Treatment of Osteoarthritis of the Knee with Microfracture and Rehabilitation

Yen, Yi‐Meng; Cascio, Brett M.; O’Brien, Luke; Stalzer, Steve; Millett, Peter J.; Steadman, J. Richard

doi:10.1249/mss.0b013e31815cb212

Cited by 52 publications

(55 citation statements)

References 31 publications

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“…HIU applied using minimally invasive techniques may provide therapeutic effects by physically modifying articular cartilage and subchondral bone. In such cases, HIU may generate microchannels in cartilage (as a form of micro-sized micro-fracture 69 ) or be used as a tool to non-thermally trim and modify tissues to restore joint anatomy.…”

Section: Challenges Facing Cartilage Repairmentioning

confidence: 99%

The potential utility of high-intensity ultrasound to treat osteoarthritis

Nieminen

Salmi

Karppinen

et al. 2014

Osteoarthritis and Cartilage

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Osteoarthritis (OA) is a widespread musculoskeletal disease that reduces quality of life and for which there is no cure. The treatment of OA is challenging since cartilage impedes the local and systemic delivery of therapeutic compounds (TCs). This review identifies high-intensity ultrasound (HIU) as a non-contact technique to modify articular cartilage and subchondral bone. HIU enables new approaches to overcome challenges associated with drug delivery to cartilage and new non-invasive approaches for the treatment of joint disease. Specifically, HIU has the potential to facilitate targeted drug delivery and release deep within cartilage, to repair soft tissue damage, and to physically alter tissue structures including cartilage and bone. The localized, non-invasive ultrasonic delivery of TCs to articular cartilage and subchondral bone appears to be a promising technique in the immediate future.

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Section: Challenges Facing Cartilage Repairmentioning

confidence: 99%

The potential utility of high-intensity ultrasound to treat osteoarthritis

Nieminen

Salmi

Karppinen

et al. 2014

Osteoarthritis and Cartilage

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“…However, MFX holes generated in osteoarthritic (OA) lesions sometimes fail to bleed. 22 Awl shape could potentially alter the biological reaction to MFX, and a variety of shapes is available (Linvatec, Streetsville, ON, Canada 4,21 ; Karl-Storz, Tuttlingen Germany 5 ; Arthrex, London, ON, Canada; Smith & Nephew, Andover, MA; Sontec Centennial, CO 19 ), but the awl used in different studies is most often not reported. 2,3,[23][24][25][26] OA is known to generate subchondral bone sclerosis, [27][28][29][30][31] which could also change the performance of a given awl.…”

Section: Microfracture (Mfx) Is Used To Resurface Focal Outerbridgementioning

confidence: 99%

Characterization of Initial Microfracture Defects in Human Condyles

et al. 2013

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Microfracture (MFX) is a cartilage repair technique that depends on cell migration from marrow-rich trabecular bone cavities into the cartilage lesion. This study tested the hypothesis that MFX awls with distinct geometry generate different hole shapes and variable bone marrow access in condyles with Grade III to IV lesions. Lateral and medial condyles from total knee arthroplasty (N = 24 male and female patients, 66 ± 9 years) were systematically microfractured ex vivo to 2 and 4 mm deep and the bone holes analyzed by micro-computed tomography. Subchondral bone in lesional condyles showed different degrees of sclerosis up to 2 mm deep ("porous," sclerotic, extremely dense). MFX holes ranged from 1.1 to 2.0 mm in diameter, and retained the awl shape with evidence of slight bone elastic rebound and bone compaction lining the holes that were increased by wider awl diameter and deeper MFX. Marrow access was significantly diminished by sclerosis for all three awls, with an average marrow access varying from 70% (nonlesional bone) to 40% (extremely dense bone). This study revealed that subchondral bone sclerosis can reach a critical limit beyond which MFX creates bone compaction and fissures instead of marrow access.

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“…2,[9][10][11] These techniques have some benefits in generating fibrocartilage or hyaline-like cartilage, but this can lack the mechanical durability needed in load-bearing joints. 3,12 Osteoarthritis (OA) is the most prevalent disease that compromises the function of articular joints and damages cartilage.…”

Section: Introductionmentioning

confidence: 99%