Articular Cartilage Pathology and Therapies
Kyriacos A. Athanasiou, Eric M. Darling, Grayson D. DuRaine, Jerry C. Hu, A. Hari Reddi in Articular Cartilage, 2017
Microfracture is the simplest, quickest, and least expensive treatment option, with arthroscopic operating time being as little as 30–90 minutes. This technique has been widely employed for isolated chondral defects of the knee (Bae et al. 2006; Mithoefer et al. 2006), shoulder (Siebold et al. 2003), and ankle (Becher and Thermann 2005). Microfracture involves having the surgeon cause small fractures into the bone of a full-thickness defect connecting into the underlying bone marrow to allow bleeding and clot formation in the defect (Mithoefer et al. 2006). This also allows for stem cells and other factors in the bone marrow to migrate into the defect. The damaged cartilage is first removed down to the calcified zone to expose healthy adjacent tissue. The calcified cartilage is then removed, and an arthroscopic awl perforates the subchondral plate to a depth of approximately 4 mm, with holes spaced 3–4 mm apart. Blood fills the defect, resulting in a fibrin clot that initiates a healing response. This clot, over a period of 8–12 weeks, will be replaced with fibrocartilage, which, although filling the defect and providing improved outcomes, is less mechanically robust than hyaline cartilage. Thus, fibrocartilage only serves as a temporary treatment.
Histomorphometry
C M Langton, C F Njeh in The Physical Measurement of Bone, 2016
Using the above method it has been observed that while sections of normal unstressed bone contain the occasional single discrete microcrack, those from bone subjected to controlled stress contain groups called ‘microfracture episodes’ [136]. At the same time, a compressive load of 2.0 kN not only visibly creates many microfissures but also increases the permeability of the matrix such that it stains apparently intact regions, separating them from unstained structurally sound tissue. These compression-induced ‘leaky’ areas (figure 6.14) resemble a naturally occurring tetracycline staining phenomenon previously noted in the mature matrix of osteoporotic subjects [121] which seemed to have become similarly ‘leaky’, this time in situ. In both instances these diffusely stained regions may indicate the presence of ultra-small micro-fissures below the resolution of the optical microscope, and witness to an unrecorded facet of bone biodynamics. As such they may provide insight into a normal hydraulic cycle within the matrix whereby transitory ultrastructural fissures are judicially opened and closed in response to the application and release of stress, only becoming permanent as a result of fatigue or other failure. Exposure to the higher compression force described above rendered permeable to stain not only most of the mineralized matrix, but also the associated soft tissues as membrane and tissue boundaries were ruptured.
Reduction and Fixation of Sacroiliac joint Dislocation by the Combined Use of S1 Pedicle Screws and an Iliac Rod
Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White in Advances in Spinal Fusion, 2003
affected by accumulation of tissue microdamage as a result of fatigue. There is compelling evidence that microdamage is repaired by targeted bone remodeling [73,74] (Fig. 7). This repair process is distinct from trabecular microfracture healing that involves microcallus formation (Fig. 8). Microcallus formation in the vertebral body increases with advanced age in the absence of major spinal trauma [75]. The targeted repair of microdamage is mechanistically similar to the process of continuous bone remodeling, which occurs normally throughout the body. In some instances, microdamage may act as a positive feedback by increasing the resorption space associated with increased resorption [76]. This may put the cancellous bone structure at greater
Epidemiology of pediatric cartilage restoration procedures in the United States: insurance and geography play a role
Published in The Physician and Sportsmedicine, 2023
Tyler B. Hall, Max J. Hyman, Neeraj M. Patel
In their recent systematic review, Valtanen et al found that OAT, OCA, and ACI all produced postoperative improvements in at least one patient-reported outcome score that surpassed the minimal clinically important difference (MCID) threshold. However, the authors also noted that inconsistent use of validated outcome measures makes it difficult to assess the relative efficacies of cartilage restoration procedures [15]. Beyond inconsistent reporting, there is a lack of high-quality evidence comparing the various cartilage restoration techniques in children and adolescents. To date, only one randomized clinical trial has studied cartilage restoration procedures in children. In this study, Gudas et al compared OAT to microfracture and reported failure rates of 0% and 41% for OAT and microfracture, respectively, at an average of 4.2 years follow-up. Furthermore, microfracture showed significant deterioration in clinical improvement over the study’s duration [8]. While these are promising results relative to microfracture, an operation that produces fibrocartilage, the long-term efficacy of OAT compared to other hyaline cartilage restoration procedures remains unclear in the pediatric population.
Arthroscopic triple arthrodesis for the patient with rheumatoid arthritis; a case report
Published in Modern Rheumatology Case Reports, 2021
Tomoyuki Nakasa, Yasunari Ikuta, Munekazu Kanemitsu, Nobuo Adachi
Subtalar joint: To access the subtalar joint, 2 portals were applied at the sinus tarsi (Figure 2(A,B)). A 2.7-mm 30° oblique arthroscope (Smith&Nephew, Memphis, TN) was used. Articular cartilage had broadly disappeared and exposed subchondral bone was partially covered with scar tissue (Figure 3(A)). Scar tissue and residual articular cartilage was curetted with a chisel, and the anterior, middle and the posterior facet were fully decorticated using a 3.5 mm cylindrical bone burr, taking care not to advance it in a medial direction, so as to avoid damage to the flexor hallucis tendon, tibial nerve and posterior tibial artery (Figure 3(B)). After that, microfracture was performed to promote subchondral bleeding (Figure 3(C)).
Microfracture technique combined with mesenchymal stem cells inducer represses miR-708-5p to target special at-rich sequence-binding protein 2 to drive cartilage repair and regeneration in rabbit knee osteoarthritis
Published in Growth Factors, 2023
YongChao Wang, Qin Su, HaiRong Tang, Qiang Tian, Xin Lin, MeiChun Fu, RenMing Zhang, ZhangFeng Luo, KeYun Zhang
Numerous studies have manifested the pathogenesis of KOA refers to cartilage (Zhao et al. 2020), subchondral bone (Wang et al. 2021), synovium (Liao et al. 2020), and other joint structures. Among them, articular cartilage degeneration has always been considered a mark of KOA (Zhao et al. 2020). The latest research clarifies the poor self-healing ability of articular cartilage, owing to the insufficient blood supply and insufficient cells in the internal tissues may be linked with the physio-pathological mechanism of KOA (Gu et al. 2018). The cartilage regeneration ability of the knee joint is weak, and it cannot repair itself after the disease occurs. If it is not treated in time, it will aggravate the cartilage damage and eventually loss of joint function (Driban et al. 2020). Under normal circumstances, the balance between the proliferation and apoptosis of articular cartilage cells is the crux to maintaining the stability of the articular cartilage environment, and abnormal cartilage cell apoptosis will disrupt this balance and facilitate articular cartilage degeneration (Gu et al. 2021). The microfracture technique is the ideal approach for articular cartilage repair. The microfracture technique is to drill several holes deep into the medullary cavity on the cleaned cartilage defect wound to result in microfractures in the subchondral cancellous bone and facilitate cartilage regeneration and repair the defect by adjusting different signal pathways (Yin et al. 2020). For example, microfracture technology stimulates the Wnt/β-Catenin pathway to promote cartilage regeneration (Schizas et al. 2019). However, microfracture surgery is less effective for KOA, especially for more significant cartilage defects.
Related Knowledge Centers
- Arthroplasty
- Arthroscopy
- Articular Cartilage Repair
- Bone
- Hyaline
- Mesenchyme
- Surgery
- Bone Fracture
- Blood
- Knee Replacement