Use of hollow awl in microfracture yielded more open marrow channels, greater stem cell mobilization

Recent research published in Arthroscopy showed use of a cannulated hollow awl during microfracture led to more patent marrow channels at the adjacent subchondral bone of the microfracture hole, as well as greater mobilization of the reparable cells to the defect in human knee joints compared with use of a conventional awl.

Researchers made a 10-mm x 20-mm, rectangular, full-thickness chondral defect on the lateral femoral condyle on each knee joint of 22 patients undergoing one-stage bilateral total knee arthroplasty for degenerative osteoarthritis with well-preserved lateral femoral condyle cartilage. Researchers performed a six-holed microfractureprocedure using a hollow awl in one knee and a conventional awl in the other knee. Using an absorbable gelatin sponge (Gelform, Pfizer), researchers collected and analyzed bleeding through microfracture holes, as well as scanned the representative three bony samples of the distal lateral femoral condyles with micro-CT for morphometric analysis of subchondral bone micro-architecture of the microfracture holes.

Results showed a significantly greater amount of bleeding and a greater number of mesenchymal stem cells in the blood clot of the hollow awl group. Researchers also found more patent marrow channels around the adjacent subchondral bone of the microfracture hole in the hollow awl group, with greater trabecular separation on the micro-CT analysis. – Originally Posted in Healio by Casey Tingle

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