Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopedic Surgery, North-Shore LIJ, Manhasset, New York, USA.
Am J Sports Med. 2019 Sep;47(11):2584-2588. doi: 10.1177/0363546519859851. Epub 2019 Jul 23.
Microfracture is a commonly utilized cartilage restoration technique for articular cartilage defects. While the removal of the calcified cartilage layer (CCL) has been shown to be critical with in vivo models, little is known with regard to surgeon reliability to adequately perform the technique.
To evaluate surgeon reliability in removing the CCL utilizing open and arthroscopic techniques.
Controlled laboratory study.
Eleven cadaveric knees were utilized to create four 12-mm diameter defects in the anterior and posterior medial femoral condyles. Eleven fellowship-trained surgeons were asked to perform the following procedures: remove the CCL open, retain the CCL open, remove the CCL arthroscopically, and retain the CCL arthroscopically. Samples underwent histologic staining and analysis with 3-dimensional micro-computed tomography. The latter was used to calculate the percentage of the CCL that was removed or retained across the entire defect.
When surgeons were asked to retain the CCL arthroscopically, 48% ± 41% (mean ± SD) remained. When surgeons were asked to remove the CCL arthroscopically, 24% ± 35% remained. There was no statistical difference between these groups ( > .05). When the CCL was retained during open preparation, 60% ± 39% remained. During attempts to remove the CCL in an open manner, 19% ± 28% remained. There was a significant difference in the amount of CCL remaining between the open removal and open retaining groups ( = .03). There were no significant differences in the percentage of CCL remaining between the open and arthroscopic preservation groups and between the open and arthroscopic removal groups.
CONCLUSION/CLINICAL RELEVANCE: This study highlights the significant variability in surgeon ability to reliably retain or remove the CCL. However, there appears to be improved ability of surgeons to more reliably remove or retain the CCL in an open fashion as compared with the arthroscopic approach.
微骨折是一种常用于关节软骨缺损的软骨修复技术。虽然在体内模型中已经证明去除钙化软骨层（CCL）是至关重要的，但对于外科医生是否能够可靠地完成该技术，知之甚少。
评估外科医生利用开放和关节镜技术去除 CCL 的可靠性。
对照实验室研究。
利用 11 个尸体膝关节在前内侧和后内侧股骨髁上创建了 4 个 12mm 直径的缺损。11 名接受过 fellowship培训的外科医生被要求进行以下操作：开放去除 CCL、保留 CCL 开放、关节镜下去除 CCL 和保留 CCL 关节镜下。标本进行组织学染色和三维微计算机断层扫描分析。后者用于计算整个缺陷中去除或保留的 CCL 百分比。
当外科医生被要求在关节镜下保留 CCL 时，48%±41%（平均值±标准差）保留下来。当外科医生被要求关节镜下去除 CCL 时，24%±35%保留下来。两组之间没有统计学差异（>.05）。当 CCL 在开放性准备过程中保留时，60%±39%保留下来。在开放性去除 CCL 的尝试中，19%±28%保留下来。在开放去除和开放保留组之间，CCL 残留量有显著差异（=.03）。在开放和关节镜保存组之间以及开放和关节镜去除组之间，CCL 残留百分比没有显著差异。
结论/临床相关性：本研究强调了外科医生可靠保留或去除 CCL 的能力存在显著差异。然而，与关节镜方法相比，外科医生似乎更有能力可靠地以开放方式去除或保留 CCL。
