Can osteochondral grafting be augmented with microfracture in an extended-size lesion of articular cartilage?
BACKGROUND
Both microfracture and osteochondral autografting procedures have been useful in treating osteochondral lesions.


OBJECTIVE
Combining microfracture and osteochondral autografting procedures can extend the size of lesions that can be treated with either technique.


METHODS
Descriptive laboratory study.


METHODS
Eight adult goats underwent osteochondral autograft transfer of a 4.5-mm femoral trochlea plug into an 8-mm full-thickness chondral defect. Microfracture was performed in the gap region surrounding the autograft. The animals were allowed normal activity until the end of the experiment at 6 months. At harvest, the knees were assessed grossly, and then evaluation was performed by histology, histomorphometry, biochemistry, and biomechanics.


RESULTS
The osteochondral plugs healed well, with integration of the bone and preservation of the chondral cap. The chondral gap between the host site articular cartilage and the transferred plug had decreased from 3 mm at implant to less than 0.1 mm. Histologic analysis demonstrated regions of variable cartilage repair, with integration of the cartilage layer at some sites but incomplete healing at others. Histomorphometry demonstrated filling of the chondral gap to 75% to 85% of the normal volume. Biochemical analysis revealed greater than 90% type II collagen at most sites, with some areas containing 80% type II collagen. Biomechanical indentation testing indicated that the repaired area had variable thickness and stiffness, with a trend of increased stiffness in the bulk graft and decreased softness at the proximal microfracture interface site.


CONCLUSIONS
The performance of a combined microfracture and osteochondral autograft transfer procedure to resurface a large chondral defect appears promising.


CONCLUSIONS
This combined technique shows promise for treatment of large chondral defects with a single operative procedure with autogenous tissue that is safe and potentially would have a shorter period of rehabilitation, similar to that of osteochondral transfers and microfracture, in a cost-effective setting.
Lane
John G
JG
Department of Orthopaedic Surgery, University of California at San Diego, 9500 Gilman Drive, La Jolla, California 92093-0863, USA.
Healey
Robert M
RM
Chen
Albert C
AC
Sah
Robert L
RL
Amiel
David
D
D000818:Animals; D054544:Arthroplasty, Subchondral / Q000379:methods*; D001696:Biomechanical Phenomena; D016025:Bone Transplantation / Q000379:methods*; D002358:Cartilage, Articular / Q000166:cytology / Q000293:injuries* / Q000601:surgery*; D019902:Chondrocytes / Q000166:cytology; D024043:Collagen Type II / Q000032:analysis; D005269:Femur / Q000601:surgery; D006041:Goats; D051457:Hyaline Cartilage / Q000166:cytology / Q000637:transplantation*; D007718:Knee Injuries / Q000601:surgery; D007719:Knee Joint / Q000601:surgery
D024043:Collagen Type II
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