The New Microfracture: All Things Considered

Johnson, Laverne C.; Spector, Myron

doi:10.1016/j.arthro.2015.04.073

Cited by 6 publications

(8 citation statements)

References 18 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 One subchondral bone puncture, no matter how large the defect, would be adequate for leading to fibrin clot matrix formation. 13 …”

Section: Discussionmentioning

confidence: 99%

“…3 Multiple close penetrations of the subchondral bone may contribute to subchondral bone cyst formation and subchondral plate disruption. 13 One subchondral bone puncture, no matter how large the defect, would be adequate for leading to fibrin clot matrix formation. 13 Osteochondral autograft transplantation involves harvesting cylindrical osteochondral plugs from nonweightbearing articular regions of the knee to be transplanted into the chondral lesion.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Cost-Effectiveness Analysis of Surgical Treatment Modalities for Chondral Lesions of the Knee: Microfracture, Osteochondral Autograft Transplantation, and Autologous Chondrocyte Implantation

Schrock

Kraeutler

Houck

et al. 2017

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background:Numerous surgical options exist to treat chondral lesions in the knee, including microfracture (MFx), osteochondral autograft transplantation (OAT), first-generation autologous chondrocyte implantation (ACI-1), and next-generation ACI (ACI-2).Purpose:To compare the cost-effectiveness of MFx, OAT, and ACI-1. The secondary purpose of this study was to compare the functional outcomes of MFx, OAT, ACI-1, and ACI-2.Study Design:Systematic review; Level of evidence, 2.Methods:Two independent reviewers conducted an online literature search of 2 databases for level 1 and 2 studies using the Lysholm, International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and/or Hospital for Special Surgery (HSS) Knee Score. A weighted mean difference in pre- to postoperative functional outcome score was calculated for each treatment. The mean per-patient costs associated with MFx, OAT, and ACI-1 were determined from a recent publication based on review of a national private insurance database. The cost for each procedure was then divided by the weighted mean difference in functional outcome score to give the cost-per-point change in outcome score.Results:A total of 12 studies (6 level 1, 6 level 2) met the inclusion criteria for the functional outcome analysis, including 730 knees (MFx, n = 300; OAT, n = 90; ACI-1, n = 68; ACI-2, n = 272). The mean follow-up was not significantly different between groups (MFx, 29.4 months; OAT, 38.3 months; ACI-1, 19.0 months; ACI-2, 26.7 months). The mean increase in functional outcome score was 23 for MFx, 19 for OAT, 20 for ACI-1, and 35 for ACI-2. The change in functional outcome score was significantly greater for ACI-2 when compared with all other treatments (P < .0001). The cost-per-point change in functional outcome score was $200.59 for MFx, $313.84 for OAT, and $536.59 for ACI-1.Conclusion:MFx, OAT, ACI-1, and ACI-2 are effective surgical procedures for the treatment of cartilage defects in the knee. All 4 treatments led to an increase in functional outcome scores postoperatively with a short-term follow-up. ACI-2 had a statistically greater improvement in functional outcome scores as compared with the other 3 procedures. MFx was found to be the most cost-effective treatment option and ACI-1 the least cost-effective.

show abstract

“…13 One subchondral bone puncture, no matter how large the defect, would be adequate for leading to fibrin clot matrix formation. 13 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Cost-Effectiveness Analysis of Surgical Treatment Modalities for Chondral Lesions of the Knee: Microfracture, Osteochondral Autograft Transplantation, and Autologous Chondrocyte Implantation

Schrock

Kraeutler

Houck

et al. 2017

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…Such bleeding mostly originates from the opened vessels of the subchondral bone extending upward into the overlying calcified cartilage layer13. The subsequently formed so-called “super clot” consists of bone marrow extracellular matrix, progenitor cells, and stem cells, which may be sufficient for the repair of the lesion3031. Possibly, this “super clot” is capable of fulfilling the same effects than the additional bone marrow aspirate in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Early loss of subchondral bone following microfracture is counteracted by bone marrow aspirate in a translational model of osteochondral repair

