The subchondral bone in articular cartilage repair: current problems in the surgical management

As the understanding of interactions between articular cartilage and subchondral bone continues to evolve, increased attention is being directed at treatment options for the entire osteochondral unit, rather than focusing on the articular surface only. It is becoming apparent that without support from an intact subchondral bed, any treatment of the surface chondral lesion is likely to fail. This article reviews issues affecting the entire osteochondral unit, such as subchondral changes after marrow-stimulation techniques and meniscectomy or large osteochondral defects created by prosthetic resurfacing techniques. Also discussed are surgical techniques designed to address these issues, including the use of osteochondral allografts, autologous bone grafting, next generation cell-based implants, as well as strategies after failed subchondral repair and problems specific to the ankle joint. Lastly, since this area remains in constant evolution, the requirements for prospective studies needed to evaluate these emerging technologies will be reviewed

Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index

<p>Abstract</p> <p>Background</p> <p>Although histopathological grading systems for disc degeneration are frequently used in research, they are not yet integrated into daily care routine pathology of surgical samples. Therefore, data on histopathological changes in surgically excised disc material and their correlation to clinical parameters such as age, gender or body mass index (BMI) is limited to date. The current study was designed to correlate major physico-clinical parameters from a population of orthopaedic spine center patients (gender, age and BMI) with a quantitative histologic degeneration score (HDS).</p> <p>Methods</p> <p>Excised lumbar disc material from 854 patients (529 men/325 women/mean age 56 (15-96) yrs.) was graded based on a previously validated histologic degeneration score (HDS) in a cohort of surgical disc samples that had been obtained for the treatment of either disc herniation or discogenic back pain. Cases with obvious inflammation, tumor formation or congenital disc pathology were excluded. The degree of histological changes was correlated with sex, age and BMI.</p> <p>Results</p> <p>The HDS (0-15 points) showed significantly higher values in the nucleus pulposus (NP) than in the annulus fibrosus (AF) (Mean: NP 11.45/AF 7.87), with a significantly higher frequency of histomorphological alterations in men in comparison to women. Furthermore, the HDS revealed a positive significant correlation between the BMI and the extent of histological changes. No statistical age relation of the degenerative lesions was seen.</p> <p>Conclusions</p> <p>This study demonstrated that histological disc alterations in surgical specimens can be graded in a reliable manner based on a quantitative histologic degeneration score (HDS). Increased BMI was identified as a positive risk factor for the development of symptomatic, clinically significant disc degeneration.</p

Influência do macheamento na interface do parafuso e do tecido ósseo na fase imediata pós-implante Influencia del taladramiento en la interfase del tornillo y del tejido óseo durante la fase inmediata post implante The influence of tapping techniques on the interface bone screw/bone tissue in immediate postoperative period

OBJETIVO: analisar experimentalmente as alterações agudas da interface entre o osso e o implante nas vértebras cervicais após a realização do macheamento do orifício piloto. MÉTODOS: foram utilizados cinco carneiros da raça Santa Inês deslanados. Na terceira vértebra cervical, foram feitos orifícios de 2,5 mm, de ambos os lados, na parte proximal e distal. No orifício proximal direito, foi realizado o macheamento antes da inserção do parafuso cortical de 3,5 mm (Grupo A); no orifício proximal esquerdo, o parafuso foi inserido sem macheamento (Grupo B); os outros dois orifícios distais foram utilizados como controle (Grupo C). As alterações da interface entre o osso e o implante foram analisadas por meio de estudo histomorfométrico, considerando o número de trabéculas fraturadas entre os filetes de rosca; a maior distância da fratura trabecular transversal provocada pela inserção do parafuso; a maior extensão da fratura trabecular longitudinal provocada pela inserção do parafuso e a linha de contato na interface osso-parafuso. RESULTADOS: o macheamento do orifício piloto provocou alterações da microestrutura do tecido ósseo ao redor do implante quando comparado às alterações produzidas pela inserção do parafuso sem o macheamento ou orifício piloto. A avaliação do contato entre o osso e o implante foi o parâmetro que apresentou diferença estatística na comparação entre a colocação do implante com e sem machemanto. CONCLUSÃO: na comparação com o orifício piloto, todos os parâmetros analisados apresentaram diferença estatística.<br>OBJETIVO: analizar experimentalmente las alteraciones agudas de la interfase entre el hueso y el implante en las vértebras cervicales, después de taladrar el orificio piloto. MÉTODOS: fueron utilizados cinco carneros de la raza Santa Inés sin lana. En la tercera vértebra cervical, fueron realizados en ambos lados unos orificios de 2.5 mm en la parte proximal y distal. En el orificio proximal derecho fue realizado el taladramiento antes de la inserción del tornillo cortical de 3.5 mm (Grupo A), en el orificio proximal izquierdo el tornillo fue insertado sin taladramiento (Grupo B) y los otros dos orificios distales fueron utilizados como controles (Grupo C). Las alteraciones de la interfase entre el hueso y el implante fueron analizadas por medio de un estudio histomorfométrico, teniendo en cuenta el número de trabéculas fracturadas entre los filetes de rosca; la mayor distancia de la fractura trabecular transversal provocada por la inserción del tornillo; la mayor extensión de la fractura trabecular longitudinal provocada por la inserción del tornillo y la línea de contacto en la interfase hueso-tornillo. RESULTADOS: taladrar el orificio piloto ha provocado alteraciones de la microestructura del tejido óseo alrededor del implante cuando comparado con las alteraciones producidas por la inserción del tornillo sin el taladramiento o el orificio piloto. La evaluación del contacto entre el hueso y el implante fue el parámetro que presentó diferencia estadística en la comparación entre la colocación del implante con o sin taladramiento. CONCLUSIÓN: al comparar con el orificio control, todos los parámetros presentaron diferencia estadística.<br>OBJECTIVE: to analyze experimentally the early alterations of the bone-screw interface with tapping techniques in the cancellous bone of the cervical vertebrae. METHODS: five wooless sheep (Santa Inês) were analyzed. Pilot holes of 2.5 mm were performed at both sides of the third cervical vertebrae in the proximal and distal portion. The tapping process was done in the right proximal hole before the 3.5 mm screw insertion (Group A), while the left proximal hole was not tapped (Group B) and the two distal holes were used as control (Group C). The interface alterations between bone and screw were analyzed through histomorphometric study, considering the number of trabeculae fractures between the screw pitch; the highest distance of transversal trabeculae fracture caused by the screw insertion; the greatest extension of the longitudinal trabeculae fracture caused by the screw insertion and the contact line between bone and screw. RESULTS: tapping the pilot hole caused alterations of bone tissue microstructure around the implant, when compared to alterations produced by insertion of the screw, without tapping or pilot hole. The evaluation of the contact between bone and screw was the parameter that presented statistical difference in comparison between the insertion of the implant with and without tapping. CONCLUSION: in comparison with the pilot hole, all the analyzed parameters presented statistical difference