Scientific Articles   |    
Articular Cartilage Degeneration Following the Treatment of Focal Cartilage Defects with Ceramic Metal Implants and Compared with Microfracture
R.J.H. Custers, MD1; D.B.F. Saris, MD, PhD1; W.J.A. Dhert, MD, PhD1; A.J. Verbout, MD, PhD1; M.H.P. van Rijen, BSc1; S.C. Mastbergen, PhD1; F.P.J.G. Lafeber, PhD1; L.B. Creemers, PhD1
1 Department of Orthopaedics (R.J.H.C., D.B.F.S., W.J.A.D., A.J.V., M.H.P.v.R., and L.B.C.) and Department of Rheumatology and Clinical Immunology (S.C.M. and F.P.J.G.L.), University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. E-mail address for R.J.H. Custers: r.j.h.custers@umcutrecht.nl. E-mail address for D.B.F. Saris: d.saris@umcutrecht.nl. E-mail address for W.J.A. Dhert: w.dhert@umcutrecht.nl. E-mail address for A.J. Verbout: a.j.verbout@umcutrecht.nl. E-mail address for M.H.P. van Rijen: m.rijen@umcutrecht.nl. E-mail address for S.C. Mastbergen: s.mastbergen@umcutrecht.nl. E-mail address for F.P.J.G. Lafeber: f.lafeber@umcutrecht.nl. E-mail address for L.B. Creemers: l.b.creemers@umcutrecht.nl
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Smith and Nephew, the Anna Foundation, the Netherlands Organisation for Health Research and Development (NWO), and the Dutch Arthritis Association. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedics and Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, and the Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Apr 01;91(4):900-910. doi: 10.2106/JBJS.H.00668
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Background: Localized cartilage defects are frequently associated with joint pain, reduced function, and a predisposition to the development of osteoarthritis. The purposes of the current study were to investigate the feasibility of the application of defect-sized femoral implants for the treatment of localized cartilage defects and to compare this treatment, in terms of joint degeneration, with the use of microfracture in a goat model of established cartilage defects.

Methods: In nine Dutch milk goats, a defect in the medial femoral condyle was created in both knees. After ten weeks, the knees were randomly treated by microfracture or by placement of an oxidized zirconium implant. At twenty-six weeks after surgery, the animals were killed. The joints were evaluated macroscopically. Implant osseointegration was measured by automated histomorphometry, and cartilage repair (after microfracture) was scored histologically. Cartilage quality was analyzed macroscopically and histologically. Glycosaminoglycan content and release were measured by alcian blue assay, and the synthesis and release of newly formed glycosaminoglycans were measured by liquid scintillation analysis of the incorporation of 35SO42— in tissue and medium.

Results: The mean bone-implant contact (and standard error) was appropriate (14.6% ± 5.4%), and the amount of bone surrounding the implant was extensive (mean, 40.3% ± 4.0%). The healing of the microfracture-treated defects was extensive, although not complete (mean, 18.38 ± 0.43 points of a maximum possible score of 24 points). The macroscopic cartilage evaluation did not show any significant differences between the treatments. On histologic evaluation, the cartilage of the medial tibial plateau articulating directly against the treated defects demonstrated significantly more degeneration in the microfracture-treated knees than in the implant-treated knees (p < 0.05). This was in accordance with a significantly higher glycosaminoglycan content, higher synthetic activity, and decreased glycosaminoglycan release of the medial tibial plateau cartilage of the implant-treated knees (p < 0.05 for all). On histological analysis, degeneration was also found in the cartilage of the lateral tibial plateau and condyle, but no significant difference was found between the treatments.

Conclusions: Both microfracture and the use of implants as a treatment for established localized cartilage defects in the medial femoral condyle caused considerable (p < 0.05) degeneration of the directly articulating cartilage as well as in more remote sites in the knee. However, in the medial tibial plateau, the metal implants caused less damage than the microfracture technique.

Clinical Relevance: Although this study shows that small metal implants may be more suitable than microfracture in the treatment of localized cartilage defects in the knee, the generalized degeneration found following both treatments should be addressed first.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Georgia - Choice Care Occupational Medicine & Orthopaedics
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    Ohio - OhioHealth Research and Innovation Institute (OHRI)