Surgical Preparation for Articular Cartilage Regeneration Without Penetration of the Subchondral Bone Plate

Purpose: Autologous chondrocyte implantation (ACI) is a treatment option even in early osteoarthritis (OA). Surgical preparation for ACI should avoid penetration of the subchondral bone plate to prevent hemorrhage, fibrin clot formation, and subsequent activation of the inflammatory response. Hypothesis: Current surgical procedures with ring curettes preserve the integrity of the subchondral bone plate, even in patients with OA. Methods: Subchondral femoral bone plates ( n = 40) of OA knees undergoing total knee arthroplasty were prepared in vivo using standard, non–brute-force debridement for ACI. To approach regular wear/early OA, only cartilage with maximally grade 3A International Cartilage Repair Society score was prepared. Effects were analyzed by light microscopy. Results: In 87.5% of the specimens (35/40), standard debridement did not violate the tide mark, except for occasional minor openings with a smooth edge (diameter approximately 20 µm). In contrast, 5/40 samples (12.5%) showed one large area with a missing bone plate and an open bone marrow space. Twenty-eight specimens (70%) showed at least remnants of uncalcified cartilage. Conclusion: On the basis of size/fine structure, the occasional minor openings are likely due to increased vascular penetration through the tide mark in the pathologically altered bone-cartilage interface in OA. The consequences of limited hemorrhage through minor openings or selected large defects following in vivo debridement are still unknown. Thus, standard debridement appears suitable for cartilage regeneration even in OA defects.

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Three-dimensional distribution of articular cartilage thickness in the elderly talus and calcaneus analysing the relationship between subchondral bone plate density and the overlying cartilage thickness

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2012.02.372 ◽

2012 ◽

Vol 20 ◽

pp. S229

Author(s):

K. Akiyama ◽

T. Sakai ◽

N. Sugimoto ◽

H. Yoshikawa ◽

K. Sugamoto

Keyword(s):

Articular Cartilage ◽

Subchondral Bone ◽

Three Dimensional ◽

The Elderly ◽

Cartilage Thickness ◽

Bone Plate ◽

Subchondral Bone Plate ◽

Dimensional Distribution ◽

The Relationship

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Alterations in subchondral bone plate, trabecular bone and articular cartilage properties of rabbit femoral condyles at 4 weeks after anterior cruciate ligament transection

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2014.11.023 ◽

2015 ◽

Vol 23 (3) ◽

pp. 414-422 ◽

Cited By ~ 28

Author(s):

C. Florea ◽

M.K.H. Malo ◽

J. Rautiainen ◽

J.T.A. Mäkelä ◽

J.M. Fick ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Articular Cartilage ◽

Trabecular Bone ◽

Subchondral Bone ◽

Cruciate Ligament ◽

Bone Plate ◽

Subchondral Bone Plate ◽

Anterior Cruciate Ligament Transection ◽

Anterior Cruciate ◽

Femoral Condyles

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Three-dimensional distribution of articular cartilage thickness in the elderly talus and calcaneus analyzing the subchondral bone plate density

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2011.12.014 ◽

2012 ◽

Vol 20 (4) ◽

pp. 296-304 ◽

Cited By ~ 22

Author(s):

K. Akiyama ◽

T. Sakai ◽

N. Sugimoto ◽

H. Yoshikawa ◽

K. Sugamoto

Keyword(s):

Articular Cartilage ◽

Subchondral Bone ◽

Three Dimensional ◽

The Elderly ◽

Cartilage Thickness ◽

Bone Plate ◽

Subchondral Bone Plate ◽

Dimensional Distribution

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A comparative study of articular cartilage thickness in the stifle of animal species used in human pre-clinical studies compared to articular cartilage thickness in the human knee

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632990 ◽

2006 ◽

Vol 19 (03) ◽

pp. 142-146 ◽

Cited By ~ 169

Author(s):

D. D. Frisbie ◽

M. W. Cross ◽

C. W. McIlwraith

Keyword(s):

Articular Cartilage ◽

Subchondral Bone ◽

Clinical Studies ◽

Femoral Condyle ◽

Cartilage Thickness ◽

Bone Plate ◽

Subchondral Bone Plate ◽

Femoral Trochlea ◽

Human Knee ◽

Calcified Cartilage

SummaryHistological measurements of the thickness of non-calcified and calcified cartilage, as well as the subchondral bone plate in five locations on the femoral trochlea and medial femoral condyles of species were used in preclinical studies of articular cartilage and compared to those of the human knee. Cadaver specimens were obtained of six human knees, as well as six equine, six goat, six dog, six sheep and six rabbit stifle joints (the animal equivalent of the human knee). Specimens were taken from the lateral trochlear ridge, medial trochlear ridge and medial femoral condyle. After histopathological processing, the thickness of non-calcified and calcified cartilage layers, as well as the subchondral bone plate, was measured. Average articular cartilage thickness over five locations were 2.2–2.5 mm for human, 0.3 mm for rabbit, 0.4–0.5 mm for sheep, 0.6–1.3 mm for dog, 0.7–1.5 mm for goat and 1.5–2 mm for horse. The horse provides the closest approximation to humans in terms of articular cartilage thickness, and this approximation is considered relevant in pre-clinical studies of cartilage healing.

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A finite element model of an idealized diarthrodial joint to investigate the effects of variation in the mechanical properties of the tissues

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/095441103770802504 ◽

2003 ◽

Vol 217 (5) ◽

pp. 341-348 ◽

Cited By ~ 20

Author(s):

F H Dar ◽

R M Aspden

Keyword(s):

Mechanical Properties ◽

Finite Element ◽

Articular Cartilage ◽

Finite Element Model ◽

Factorial Design ◽

Subchondral Bone ◽

Element Model ◽

Bone Plate ◽

Subchondral Bone Plate ◽

Wide Range

The stiffness of articular cartilage increases dramatically with increasing rate of loading, and it has been hypothesized that increasing the stiffness of the subchondral bone may result in damaging stresses being generated in the articular cartilage. Despite the interdependence of these tissues in a joint, little is understood of the effect of such changes in one tissue on stresses generated in another. To investigate this, a parametric finite element model of an idealized joint was developed. The model incorporated layers representing articular cartilage, calcified cartilage, the subchondral bone plate and cancellous bone. Taguchi factorial design techniques, employing a two-level full-factorial and a four-level fractional factorial design, were used to vary the material properties and thicknesses of the layers over the wide range of values found in the literature. The effects on the maximum values of von Mises stress in each of the tissues are reported here. The stiffness of the cartilage was the main factor that determined the stress in the articular cartilage. This, and the thickness of the cartilage, also had the largest effect on the stresses in all the other tissues with the exception of the subchondral bone plate, in which stresses were dominated by its own stiffness. The stiffness of the underlying subchondral bone had no effect on the stresses generated in the cartilage. This study shows how stresses in the various tissues are affected by changes in their mechanical properties and thicknesses. It also demonstrates the benefits of a structured, systematic approach to investigating parameter variation in finite element models.

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