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The Effect of Different Bone Marrow Stimulation Techniques on Human Talar Subchondral Bone: A Micro-Computed
Arianna L Gianakos1, Youichi Yasui2, Ethan J Fraser2
1Hospital for Special Surgery, New York, U.S.A..
Summary
Smaller diameter bone marrow stimulation (BMS) tools cause fewer microarchitectural disturbances in subchondral bone. This study found that smaller microfracture awls improved bone marrow access compared to larger tools or Kirschner wires.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Regenerative Medicine
Background:
- Subchondral bone integrity is crucial for joint health.
- Bone marrow stimulation (BMS) techniques aim to promote cartilage repair by accessing bone marrow progenitor cells.
- Understanding the impact of different BMS instruments on subchondral bone microarchitecture is essential for optimizing treatment outcomes.
Purpose of the Study:
- To evaluate morphological alterations and microarchitectural disturbances in subchondral bone.
- To assess bone marrow access following different bone marrow stimulation (BMS) techniques.
- To compare the effects of varying instrument diameters on subchondral bone structure using micro-computed tomography.
Main Methods:
- Five cadaveric talar dome articular surfaces were divided into a 3x3 grid.
- Subchondral bone was penetrated using a 1.00-mm microfracture awl (s.MFX), a 2.00-mm microfracture awl (l.MFX), or a 1.25-mm Kirschner wire (K-wire).
- Micro-computed tomography analyzed bone destruction, communicating channels to bone marrow, and calculated bone volume, surface area, thickness, and number.
Main Results:
- The smaller microfracture awl (s.MFX) resulted in significantly more grade 1 holes compared to larger instruments.
- Bone marrow channel assessment showed a statistically significant increase in channels with s.MFX compared to K-wire and l.MFX.
- Bone volume fraction was significantly lower for s.MFX compared to l.MFX, indicating less trabecular compaction.
Conclusions:
- Bone marrow stimulation techniques employing larger diameter instruments lead to greater trabecular compaction and sclerosis.
- Kirschner wire and larger microfracture awl techniques reduce bone marrow access due to fewer open communicating channels.
- Smaller diameter BMS devices may minimize microarchitectural disturbances in the subchondral bone, suggesting careful instrument selection is necessary.
