Microdrilling Resulted in Less Subchondral Bone Destruction Than a Traditional Microfracture Awl for Articular Cartilage Defect Bone Marrow Stimulation.

Abstract

Purpose

The purpose of this study was to compare bone marrow stimulation using micro-computed tomography (micro-CT) analysis of an abrasion arthroplasty technique, drilling k-wire technique, traditional microfacture awl, or a microdrill instrument for subchondral bone defects.

Methods

Eleven cadaveric distal femoral specimens were obtained and divided into 3 common areas of osteochondral defect: trochlea and weightbearing portions of the medial and lateral femoral condyles. Each area of interest was then denuded of cartilage using a PoweRasp and divided into quadrants. Each quadrant was assigned either a 1.6 mm Kirschner wire (k-wire), 1.25 mm microfracture awl, 1.5 mm fluted microdrill, PowerPick, or a curette (abrasion arthroplasty) to create 4 channels into the subchondral bone sing the same instrument. Subchondral bone and adjacent tissue areas were then evaluated using micro-CT to analyze adjacent bone destruction and extension into the bone marrow.

Results

Overall, there was a significantly decreased area of bone destruction or compression using the microdrill (0.030 mm) as compared to the microfracture awl (0.072 mm) and k-wire (0.062 mm) (P < .05). Within the trochlea and the medial femoral condyle, there was significantly decreased bony compression with the microdrill as compared to the awl and k-wire (P < .05); however, when stratified, this was not significant among the lateral femoral condylar samples (P = .08).

Conclusion

Bone marrow stimulation causes bony compression that may negatively impact subchondral bone and trabecular alignment. It is important to understand which tools used for bone marrow stimulation cause the least amount of damage to the subchondral bone.

Clinical relevance

This study demonstrates the decreased subchondral bony defects seen with the microdrill versus the traditional microfracture awl indicating that when performing bone marrow stimulation, the microdrill may be a less harmful tool to the subchondral bone.

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Citation

Published Version (Please cite this version)

10.1016/j.asmr.2023.100786

Publication Info

Meyer, Lucy E, Richard M Danilkowicz, Zoe W Hinton, Bryan S Crook, Bijan Abar, Nicholas B Allen, Mitchell Negus, Eoghan T Hurley, et al. (2023). Microdrilling Resulted in Less Subchondral Bone Destruction Than a Traditional Microfracture Awl for Articular Cartilage Defect Bone Marrow Stimulation. Arthroscopy, sports medicine, and rehabilitation, 5(5). p. 100786. 10.1016/j.asmr.2023.100786 Retrieved from https://hdl.handle.net/10161/29306.

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Scholars@Duke

Toth

Alison Patricia Toth

Associate Professor of Orthopaedic Surgery

Dr. Toth specializes in sports medicine with a focus on anterior cruciate ligament (ACL) and multi-ligament knee reconstruction, knee and shoulder arthroscopy, shoulder impingement and instability, rotator cuff tears, articular cartilage healing and repair; meniscus healing and repair; patella dislocation, and cell and molecular biology approaches to the treatment of musculoskeletal injuries.

Amendola

Annunziato Amendola

Virginia Flowers Baker Distinguished Professor of Orthopaedic Surgery

Chief of Sports Medicine


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