Effect of subchondral drilling on the microarchitecture of subchondral bone: analysis in a large animal model at 6 months.
BACKGROUND
Marrow stimulation techniques such as subchondral drilling are clinically important treatment options for symptomatic small cartilage defects. Little is known about whether they induce deleterious changes in the subchondral bone.


OBJECTIVE
Subchondral drilling induces substantial alterations of the microarchitecture of the subchondral bone that persist for a clinically relevant postoperative period in a preclinical large animal model.


METHODS
Controlled laboratory study.


METHODS
Standardized full-thickness chondral defects in the medial femoral condyles of 19 sheep were treated by subchondral drilling. Six months postoperatively, the formation of cysts and intralesional osteophytes was evaluated. A standardized methodology was developed to segment the ovine subchondral unit into reproducible volumes of interest (VOIs). Indices of bone structure were determined by micro-computed tomography (micro-CT).


RESULTS
Analysis of the microarchitecture revealed the absence of zonal stratification in the ovine subarticular spongiosa, permitting an unimpeded and simultaneous analysis of the entire subchondral trabecular network. Subchondral drilling led to the formation of subchondral bone cysts (63%) and intralesional osteophytes (26%). Compared with the adjacent unaffected subchondral bone, drilling induced significant alterations in nearly all parameters for the microarchitecture of the subchondral bone plate and the subarticular spongiosa, most importantly in bone volume, bone surface/volume ratio, trabecular thickness, separation, pattern factor, and bone mineral density (BMD) (all P ≤ .01).


CONCLUSIONS
The data show that the ovine subchondral bone can be reliably evaluated using micro-CT with standardized VOIs. We report that subchondral drilling deteriorates the microarchitecture both of the subchondral bone plate and subarticular spongiosa and decreases BMD. These results suggest that the entire osteochondral unit is altered after drilling for an extended postoperative period.


CONCLUSIONS
The subchondral bone remains fragile after subchondral drilling for longer durations than previously expected. Further evaluations of structural subchondral bone parameters of patients undergoing marrow stimulation are warranted.
Center of Experimental Orthopaedics, Saarland University, Homburg, Germany.
Patrick
P
Orth
Lars
L
Goebel
Uwe
U
Wolfram
Mei Fang
MF
Ong
Stefan
S
Gräber
Dieter
D
Kohn
Magali
M
Cucchiarini
Anita
A
Ignatius
Dietrich
D
Pape
Henning
H
Madry
D000818:Animals; D054544:Arthroplasty, Subchondral / Q000009:adverse effects / Q000379:methods*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery* / Q000648:ultrastructure*; D005858:Germany; D023421:Models, Animal; D017063:Outcome Assessment, Health Care; D012756:Sheep; D014057:Tomography, X-Ray Computed