BIOLOGY OF

MICROFRACTUR
E
DR.V.CHANDAN NOEL
INTRODUCTION
 INTRODUCED BY STEADMAN AND RODRIGO

 PERFECTED TECHNIQUE OF PRIDIE DRILLING .

 INVOLVES MAKING DUVETS IN THE SUBCHONDRAL BONE FOR MARROW

ACTIVE CELLS TO FILL THE DEFECT.

 SUPER CLOT FORMED UNDERGOES METAPLASIA OVER TIME AND FORMS A

REPARATIVE CARTILAGE
• MSC’S
• GROWTH FACTORS-TGF-b3,
BMP-6, and IGF-1
 MSC’S FORMATION OF
NEOANGIOGENESIS ECM AT 6 WEEKS

TYPE 1
CHONDROGENESIS
COLLAGEN
 TYPE II COLLAGEN AND AGGRECAN INCREASES OVER TIME STARTING IN
THE DEEP ZONE, AND PROGRESSING TOWARD THE SURFACE.

 OVER TIME COLLAGEN FIBERS IN THE SUPERFICIAL ZONE CHANGE FROM

A PERPENDICULAR TO A TANGENTIAL ORIENTATION.

• FIBROCARTILAGE (48-68%)
• FIBROUS TISSUE (28-68%)
• HYALINE CARTILAGE (20-66%).
 TIMELINE OF EVENTS

8 15 3
weeks weeks weeks
 QUALITY OF THE CARTILAGE

REPAIR TISSUE IS OVERALL POORLY

INTEGRATED WITH THE
SURROUNDING NORMAL CARTILAGE

LESS AGGRECAN CONTENT IN THE REPAIR CARTILAGE

WHY THIS
HAPPENS…..???
1mm 1.8mm
Restoration of the microstructure of the
subchondral was improved after 1.0-mm
compared to 1.8-mm drill hole.

1.0-mm holes led to improved histological

matrix & cellular morphology- higher type II
collagen and reduced type I collagen
SUBCHONDRAL BONE INTEGRITY RATHER THAN THE NUMBER OF MSCS DETERMINE
THE QUALITY OF REPAIR TISSUE
• Better fill and repair with 6mm
• 3 times more surface area in contact with marrow
• More access channels to marrow and recruit more potential cells from marrow stroma
HISTOLOGICAL ANALYSIS B/W 6MM & 2 MM
THE INCOMPLETE RECONSTITUTION HAS BEEN ASSOCIATED WITH MORE FIBROUS
CARTILAGE REPAIR AND INCREASED DEGENERATION OF REPAIR TISSUE.
BONE MARROW EDEMA IS ASSOCIATED WITH A
REDUCTION IN PERFUSION IN SUBCHONDRAL BONE
 CORRELATION OF MRI EDEMA AND CLINICAL OUTCOMES
FOLLOWING MICROFRACTURE OF OSTEOCHONDRAL LESIONS
OF THE TALUS

THOSE PATIENTS WITH A

MODERATE OR SEVERE EDEMA
INTENSITY HAD INFERIOR
CLINICAL OUTCOMES
 SCRAPE AWAY THE CALCIFIED
CARTILAGE

70 % fill 50 % fill

SUPERIOR DEFECT FILLING WITH REMOVAL OF THE CALCIFIED CARTILAGE

PRIOR TO MICROFRACTURING
AUGMENTS
CHONDROTISSUE MADE OF A POLY-GLYCOLIC ACID (PGA) SCAFFOLD AND HYALURONAN.

• HYALINE-LIKE REPAIR TISSUE

• EVENLY DISTRIBUTED TYPE II COLLAGEN AND PROTEOGLYCAN

• NORMAL APPEARING CHONDROCYTES

CHONDUX COMBINES A BIOLOGICL ADHESIVE AND PHOTOPOLYMERIZED HYDROGEL
SCAFFOLD IN THE MICROFRACTURE TO ENHANCE REPAIR BY ENDOGENOUS STEM CELLS.
• >80% FILL AT 12 MONTHS

• IMPROVING DISTRIBUTION IN TYPE 2

COLLAGEN

• IMPROVED IKDC SCORES

• CHITOSAN-GLYCEROL PHOSPHATE/BLOOD CLOTS SHOWED INCREASED ADHESION TO THE WALLS OF THE
DEFECTS.
• @6 MOS- MORE HYALINE LIKE REPAIR TISSUE WITH TYPE 2 COLLAGEN AND PROTEOGLYCANS
8 mo’s
 4-MM FULL-THICKNESS ARTICULAR CARTILAGE DEFECT IN THE STIFLE JOINT
 THEY DIVIDED INTO 3 GROUPS:

 GROUP A (CONTROL)-NO INJECTIONS

 GROUP B (HA)- WEEKLY INJECTION OF 1 ML OF SODIUM HYALURONATE FOR 3 WEEKS
 GROUP C -(HA + BMAC), SIMILAR TO GROUP B BUT WITH 2 ML OF AUTOLOGOUS BMAC.
TAKE HOME MESSAGE
 Cartilage repair is a evolving science

 Microfracture is one of the key techniques of repair with a reasonable amount of success

 Mostly commonly done cartilage reparative procedure

 Improved techniques- nano fracture awls, newer awls with lesser dia’s

 Respecting the integrity of subchondral bone

 Augmentation scaffolds open way to new possibilities – currently chondux ,cargel and chondrotissue show
promise