2017 ISAKOS Biennial Congress ePoster #211

 

Arthroscopic Cartilage Defect Preparation: Histologic Analysis Demonstrates Clinically Relevant and Technique-Dependent Differences

Boguslaw Sadlik, MD, PhD, Bielsko-Biala POLAND
Mariusz A. Puszkarz, MD, Rybnik POLAND
Martin Wiewiorski, MD, Basel SWITZERLAND
Alberto Gobbi, MD, Milan ITALY

Biological Reconstruction Department / Orthopaedic Department, Bielsko-Biala, POLAND

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use:

Summary

Specialized angle-specific instruments enable the preparation of cartilage defects with consistent perpendicularity of surrounding cartilage to subchondral bone, and superior histological properties within and about the cartilage defect, compared to standard debridement techniques.

Abstract

Purpose

To compare the quality of arthroscopic cartilage debridement performed by different methods, in order to provide technical guidance with the goal of optimizing cartilage lesion preparation prior to cartilage repair procedures.

Methods

and Materials
Standarized ovoid areas of cartilage (8x12mm) were demarcated within the femoral condyles of 22 human cadaver knee specimens. A simulated cartilage defect was created in each knee using two different techniques (1 – standard technique (ST): arthroscopic shaver and ringed curettes, 2 – chondrectome technique (CT): specially designed angle-specific debridement instruments). Individual osteochondral blocks encompassing each lesion were harvested and sectioned. A histological comparative analysis was performed within each technique grouping and between technique groupings to evaluate the morphology of the simulated cartilage defects.

Results

The mean lesion angle of cartilage surrounding the defect was 94.3° ± 8.7° in the CT group compared to 108.7° ± 19.5° in the ST group (p<0.001). In the CT group, verticality of surrounding cartilage wall was not associated with location about the defect periphery. In the ST group, the mean lesion angle perpendicularity to the subchondral end-plate was significantly different, depending on location about the periphery of the defect (p<0.001). The mean lesion angle of the front/inner and front/outer regions of the CT group demonstrated superior perpendicularity than the corresponding regions in the ST group (p<0.001). In a significant proportion of the CT samples, within-group analysis demonstrated superior histological properties of surrounding cartilage (p=0.002), cartilage wall profile (p=0.013), debrided lesion depth (p<0.001), and bone surface profile (p<0.001), but not in the ST group.

Conclusion

Specialized angle-specific instruments enable the preparation of cartilage defects with consistent perpendicularity of surrounding cartilage to subchondral bone, and superior histological properties within and about the cartilage defect, compared to standard debridement techniques. This novel method of cartilage lesion preparation should be considered the preferred technique in procedures involving cartilage repair.