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Microfracture for chondral defects: assessment of the variability of surgical technique in cadavers

  • Experimental Study
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to assess the variability of the microfracture technique when performed by experienced knee arthroscopy surgeons.

Method

Four surgeons were each asked to perform microfracture on six preformed cartilage defects in fresh human cadaveric knees. Surgeons were instructed on penetration depth, inter-hole distance, and to place the holes perpendicular to the subchondral surface. Micro-computed tomography was used to calculate depth error, inter-hole distance error, and deviation of penetration angles from the perpendicular.

Results

All surgeons misjudged depth and inter-hole distance, tending to make microfracture holes too deep (depth error 1.1 mm ± 1.9) and too close together (inter-hole distance error: −0.8 mm ± 0.4). Fifty-one per cent of holes were angled more than 10° from the perpendicular (range 2.6°–19.8°). Both depth and distance errors were significantly lower in the trochlear groove than on the femoral condyle (p < 0.05). Surface shearing was associated with both penetration depth >4 mm and angles >20°. Inter-hole infraction occurred in holes closer than 2.5 mm to each other.

Conclusion

Even experienced knee arthroscopy surgeons demonstrate inconsistency in surgical technique when performing microfracture. While further research will be required to demonstrate that these variations in surgical technique are associated with poorer clinical outcomes after microfracture, surgeons should attempt to minimizing such variations in order to prevent surface shearing and inter-hole infraction.

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Author information

Authors and Affiliations

  1. Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Artur Kroell

  2. University of Toronto Orthopaedic Sports Medicine, 600 University Avenue, Suite 476C, Toronto, ON, M5G 1X5, Canada

    Paul Marks, Jaskarndip Chahal, Tim Dwyer, Daniel Whelan & John Theodoropoulos

  3. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Paul Marks

  4. Toronto Western Hospital, Toronto, ON, Canada

    Jaskarndip Chahal

  5. Women’s College Hospital, Toronto, ON, Canada

    Jaskarndip Chahal, Tim Dwyer & John Theodoropoulos

  6. Department of Clinical Studies, Ontario Veterinary College at the University of Guelph, Guelph, ON, Canada

    Mark Hurtig

  7. Mt Sinai Hospital, Toronto, ON, Canada

    Tim Dwyer & John Theodoropoulos

  8. St Michael’s Hospital, Toronto, ON, Canada

    Daniel Whelan

Authors
  1. Artur Kroell
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  2. Paul Marks
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  3. Jaskarndip Chahal
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  4. Mark Hurtig
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  5. Tim Dwyer
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  6. Daniel Whelan
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  7. John Theodoropoulos
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Corresponding author

Correspondence to John Theodoropoulos.

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Kroell, A., Marks, P., Chahal, J. et al. Microfracture for chondral defects: assessment of the variability of surgical technique in cadavers. Knee Surg Sports Traumatol Arthrosc 24, 2374–2379 (2016). https://doi.org/10.1007/s00167-014-3481-8

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  • DOI: https://doi.org/10.1007/s00167-014-3481-8

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