Abstract
BackgroundMicrofracture is a surgical technique that involves creating multiple holes of 3–4 mm depth in the subchondral bone to recruit stem cells in the bone marrow to the lesion, inducing fibrocartilage repair and knee cartilage regeneration. Recently, it has been reported that increasing the exposed area of the lower cartilaginous bone (drilling a lot of holes) increases the outflow of stem cells, which is expected to affect the physical properties of the subchondral bone when the exposed area is large. The purpose of this study was to analyse the effect of the distance between the holes in the microfracture procedure on the structural stability of the osteochondral bone using a finite element method.MethodsIn this study, lateral aspects of the femoral knee, which were removed during total knee arthroplasty were photographed using microtomography. The model was implemented using a solitary walks program, which is a three-dimensional simplified geometric representation based on the basic microtomography data. A microfracture model was created by drilling 4 mm-deep holes at 1, 1.5, 2, 2.5, 3, 4, and 5 mm intervals in a simplified three-dimensional (3D) geometric femoral model. The structural stability of these models was analysed with the ABAQUS program. We compared the finite element model (FEM) based on the microtomography image and the simplified geometric finite element model.ResultsVon Mises stress of the subchondral bone plate barely increased, even when the distance between holes was set to 1 mm. Altering the distance between the holes had little impact on the structural stability of the subchondral bone plate. Safety factors were all below 1.ConclusionsAlthough we did not confirm an optimal distance between holes, this study does provide reference data and an epidemiological basis for determining the optimal distance between the holes used in the microfracture procedure.
Highlights
Microfracture is a surgical technique that involves creating multiple holes of 3–4 mm depth in the subchondral bone to recruit stem cells in the bone marrow to the lesion, inducing fibrocartilage repair and knee cartilage regeneration
One report suggested that the volume of mesenchymal stem cells (MSCs) migrating to the defect through the microperforations affect the outcome of cartilage regeneration
We have previously found that increasing the surface area of bone marrow stimulation by adjusting the size and quantity of holes in the subchondral bone plate led to the greatest count of MSC drained from microfracture holes
Summary
Microfracture is a surgical technique that involves creating multiple holes of 3–4 mm depth in the subchondral bone to recruit stem cells in the bone marrow to the lesion, inducing fibrocartilage repair and knee cartilage regeneration. We have previously found that increasing the surface area of bone marrow stimulation by adjusting the size and quantity of holes in the subchondral bone plate led to the greatest count of MSC drained from microfracture holes. May damage the mechanical stability of the subchondral bone, as the knee is subject loading by the body’s weight, and this may hinder cartilage repair. Biomechanical studies investigating the effects of the number, size, depth and interval of holes during microfracture on the structural stability of the subchondral bone are required
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