A Preliminary Study of Joint Surface Changes After an Intraarticular Fracture: A Sheep Model of a Tibia Fracture With Weight Bearing After Internal Fixation

Trumble, Thomas E.; Allan, Christopher H.; Miyano, John; Clark, John M.; Ott, Susan M.; Jones, D. E. Casey; Fernacola, Patrick; Magnusson, Marteinn; Tencer, Allan F.

doi:10.1097/00005131-200106000-00004

Cited by 21 publications

(15 citation statements)

References 15 publications

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“…Strauss et al report long-term results as we do, with a follow-up time of 12 mo. 45 In a study of intra-articular step-off fractures, Trumble et al 46 reported evidence of a tendency for articular congruency to improve after fracture, reflecting structural adaption. This is of interest because a remodeling process might also occur in adjacent articular cartilage around a defect.…”

Section: Discussionmentioning

confidence: 99%

Cell-Laden and Cell-Free Matrix-Induced Chondrogenesis versus Microfracture for the Treatment of Articular Cartilage Defects

Gille¹,

Kunow²,

Boisch

et al. 2010

CARTILAGE

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Objective:The aim of this study was to evaluate the regenerative potential of cell-laden and cell-free collagen matrices in comparison to microfracture treatment applied to full-thickness chondral defects in an ovine model.Methods:Animals (n = 30) were randomized into 5 treatment groups, and 7-mm full-cartilage-thickness defects were set at the trochlea and medial condyle of both knee joints and treated as follows: 2 scaffolds in comparison (collagen I/III, Chondro-Gide®; collagen II, Chondrocell®) for covering microfractured defects (autologous matrix-induced chondrogenesis), both scaffolds colonized in vitro with autologous chondrocytes (matrix-associated chondrocyte transplantation), or scaffold-free microfracture technique. One year after surgery, cartilage lesions were biomechanically (indentation test), histologically (O’Driscoll score), and immunohistochemically (collagen type I and II staining) evaluated.Results:All treatment groups of the animal model induced more repair tissue and showed better histological scores and biomechanical properties compared to controls. The average thickness of the repair tissue was significantly greater when a scaffold was used, especially the collagen I/III membrane. However, none of the index procedures surpassed the others from a biomechanical point of view or based on the histological scoring. Collagen type II expression was better in condylar defects compared to the trochlea, especially in those treated with collagen I/III membranes.Conclusion:Covering of defects with suitable matrices promotes repair tissue formation and is suggested to be a promising treatment option for cartilage defects. However, it failed to improve the biomechanical and histological properties of regenerated articular cartilage compared to microfracture alone in an ovine model under the given circumstances.

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Section: Discussionmentioning

confidence: 99%

Cell-Laden and Cell-Free Matrix-Induced Chondrogenesis versus Microfracture for the Treatment of Articular Cartilage Defects

Gille¹,

Kunow²,

Boisch

et al. 2010

CARTILAGE

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“…Displaced intraarticular fractures form an incongruent surface that increases local contact stresses. 1,[3][4][5][6]11,12,16,18,22 With time, these increased contact stresses may exceed the tolerance of articular cartilage and result in the development of posttraumatic osteoarthritis. 7,9,19 Biomechanical studies have shown significant contact surface pressure changes with as little as 1 mm of articular incongruency 3,6,19,22 and studies done on the upper extremity have shown an increased incidence of posttraumatic arthritis with 1 to 2 mm of articular incongruency.…”

mentioning

confidence: 99%

“…In an effort to confirm these observations and determine how the articular surface and subchondral bone remodels after an intraarticular fracture, joint surface changes were examined in a weightbearing sheep model with an intraarticular fracture. 18 …”

mentioning

confidence: 99%

Remodeling of Articular Defects in an Animal Model

Trumble¹,

Verheyden²

2004

Clinical Orthopaedics &Amp; Related Research

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When treating displaced intraarticular fractures, the goal has been to restore normal articular cartilage contour to decrease local contact stresses that may lead to the development of posttraumatic osteoarthritis. To confirm observations that articular cartilage step-offs can remodel with time and to determine how the articular surface and subchondral bone remodels after an intraarticular fracture, joint surface changes were examined in a weightbearing sheep model with an intraarticular fracture. Articular surface pressure changes were observed across a 1-mm osteotomy. Twelve weeks after an intraarticular osteotomy, there was a decrease in differential pressure distribution between the normal articular cartilage and the depressed articular surface. Histologic analysis showed thinning of the articular cartilage on the high side of the osteotomy with collagen compression and bending of the collagen fibrils. On the low side of the osteotomy, increased chondrocyte cellularity and hypertrophy were observed. In addition, bending of collagen fibrils was observed in an unloaded state in an attempt to form a smooth overlapping shelf at the osteotomy site. Because intraarticular incongruency, with resultant joint contact pressure differences, seems to be involved in the development of posttraumatic arthritis, methods to improve cartilage remodeling may improve outcome after intraarticular fractures.

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“…17 Trumble et al also suggested in his study that an articular step of <2 mm is critical for good outcome. 18 Rademaker et al in his retrospective study described that an articular step off <2 mm did not significantly differ from that of upto 4mm in causing secondary arthritis. 19 In our study two patients had an acceptable step off <2 mm and one patients had a step off up to 4 mm which was unacceptable and required revision.…”

Section: Discussionmentioning

confidence: 91%

Unusual medial tibial plateau fracture fixation using dual plating

et al. 2019

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Background: Medial tibial plateau fractures is a subtype of proximal tibial fractures that involve the articular surface and can present in several distinct patterns. Purpose of this study was to assess the clinical outcome of stabilizing these biplanar medial tibial plateau fractures using dual plating technique through a single incision.Methods: Between 2017 to 2019, 12 men and 8 women with closed medial tibial plateau fracture who underwent reconstruction using two plates through a posteromedial approach were included in the study group. The fractures were classified using the three column concept of Lou.Results: One patient had an articular step off that was unacceptable and two patients had an acceptable articular step off. Functional assessment was done using the objective scoring of Oxford knee score criteria and radiological assessment was done using the Rasmussen modified score.Conclusions: Biplanar reconstruction using dual plates is a reliable and safe technique to reconstruct complex medial tibial plateau fractures.

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A Preliminary Study of Joint Surface Changes After an Intraarticular Fracture: A Sheep Model of a Tibia Fracture With Weight Bearing After Internal Fixation

Abstract: In this model with a small fracture displacement (1.0 millimeter), which was less than the thickness of the articular cartilage (1.5 millimeters), the contour of the joint improved despite residual articular surface incongruency after the fracture healing.

Cited by 21 publications

References 15 publications

Cell-Laden and Cell-Free Matrix-Induced Chondrogenesis versus Microfracture for the Treatment of Articular Cartilage Defects

Cell-Laden and Cell-Free Matrix-Induced Chondrogenesis versus Microfracture for the Treatment of Articular Cartilage Defects

Remodeling of Articular Defects in an Animal Model

Unusual medial tibial plateau fracture fixation using dual plating

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