter holes in the defect 2 mm deep; in the remaining eight goats, six 0.45-mm diameter holes were punctured to a depth of 4 mm. All contralateral defects were treated with three 1.1-mm diameter holes 3 mm deep, mimicking the clinical situation, as internal controls. After 24 weeks, histologic analyses were performed using Masson-Goldner/Safranin-O sections scored using a modified O'Driscoll histologic score (scale, 0-22) and analyzed for osteoid deposition. Before histology, repair tissue quality and defect fill were assessed by calculating the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The authors certify that the animal protocol for this investigation was approved by the Academic Medical Center and VU University, Amsterdam, and that all investigations were conducted in conformity with ethical principles of research. The design and creation of surgical templates was performed at TU Delft, Delft, The Netherlands. Animal operations were performed at VU University, Amsterdam, The Netherlands. Histology was performed at ACTA, Amsterdam, The Netherlands. Micro-CT acquisition and analyses were performed at Erasmus MC, Rotterdam, The Netherlands. Analyses were performed at Academic Medical Center, Amsterdam, The Netherlands. Conclusions The results indicate that the geometry of microfracture holes does not influence cartilage healing in the caprine talus. Clinical Relevance Bone marrow stimulation technique does not appear to be improved by changing the depth or diameter of the holes.

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