Chapter 4A Bone Marrow Stimulating Techniques

Drilling, Abrasion Arthroplasty, and Microfracture

Wayne Gersoff

Introduction

The principle of bone marrow stimulating techniques involves the penetration of the subchondral bone plate to provide vascular access channels to the area of chondral defect. This allows for mesenchymal cells to fill the defect and provide a repair tissue fill of the articular cartilage defect. Three techniques are commonly used: abrasion arthroplasty,¹ subchondral drilling,² and microfracture.³

Steps Common to all Techniques

1. During knee arthroscopy, identify the area of articular cartilage injury (Fig. 4A-1).

2. Utilizing an arthroscopic shaver or curette, debride the borders of the defect back to stable, vertical walls (Figs. 4A-2 and 4A-3).

3. Remove calcified cartilage from subchondral bone using a shaver or curette. Leave no loose flaps or debris in the lesion site. The defect is now prepared (Fig. 4A-4).

FIGURE 4A-1 Articular cartilage damage to femoral condyle.

FIGURE 4A-2 and FIGURE 4A-3 Utilizing a shaver and curette to debride.

FIGURE 4A-4 Debridement of calcified cartilage.

Abrasion Arthroplasty

1. Using an arthroscopic burr—either round or oval—abrade the exposed subchondral bone to produce a punctuate bleeding surface. If using a tourniquet, let it down to confirm the presence of punctuate bleeding bone (Figs. 4A-5 and 4A-6).

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