Reviewing subchondral cartilage surgery: considerations for standardised and outcome predictable cartilage remodelling

Abstract

The authors suggest a new method for a standardised procedure using a new perforating device. Advances in MSS by subchondral bone marrow perforation are discussed. It remains to be determined by clinical studies how this method compares to microfracturing. The subchondral needling offers the surgeon and the investigator a method that facilitates comparison studies because of its defined depth of subchondral penetration and needle size.

Nanofractured autologous matrix induced chondrogenesis (NAMIC©) — Further development of collagen membrane aided chondrogenesis combined with subchondral needling

“…Indications for NAMIC© are basically the same as the authors' recommendation for nanofracturing [6]: A symptomatic International Cartilage Repair Society (ICRS) grade 4 cartilage lesion, the lesion should not be bigger than four square centimeters and should lie in the weight bearing region of the joint. Kissing lesions should also be excluded as in the AMIC© procedure.…”

“…This partial weight bearing pertains to the possible risk of a compression fracture after microfracturing due to small and ill-defined bone bridges between the V-shaped holes [6] which might not bear enough weight. Articular remodeling and chondral maturation may take up to six months so limited weight bearing for a certain amount of time is important.…”

“…However, six weeks partial weight bearing and disadvantages of microfracturing, the risk of iatrogenic fractures and an unpredictable outcome due to a missing standardization of the method has led the authors to further develop subchondral surgery [6]. Small holes of a defined diameter of one millimeter and a penetration depth of nine millimeters may be placed as subchondral needling or nanofracturing.…”

Management of Knee Cartilage Defects with the Autologous Matrix-Induced Chondrogenesis (AMIC) Technique

“…Since there is sufficient bridging between the drilled holes and the holes are straight there should be no reason for a subchondral impression fracture. Earlier weight-bearing has been suggested after nanofractures [25][26][27].…”

Comparison between embryonic stem cell versus adult stem cell to restore cartilage repair: an experimental study

“…The calcified layer was removed; vertical walls were created at the periphery of the cartilage lesion. In group-A, the defects were then treated with Nanofracture: each cartilage lesion was treated with 5 channels having a 9 mm depth using a cannulated awl and a 1mm thick Nitinol needle with a 3 mm distance between each channel; the surgical technique was previously described [6] . In group-B, liquid phase duplex Polymerase Chain Reaction (PCR) was performed on approximately 90 in vitro produced and vitrified blastocysts at day 6 -7 of culture according to the technique of Mara et al [7] as previously described [8] .…”