The Microfracture Technique for the Treatment of Articular Cartilage Lesions in the Knee

Mithoefer, Kai; Williams, Riley J.; Warren, Russell F.; Potter, Hollis G.; Spock, Christopher; Jones, Edward C.; Wickiewicz, Thomas L.; Marx, Robert G.

doi:10.2106/00004623-200509000-00002

Cited by 366 publications

(329 citation statements)

References 30 publications

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“…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.…”

Section: Microfracture Vs Drilling For Cartilage Repaircontrasting

confidence: 64%

“…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.…”

mentioning

confidence: 99%

“…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. 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.…”

mentioning

confidence: 99%

“…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. [17][18][19] In marrow-stimulating procedures, perforations to the subchondral bone allow the influx of blood and marrow-derived cells into the holes and defect followed by the formation of a blood clot.…”

mentioning

confidence: 99%

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

Chen

Sun²,

Hoemann

et al. 2009

Journal Orthopaedic Research

235

201

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Bone marrow stimulation is performed using several surgical techniques that have not been systematically compared or optimized for a desired cartilage repair outcome. In this study, we investigated acute osteochondral characteristics following microfracture and comparing to drilling in a mature rabbit model of cartilage repair. Microfracture holes were made to a depth of 2 mm and drill holes to either 2 mm or 6 mm under cooled irrigation. Animals were sacrificed 1 day postoperatively and subchondral bone assessed by histology and micro-CT. We confirmed one hypothesis that microfracture produces fractured and compacted bone around holes, essentially sealing them off from viable bone marrow and potentially impeding repair. In contrast, drilling cleanly removed bone from the holes to provide access channels to marrow stroma. Our second hypothesis that drilling would cause greater osteocyte death than microfracture due to heat necrosis was not substantiated, because more empty osteocyte lacunae were associated with microfracture than drilling, probably due to shearing and crushing of adjacent bone. Drilling deeper to 6 mm versus 2 mm penetrated the epiphyseal scar in this model and led to greater subchondral hematoma. Our study revealed distinct differences between microfracture and drilling for acute subchondral bone structure and osteocyte necrosis. Additional ongoing studies suggest these differences significantly affect long-term cartilage repair outcome. ß

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Section: Microfracture Vs Drilling For Cartilage Repaircontrasting

confidence: 64%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Chen

Sun²,

Hoemann

et al. 2009

Journal Orthopaedic Research

235

201

View full text Add to dashboard Cite

show abstract

“…154 Additionally, bone volume fi lling of the defect aft er 1 year will be measured, and graded as good (67% to 100%), moderate (34% to 66%), or poor (0% to 33%). 288 …”

Section: Secondary Outcome Measuresmentioning

confidence: 99%