title: The Effect of Different Bone Marrow Stimulation Techniques on Human Talar Subchondral Bone: A Micro-Computed Tomography Evaluation.
abstract: To evaluate morphological alterations, microarchitectural disturbances, and the extent of bone marrow access to the subchondral bone marrow compartment using micro-computed tomography analysis in different bone marrow stimulation (BMS) techniques.
  
  
  
  Nine zones in a 3 × 3 grid pattern were assigned to 5 cadaveric talar dome articular surfaces. A 1.00-mm microfracture awl (s.MFX), a 2.00-mm standard microfracture awl (l.MFX), or a 1.25-mm Kirschner wire (K-wire) drill hole was used to penetrate the subchondral bone in each grid zone. Subchondral bone holes and adjacent tissue areas were assessed by micro-computed tomography to analyze adjacent bone area destruction and communicating channels to the bone marrow. Grades 1 to 3 were assigned, where 1 = minimal compression/sclerosis; 2 = moderate compression/sclerosis; 3 = severe compression/sclerosis. Bone volume/total tissue volume, bone surface area/bone volume, trabecular thickness, and trabecular number were calculated in the region of interest.
  
  
  
  Visual assessment revealed that the s.MFX had significantly more grade 1 holes (P < .001) and that the l.MFX had significantly more poor/grade 3 holes (P = .002). Bone marrow channel assessment showed a statistically significant increase in the number of channels in the s.MFX when compared with both K-wire and l.MFX holes (P < .001). Bone volume fraction for the s.MFX was significantly less than that of the l.MFX (P = .029).
  
  
  
  BMS techniques using instruments with larger diameters resulted in increased trabecular compaction and sclerosis in areas adjacent to the defect. K-wire and l.MFX techniques resulted in less open communicating bone marrow channels, denoting a reduction in bone marrow access. The results of this study indicate that BMS using larger diameter devices results in greater microarchitecture disturbances.
  
  
  
  The current study suggests that the choice of a BMS technique should be carefully considered as the results indicate that smaller diameter hole sizes may diminish the amount of microarchitectural disturbances in the subchondral bone.
authors.affiliation: Hospital for Special Surgery, New York, U.S.A.. Electronic address: gianakosa@hss.edu.
authors.forename: Arianna L
authors.initials: AL
authors.lastname: Gianakos
authors.affiliation: Hospital for Special Surgery, New York, U.S.A.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: Hospital for Special Surgery, New York, U.S.A.
authors.forename: Ethan J
authors.initials: EJ
authors.lastname: Fraser
authors.affiliation: Hospital for Special Surgery, New York, U.S.A.
authors.forename: Keir A
authors.initials: KA
authors.lastname: Ross
authors.affiliation: Hospital for Special Surgery, New York, U.S.A.
authors.forename: Marcelo P
authors.initials: MP
authors.lastname: Prado
authors.affiliation: Department of Clinical Sciences, Cornell University, Ithaca, New York, U.S.A.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Fortier
authors.affiliation: Hospital for Special Surgery, New York, U.S.A.
authors.forename: John G
authors.initials: JG
authors.lastname: Kennedy
mesh_terms: D054544:Arthroplasty, Subchondral / Q000295:instrumentation*; D001853:Bone Marrow / Q000000981:diagnostic imaging*; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012598:Sclerosis; D013628:Talus / Q000000981:diagnostic imaging* / Q000473:pathology; D055114:X-Ray Microtomography