Cartilage repair in the rabbit knee: mosaic plasty resulted in higher degree of tissue filling but affected subchondral bone more than microfracture technique

A blinded, randomized, controlled, long-term follow-up trial in 88 knees

Abstract

Purpose

Discrepancies and variances in outcome following different surgical techniques for cartilage repair are poorly understood. Successful repair relies on proper tissue filling without initiating degenerative processes in the cartilage–bone unit. Consequently, the objective of the current study was to compare two available techniques for cartilage repair, i.e., microfracture technique and mosaic plasty, regarding tissue filling and subchondral bone changes in an experimental model.

Methods

A 4-mm pure chondral defect was created in the medial femoral condyle of both knees in New Zealand rabbits, aged 22 weeks. A stereomicroscope was used to optimize the preparation of the defects. In one knee (randomized), the defect was treated with microfracture technique whereas in the other with mosaic plasty. The animals were killed at 12, 24 and 36 weeks after surgery. Defect filling, new bone formation above the level of the tidemark and the density of subchondral mineralized tissue were estimated by histomorphometry.

Results

Mosaic plasty resulted in a significantly 34% higher degree of tissue filling than microfracture technique at 36 weeks, SD of mean difference being 34%. Mosaic plasty resulted in significantly more new bone formation and reduced subchondral mineralized tissue density compared to microfracture technique. The differences between the two techniques were apparent mainly at the long-term follow-up.

Conclusion

Tissue filling is a limiting factor regarding microfracture technique when compared to mosaic plasty, whereas mosaic plasty resulted in more bone changes than microfracture technique—the implications of the latter remain to be settled. This study underlines the difficulty in predicting outcome in the single case with any of these two techniques, particularly in a long-term perspective.

Level of evidence

II.

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Acknowledgments

The authors thank Ansgar Aasen and his staff at the Institute of Surgical Sciences, Dag Sørensen and his staff at the Institute of Comparative Medicine and bioengineer Aileen Murdoch Larsen for technical assistance. The study was supported by grants from Oslo Sports Trauma Research Centre (OSTRC). The center is financed by the South-Eastern Norway Regional Health Authority, the Royal Norwegian Ministry of Education and Research, the Norwegian Olympic Committee & Confederation of Sport and Norsk Tipping.

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No conflicting interests declared.

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Heir, S., Årøen, A., Løken, S. et al. Cartilage repair in the rabbit knee: mosaic plasty resulted in higher degree of tissue filling but affected subchondral bone more than microfracture technique. Knee Surg Sports Traumatol Arthrosc 20, 197–209 (2012). https://doi.org/10.1007/s00167-011-1596-8

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Keywords

  • Cartilage
  • Chondral defect
  • Microfracture
  • Mosaic
  • Filling
  • Subchondral bone
  • Knee
  • Rabbit
  • Surgery