TY - JOUR
T1 - Feasibility Study to Determine if Microfracture Surgery Using Water Jet Drilling Is Potentially Safe for Talar Chondral Defects in a Caprine Model
AU - Kok, Aimee C.
AU - den Dunnen, Steven
AU - Lambers, Kaj T. A.
AU - Kerkhoffs, Gino M. M. J.
AU - Tuijthof, Gabrielle J. M.
PY - 2021
Y1 - 2021
N2 - Objective: Surgical microfracture is considered a first-line treatment for talar osteochondral defects. However, current rigid awls and drills limit access to all locations in human joints and increase risk of heat necrosis of bone. Using a flexible water jet instrument to drill holes can improve the reachability of the defect without inducing thermal damage. The aim of this feasibility study is to determine whether water jet drilling is potentially safe compared with conventional microfracture awls by studying side effects and perioperative complications, as well as the quality of cartilage repair tissue. Design: Talar chondral defects with 6-mm diameter were created bilaterally in 6 goats (12 samples). One defect in each goat was treated with microfracture created with conventional awls, the contralateral defect was treated with holes created with 5-second water jet bursts at a pressure of 50 MPa. Postoperative complications were recorded and after 24 weeks analyses were performed using the ICRS (International Cartilage Repair Society) macroscopic score and modified O’Driscoll histological score. Results: Several practical issues using the water jet in the operating theatre were noted. Water jet drilling resulted in fibrocartilage repair tissue similar to the repair tissue from conventional awls. Conclusions: These results suggest that water jet drilling gives adequate fibrocartilage repair tissue. Furthermore, the results highlight essential prerequisites for safe application of surgical water jet drilling: stable water pressure, water jet beam coherence, stable positioning of the nozzle head when jetting, and minimizing excessive fluid extravasation.
AB - Objective: Surgical microfracture is considered a first-line treatment for talar osteochondral defects. However, current rigid awls and drills limit access to all locations in human joints and increase risk of heat necrosis of bone. Using a flexible water jet instrument to drill holes can improve the reachability of the defect without inducing thermal damage. The aim of this feasibility study is to determine whether water jet drilling is potentially safe compared with conventional microfracture awls by studying side effects and perioperative complications, as well as the quality of cartilage repair tissue. Design: Talar chondral defects with 6-mm diameter were created bilaterally in 6 goats (12 samples). One defect in each goat was treated with microfracture created with conventional awls, the contralateral defect was treated with holes created with 5-second water jet bursts at a pressure of 50 MPa. Postoperative complications were recorded and after 24 weeks analyses were performed using the ICRS (International Cartilage Repair Society) macroscopic score and modified O’Driscoll histological score. Results: Several practical issues using the water jet in the operating theatre were noted. Water jet drilling resulted in fibrocartilage repair tissue similar to the repair tissue from conventional awls. Conclusions: These results suggest that water jet drilling gives adequate fibrocartilage repair tissue. Furthermore, the results highlight essential prerequisites for safe application of surgical water jet drilling: stable water pressure, water jet beam coherence, stable positioning of the nozzle head when jetting, and minimizing excessive fluid extravasation.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85074567385&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31646879
U2 - https://doi.org/10.1177/1947603519880332
DO - https://doi.org/10.1177/1947603519880332
M3 - Article
C2 - 31646879
SN - 1947-6035
VL - 13
SP - 1627S–1636S
JO - Cartilage
JF - Cartilage
IS - Suppl. 2
ER -