title: Microfracture for chondral defects: assessment of the variability of surgical technique in cadavers.
abstract: OBJECTIVE
  The purpose of this study was to assess the variability of the microfracture technique when performed by experienced knee arthroscopy surgeons.
  
  
  METHODS
  Four surgeons were each asked to perform microfracture on six preformed cartilage defects in fresh human cadaveric knees. Surgeons were instructed on penetration depth, inter-hole distance, and to place the holes perpendicular to the subchondral surface. Micro-computed tomography was used to calculate depth error, inter-hole distance error, and deviation of penetration angles from the perpendicular.
  
  
  RESULTS
  All surgeons misjudged depth and inter-hole distance, tending to make microfracture holes too deep (depth error 1.1 mm ± 1.9) and too close together (inter-hole distance error: -0.8 mm ± 0.4). Fifty-one per cent of holes were angled more than 10° from the perpendicular (range 2.6°-19.8°). Both depth and distance errors were significantly lower in the trochlear groove than on the femoral condyle (p < 0.05). Surface shearing was associated with both penetration depth >4 mm and angles >20°. Inter-hole infraction occurred in holes closer than 2.5 mm to each other.
  
  
  CONCLUSIONS
  Even experienced knee arthroscopy surgeons demonstrate inconsistency in surgical technique when performing microfracture. While further research will be required to demonstrate that these variations in surgical technique are associated with poorer clinical outcomes after microfracture, surgeons should attempt to minimizing such variations in order to prevent surface shearing and inter-hole infraction.
authors.affiliation: Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
authors.forename: Artur
authors.initials: A
authors.lastname: Kroell
authors.affiliation: University of Toronto Orthopaedic Sports Medicine, 600 University Avenue, Suite 476C, Toronto, ON, M5G 1X5, Canada.|Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Marks
authors.affiliation: University of Toronto Orthopaedic Sports Medicine, 600 University Avenue, Suite 476C, Toronto, ON, M5G 1X5, Canada.|Toronto Western Hospital, Toronto, ON, Canada.|Women's College Hospital, Toronto, ON, Canada.
authors.forename: Jaskarndip
authors.initials: J
authors.lastname: Chahal
authors.affiliation: Department of Clinical Studies, Ontario Veterinary College at the University of Guelph, Guelph, ON, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Hurtig
authors.affiliation: University of Toronto Orthopaedic Sports Medicine, 600 University Avenue, Suite 476C, Toronto, ON, M5G 1X5, Canada.|Women's College Hospital, Toronto, ON, Canada.|Mt Sinai Hospital, Toronto, ON, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Dwyer
authors.affiliation: University of Toronto Orthopaedic Sports Medicine, 600 University Avenue, Suite 476C, Toronto, ON, M5G 1X5, Canada.|St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Whelan
authors.affiliation: University of Toronto Orthopaedic Sports Medicine, 600 University Avenue, Suite 476C, Toronto, ON, M5G 1X5, Canada. jtheodoropoulos@mtsinai.on.ca.|Women's College Hospital, Toronto, ON, Canada. jtheodoropoulos@mtsinai.on.ca.|Mt Sinai Hospital, Toronto, ON, Canada. jtheodoropoulos@mtsinai.on.ca.
authors.forename: John
authors.initials: J
authors.lastname: Theodoropoulos
mesh_terms: D054544:Arthroplasty, Subchondral / Q000379:methods*; D001182:Arthroscopy; D002102:Cadaver; D002357:Cartilage Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000601:surgery*; D005269:Femur / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D055114:X-Ray Microtomography
keywords: CT; Microfracture; Surgical technique; Variability