Search

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.

The purpose of this study was to report on a small case series of patients undergoing particulated autologous cartilage implantation (PACI) for to treat traumatic displaced OLTs. Four patients underwent PACI procedures at a median time of 16.5 days (range 6 to 26) after the initial trauma. Demographic data, mechanism of injury, OLT characteristics, concomitant procedures, complications, and reoperations were recorded. Postoperative patient-reported outcome measures were collected including the Visual Analog Score (VAS), Short-Form -12 (SF-12), foot and ankle ability measure (FAAM), and American Orthopaedic Foot and Ankle Surgery (AOFAS) hindfoot scores. Postoperative MRI and second-look arthroscopy were assessed for two patients. The mean age of the cohort at the time of the PACI procedure was 23.3 (range 15 to 37) years. At a mean most recent follow-up of 61.8 months (range 33 to 99), the mean postoperative patient-reported outcomes scores were: VAS (0.5; range 0 to 1), PCS SF-12 (45.2; range 34.99 to 54.44), MCS SF-12 (44.1; range 37.75 to 49.2), FAAM ADL (87.5; range 70 to 100), FAAM sporting (71.5; range 29 to 100), and AOFAS hindfoot (86.3; range 77 to 100). The mean time to return to preinjury activity was 7.04to 9 months. There were no graft-related complications. Two of the patients underwent second-look arthroscopy and were found to have intact repairs. The PACI showed promising midterm clinical outcomes and return to preinjury activity level without graft-related complications for irreducible displaced traumatic OLTs. Although our study showed promising outcomes at 61.8 months follow-up, larger cohort studies with standardized surgical protocols are needed to determine whether PACI has favorable outcomes comparted to other restorative and reparative OLT procedures.

Osteochondral lesions of the talus (OLTs) are difficult to treat. Arthroscopic microfracture augmented with micronized cartilage (BioCartilage; Arthrex, Naples, FL) and platelet-rich plasma is emerging as a treatment for moderate-sized, well-contained full-thickness OLTs. This treatment may provide superior histologic results and is less technically demanding and yields less morbidity than an open osteochondral allograft or autograft transfer. This technique guide presents the senior author’s preferred strategy for treatment of a moderate-sized OLT with arthroscopic microfracture and placement of micronized cartilage and platelet-rich plasma.

Several options exist for the treatment of osteochondral lesions of the talus. Particulated juvenile cartilage allograft transplantation (PJCAT) has become a viable treatment modality for osteochondral lesions of the talus that are not amenable to microfracture or for which microfracture has failed. Arthroscopic placement of this type of graft obviates the need for osteotomy or plafondplasty and does not prevent additional procedures from being performed through an anterior approach. Special instrumentation and setup are not required to perform this procedure. Our arthroscopic technique for placement of particulated juvenile cartilage into osteochondral lesions of the talus is described. Case series and outcomes after arthroscopic ankle PJCAT are currently not reported within the literature; however, it is believed that the outcomes are at least similar to those of open ankle PJCAT.