Download PDF
J Knee Surg 2018; 31(03): 231-238
DOI: 10.1055/s-0037-1618592
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cartilage Restoration: Microfracture and Osteochondral Autograft Transplantation

Michael L. Redondo
1   Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Adam J. Beer
1   Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Adam B. Yanke
1   Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

24 November 2017

05 December 2017

Publication Date:
02 February 2018 (online)

    Permissions and Reprints

Abstract

The treatment of patellofemoral cartilage defects presents several distinct challenges when compared with cartilage restoration techniques used for other compartments of the knee due to the unique anatomy and distribution of forces. The etiologies of patellofemoral articular cartilage lesions include acute traumatic instability injuries, such as dislocation and subluxation, osteochondritis dissecans, and chronic degenerative changes. Regardless of the etiology, untreated patellofemoral cartilage lesions can contribute to activity-limiting anterior knee pain. The goal of patellofemoral cartilage restoration procedures is to impart symptomatic relief and improve quality of life by repairing the articular cartilage surface and any comorbid malalignment or maltracking.

Microfracture and osteochondral autograft transplantation (OAT) are two cartilage restoration procedures to consider when treating full-thickness patellofemoral chondral defects. Considered by some experts to be the gold standard therapy, microfracture is one of the most common procedures used for cartilage restoration. The technique involves the perforation of the subchondral bone plate for the release of marrow elements, filling the defect with a fibrocartilage clot repair. Though less commonly used, OAT allows defect replacement with native hyaline cartilage via autologous transplantation from a non-weight bearing area. The purpose of this article is to discuss the indication, technical considerations, and outcomes of microfracture and OAT when used for treating chondral lesions of the patellofemoral joint.

