Remodeling of Articular Step-Offs

Abstract

One of the major unresolved questions in trauma repair concerns the degree of step-off that can be accepted in a joint surface. In answer to this question, a new rabbit model of femoral step-off was developed. Osteoarthrotic changes in cartilage and bone and the failure of repair responses were seen at 20 weeks in the presence of a 3-mm wide sagittal defect displaced 5 mm from the joint surface and spanning the anteroposterior extent of the medial femoral condyle. This study examined the effects of a similar defect, displaced 2 mm from the joint surface, to determine whether the development of osteoarthrosis is dependent on the size of the step-off. Defects were created in 18 New Zealand white rabbits. In a second group, the medial joint surface was osteotomized, but was not displaced. In contrast to th first study, cartilaginous and bony repair resulted in closure of the surgical defect and restoration of femoral congruity. Histologic and biochemical parameters did not differ significantly between groups. The results indicate that cartilage and bone possess the ability to remodel small articular step-offs and to restore joint congruity. Furthermore, the combined data suggest that the development of osteoarthrosis requires significant articular incongruity.