Meyer Lucy E, Danilkowicz Richard M, Hinton Zoe W, Crook Bryan S, Abar Bijan, Allen Nicholas B, Negus Mitchell, Hurley Eoghan T, Toth Alison P, Amendola Annunziato, Adams Samuel B
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
Department of Mechanical Engineering and Material Science, Duke University, Durham, North Carolina, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Sep 16;5(5):100786. doi: 10.1016/j.asmr.2023.100786. eCollection 2023 Oct.
The purpose of this study was to compare bone marrow stimulation using micro-computed tomography (micro-CT) analysis of an abrasion arthroplasty technique, drilling k-wire technique, traditional microfacture awl, or a microdrill instrument for subchondral bone defects.
Eleven cadaveric distal femoral specimens were obtained and divided into 3 common areas of osteochondral defect: trochlea and weightbearing portions of the medial and lateral femoral condyles. Each area of interest was then denuded of cartilage using a PoweRasp and divided into quadrants. Each quadrant was assigned either a 1.6 mm Kirschner wire (k-wire), 1.25 mm microfracture awl, 1.5 mm fluted microdrill, PowerPick, or a curette (abrasion arthroplasty) to create 4 channels into the subchondral bone sing the same instrument. Subchondral bone and adjacent tissue areas were then evaluated using micro-CT to analyze adjacent bone destruction and extension into the bone marrow.
Overall, there was a significantly decreased area of bone destruction or compression using the microdrill (0.030 mm) as compared to the microfracture awl (0.072 mm) and k-wire (0.062 mm) ( < .05). Within the trochlea and the medial femoral condyle, there was significantly decreased bony compression with the microdrill as compared to the awl and k-wire ( < .05); however, when stratified, this was not significant among the lateral femoral condylar samples ( = .08).
Bone marrow stimulation causes bony compression that may negatively impact subchondral bone and trabecular alignment. It is important to understand which tools used for bone marrow stimulation cause the least amount of damage to the subchondral bone.
This study demonstrates the decreased subchondral bony defects seen with the microdrill versus the traditional microfracture awl indicating that when performing bone marrow stimulation, the microdrill may be a less harmful tool to the subchondral bone.
本研究旨在通过微计算机断层扫描（micro-CT）分析，比较用于软骨下骨缺损的磨损关节成形术技术、钻孔克氏针技术、传统微骨折锥或微钻器械进行骨髓刺激的效果。
获取11个尸体股骨远端标本，分为3个常见的骨软骨缺损区域：滑车以及股骨内侧和外侧髁的负重部分。然后使用电动锉刀去除每个感兴趣区域的软骨，并将其分成象限。每个象限分别使用1.6毫米克氏针（k-wire）、1.25毫米微骨折锥、1.5毫米带槽微钻、电动骨锉或刮匙（磨损关节成形术），用同一器械在软骨下骨中创建4个通道。然后使用微CT评估软骨下骨和相邻组织区域，以分析相邻骨破坏和向骨髓的延伸情况。
总体而言，与微骨折锥（0.072毫米）和克氏针（0.062毫米）相比，使用微钻时骨破坏或压缩面积显著减小（P<0.05）。在滑车和股骨内侧髁内，与锥和克氏针相比，微钻导致的骨压缩显著减小（P<0.05）；然而，分层分析时，在股骨外侧髁样本中这一差异不显著（P = 0.08）。
骨髓刺激会导致骨压缩，这可能对软骨下骨和小梁排列产生负面影响。了解用于骨髓刺激的哪些工具对软骨下骨造成的损伤最小很重要。
本研究表明，与传统微骨折锥相比，微钻造成的软骨下骨缺损减少，这表明在进行骨髓刺激时，微钻对软骨下骨可能是危害较小的工具。
