Is Microfracture of Chondral Defects in the Knee Associated With Different Results in Patients Aged 40 Years or Younger?

122

114

Section: Introductionmentioning

confidence: 99%

A Cell-free Scaffold-based Cartilage Repair Provides Improved Function Hyaline-like Repair at One year

Siclari

Mascaro

Gentili

et al. 2012

122

114

“…Systematic reviews have shown a current clinical success percentage of 86%. The affect of patient and defectspecific prognostic factors such as lesion size [11,12], location [11,40], age [11,20,43], or body weight [12,18] is inconclusive owing to the absence of well-designed prospective studies [18,19]. The exact mechanisms of the healing process are unknown, which makes prediction of clinical outcome difficult [36,48].…”

Section: Introductionmentioning

confidence: 99%

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Kok

Tuijthof

Dunnen

et al. 2013

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.

“…Osteochondral autograft offers the benefits of mature hyaline cartilage transplantation, primary bone healing, and quick recovery and is recommended for high-demand athletes but is limited by donor graft morbidity [10,11]. Microfracture produces fibrocartilage and has inferior biomechanical properties [7,15,32,38], while autologous chondrocyte implantation produces a better hybrid of fibrocartilage and hyaline cartilage [7,32,38,51] but requires prolonged and complicated rehabilitation [34]. The use of scaffold alone offers a new strategy in the treatment of osteochondral injuries and diseases.…”

Section: Introductionmentioning

confidence: 99%

Oligo[poly(ethylene glycol)fumarate] Hydrogel Enhances Osteochondral Repair in Porcine Femoral Condyle Defects

Hui

Ren

Afizah

et al. 2013

Background Management of osteochondritis dissecans remains a challenge. Use of oligo[poly(ethylene glycol)fumarate] (OPF) hydrogel scaffold alone has been reported in osteochondral defect repair in small animal models. However, preclinical evaluation of usage of this scaffold alone as a treatment strategy is limited.Questions/purposes We therefore (1) determined in vitro pore size and mechanical stiffness of freeze-dried and rehydrated freeze-dried OPF hydrogels, respectively; (2) assessed in vivo gross defect filling percentage and histologic findings in defects implanted with rehydrated freeze-dried hydrogels for 2 and 4 months in a porcine model; (3) analyzed highly magnified histologic sections for different types of cartilage repair tissues, subchondral bone, and scaffold; and (4) assessed neotissue filling percentage, cartilage phenotype, and Wakitani scores. Methods We measured pore size of freeze-dried OPF hydrogel scaffolds and mechanical stiffness of fresh and rehydrated forms. Twenty-four osteochondral defects from 12 eight-month-old micropigs were equally divided into scaffold and control (no scaffold) groups. Gross and histologic examination, one-way ANOVA, and one-way Mann-Whitney U test were performed at 2 and 4 months postoperatively. Results Pore sizes ranged from 20 to 433 lm in diameter. Rehydrated freeze-dried scaffolds had mechanical stiffness of 1 MPa. The scaffold itself increased percentage of