Gao

Orth

Müller-Brandt

et al. 2017

Sci Rep

View full text Add to dashboard Cite

Microfracture of cartilage defects may induce alterations of the subchondral bone in the mid- and long-term, yet very little is known about their onset. Possibly, these changes may be avoided by an enhanced microfracture technique with additional application of bone marrow aspirate. In this study, full-thickness chondral defects in the knee joints of minipigs were either treated with (1) debridement down to the subchondral bone plate alone, (2) debridement with microfracture, or (3) microfracture with additional application of bone marrow aspirate. At 4 weeks after microfracture, the loss of subchondral bone below the defects largely exceeded the original microfracture holes. Of note, a significant increase of osteoclast density was identified in defects treated with microfracture alone compared with debridement only. Both changes were significantly counteracted by the adjunct treatment with bone marrow. Debridement and microfracture without or with bone marrow were equivalent regarding the early cartilage repair. These data suggest that microfracture induced a substantial early resorption of the subchondral bone and also highlight the potential value of bone marrow aspirate as an adjunct to counteract these alterations. Clinical studies are warranted to further elucidate early events of osteochondral repair and the effect of enhanced microfracture techniques.

show abstract

“… 15 , 16 , 33 , 37 , 39 Specific concerns regarding the durability of the MFx technique include the effect of microfractures in the subchondral bone, possibly making the bone brittle 2 and leading to subchondral cyst formation and subchondral plate disruption. 20 Furthermore, MFx leads to the growth of fibrocartilage, which differs in biomechanical properties from the native hyaline cartilage. 26 Based on this evidence, some sports medicine surgeons have recently abandoned the traditional MFx technique in exchange for a return to drilling due to a belief that drilling is less detrimental to the subchondral bone and may result in deeper penetration and stimulation of bone marrow cells with higher regenerative potential.…”

mentioning

confidence: 99%

Microfracture Versus Drilling of Articular Cartilage Defects: A Systematic Review of the Basic Science Evidence

Kraeutler

Aliberti

Scillia

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Microfracture (MFx) is one of the most common techniques used for the treatment of articular cartilage defects, although recently there has been a trend toward the use of drilling rather than MFx for the treatment of these defects. Purpose: To perform a systematic review of basic science studies to determine the effect of microfracture versus drilling for articular cartilage repair. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and EMBASE to identify basic science studies comparing outcomes of MFx versus drilling. The search phrase used was microfracture AND (drilling OR microdrilling). Inclusion criteria were basic science studies that directly compared the effect of MFx versus drilling on subchondral bone, bone marrow stimulation, and cartilage regeneration. Results: A total of 7 studies met the inclusion criteria and were included in this systematic review. Of these, 4 studies were performed in rabbits, 1 study in sheep, and 2 studies in humans. All of the included studies investigated cartilage repair in the knee. In the animal studies, microfracture produced fractured and compacted bone and led to increased osteocyte necrosis compared with drilling. Deep drilling (6 mm) was superior to both shallow drilling (2 mm) and MFx in terms of increased subchondral hematoma with greater access to marrow stroma, improved cartilage repair, and increased mineralized bone. However, the overall quality of cartilage repair tissue was poor regardless of marrow stimulation technique. In 2 studies that investigated repair tissue after MFx and/or drilling in human patients with osteoarthritis and cartilage defects, the investigators found that cartilage repair tissue did not achieve the quality of normal hyaline articular cartilage. Conclusion: In the limited basic science studies that are available, deep drilling of cartilage defects in the knee resulted in improved biological features compared with MFx, including less damage to the subchondral bone and greater access to marrow stroma. Regardless of marrow stimulation technique, the overall quality of cartilage regeneration was poor and did not achieve the characteristics of native hyaline cartilage. Overall, there is a general lack of basic science literature comparing microfracture versus drilling for focal chondral defects.

show abstract

The New Microfracture: All Things Considered

Cited by 6 publications

References 18 publications

A Cost-Effectiveness Analysis of Surgical Treatment Modalities for Chondral Lesions of the Knee: Microfracture, Osteochondral Autograft Transplantation, and Autologous Chondrocyte Implantation

A Cost-Effectiveness Analysis of Surgical Treatment Modalities for Chondral Lesions of the Knee: Microfracture, Osteochondral Autograft Transplantation, and Autologous Chondrocyte Implantation

Early loss of subchondral bone following microfracture is counteracted by bone marrow aspirate in a translational model of osteochondral repair

Microfracture Versus Drilling of Articular Cartilage Defects: A Systematic Review of the Basic Science Evidence

Contact Info

Product

Resources

About