Keywords

microfracture - osteochondral autograft transplantation - cartilage restoration
 

  • References

  • 1 Astur DC, Arliani GG, Binz M. , et al. Autologous osteochondral transplantation for treating patellar chondral injuries: evaluation, treatment, and outcomes of a two-year follow-up study. J Bone Joint Surg Am 2014; 96 (10) 816-823
    CrossrefPubMedGoogle Scholar
  • 2 Brophy RH, Wojahn RD, Lamplot JD. Cartilage restoration techniques for the patellofemoral joint. J Am Acad Orthop Surg 2017; 25 (05) 321-329
    CrossrefPubMedGoogle Scholar
  • 3 Arøen A, Løken S, Heir S. , et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 2004; 32 (01) 211-215
    CrossrefPubMedGoogle Scholar
  • 4 McCormick F, Harris JD, Abrams GD. , et al. Trends in the surgical treatment of articular cartilage lesions in the United States: an analysis of a large private-payer database over a period of 8 years. Arthroscopy 2014; 30 (02) 222-226
    CrossrefPubMedGoogle Scholar
  • 5 Yanke AB, Wuerz T, Saltzman BM, Butty D, Cole BJ. Management of patellofemoral chondral injuries. Clin Sports Med 2014; 33 (03) 477-500
    CrossrefPubMedGoogle Scholar
  • 6 Madry H, Gao L, Eichler H, Orth P, Cucchiarini M. Bone marrow aspirate concentrate-enhanced marrow stimulation of chondral defects. Stem Cells Int 2017; 2017: 1609685
    PubMedGoogle Scholar
  • 7 Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg 2003; 16 (02) 83-86
    Google Scholar
  • 8 Frisbie DD, Trotter GW, Powers BE. , et al. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg 1999; 28 (04) 242-255
    CrossrefPubMedGoogle Scholar
  • 9 McIlwraith CW, Frisbie DD. Microfracture: basic science studies in the horse. Cartilage 2010; 1 (02) 87-95
    CrossrefPubMedGoogle Scholar
  • 10 Frisbie DD, Morisset S, Ho CP, Rodkey WG, Steadman JR, McIlwraith CW. Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses. Am J Sports Med 2006; 34 (11) 1824-1831
    CrossrefPubMedGoogle Scholar
  • 11 Matsunaga D, Akizuki S, Takizawa T, Yamazaki I, Kuraishi J. Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis. Knee 2007; 14 (06) 465-471
    CrossrefPubMedGoogle Scholar
  • 12 Mithoefer K, Williams III RJ, Warren RF. , et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 2005; 87 (09) 1911-1920
    CrossrefPubMedGoogle Scholar
  • 13 Chen H, Sun J, Hoemann CD. , et al. Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair. J Orthop Res 2009; 27 (11) 1432-1438
    Google Scholar
  • 14 Chen H, Hoemann CD, Sun J. , et al. Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair. J Orthop Res 2011; 29 (08) 1178-1184
    CrossrefPubMedGoogle Scholar
  • 15 Cole BJ, Farr J, Winalski CS. , et al. Outcomes after a single-stage procedure for cell-based cartilage repair: a prospective clinical safety trial with 2-year follow-up. Am J Sports Med 2011; 39 (06) 1170-1179
    CrossrefPubMedGoogle Scholar
  • 16 Orth P, Goebel L, Wolfram U. , et al. Effect of subchondral drilling on the microarchitecture of subchondral bone: analysis in a large animal model at 6 months. Am J Sports Med 2012; 40 (04) 828-836
    CrossrefPubMedGoogle Scholar
  • 17 Beck A, Murphy DJ, Carey-Smith R, Wood DJ, Zheng MH. Treatment of articular cartilage defects with microfracture and autologous matrix-induced chondrogenesis leads to extensive subchondral bone cyst formation in a sheep model. Am J Sports Med 2016; 44 (10) 2629-2643
    CrossrefPubMedGoogle Scholar
  • 18 Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 2009; 37 (10) 2053-2063
    CrossrefPubMedGoogle Scholar
  • 19 Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 2009; 37 (05) 902-908
    CrossrefPubMedGoogle Scholar
  • 20 Pestka JM, Bode G, Salzmann G, Südkamp NP, Niemeyer P. Clinical outcome of autologous chondrocyte implantation for failed microfracture treatment of full-thickness cartilage defects of the knee joint. Am J Sports Med 2012; 40 (02) 325-331
    CrossrefPubMedGoogle Scholar
  • 21 Nawaz SZ, Bentley G, Briggs TW. , et al. Autologous chondrocyte implantation in the knee: mid-term to long-term results. J Bone Joint Surg Am 2014; 96 (10) 824-830
    CrossrefPubMedGoogle Scholar
  • 22 Strauss EJ, Galos DK. The evaluation and management of cartilage lesions affecting the patellofemoral joint. Curr Rev Musculoskelet Med 2013; 6 (02) 141-149
    CrossrefPubMedGoogle Scholar
  • 23 Getgood A, Bollen S. What tissue bankers should know about the use of allograft tendons and cartilage in orthopaedics. Cell Tissue Bank 2010; 11 (01) 87-97
    CrossrefPubMedGoogle Scholar
  • 24 Ahmad CS, Cohen ZA, Levine WN, Ateshian GA, Mow VC. Biomechanical and topographic considerations for autologous osteochondral grafting in the knee. Am J Sports Med 2001; 29 (02) 201-206
    CrossrefPubMedGoogle Scholar
  • 25 Bentley G, Biant LC, Carrington RW. , et al. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 2003; 85 (02) 223-230
    Google Scholar
  • 26 Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 25-32
    PubMedGoogle Scholar
  • 27 Emre TY, Ege T, Kose O, Tekdos Demırcıoglu D, Seyhan B, Uzun M. Factors affecting the outcome of osteochondral autografting (mosaicplasty) in articular cartilage defects of the knee joint: retrospective analysis of 152 cases. Arch Orthop Trauma Surg 2013; 133 (04) 531-536
    CrossrefPubMedGoogle Scholar
  • 28 Alford JW, Cole BJ. Cartilage restoration, part 2: techniques, outcomes, and future directions. Am J Sports Med 2005; 33 (03) 443-460
    CrossrefPubMedGoogle Scholar
  • 29 Garretson III RB, Katolik LI, Verma N, Beck PR, Bach BR, Cole BJ. Contact pressure at osteochondral donor sites in the patellofemoral joint. Am J Sports Med 2004; 32 (04) 967-974
    CrossrefPubMedGoogle Scholar
  • 30 Nho SJ, Foo LF, Green DM. , et al. Magnetic resonance imaging and clinical evaluation of patellar resurfacing with press-fit osteochondral autograft plugs. Am J Sports Med 2008; 36 (06) 1101-1109
    CrossrefPubMedGoogle Scholar
  • 31 Emre TY, Atbasi Z, Demircioglu DT, Uzun M, Kose O. Autologous osteochondral transplantation (mosaicplasty) in articular cartilage defects of the patellofemoral joint: retrospective analysis of 33 cases. Musculoskelet Surg 2017; 101 (02) 133-138
    CrossrefPubMedGoogle Scholar
  • 32 Mithoefer K, Gill TJ, Cole BJ, Williams RJ, Mandelbaum BR. Clinical outcome and return to competition after microfracture in the athlete's knee: an evidence-based systematic review. Cartilage 2010; 1 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 33 Gille J, Behrens P, Volpi P. , et al. Outcome of autologous matrix induced chondrogenesis (AMIC) in cartilage knee surgery: data of the AMIC Registry. Arch Orthop Trauma Surg 2013; 133 (01) 87-93
    CrossrefPubMedGoogle Scholar
  • 34 Negrin L, Kutscha-Lissberg F, Gartlehner G, Vecsei V. Clinical outcome after microfracture of the knee: a meta-analysis of before/after-data of controlled studies. Int Orthop 2012; 36 (01) 43-50
    CrossrefPubMedGoogle Scholar