Surgeon Ability to Appropriately Address the Calcified Cartilage Layer: An In Vitro Study of Arthroscopic and Open Techniques
Background: Microfracture is a commonly utilized cartilage restoration technique for articular cartilage defects. While the removal of the calcified cartilage layer (CCL) has been shown to be critical with in vivo models, little is known with regard to surgeon reliability to adequately perform the technique.
Purpose: To evaluate surgeon reliability in removing the CCL utilizing open and arthroscopic techniques.
Study Design: Controlled laboratory study.
Methods: Eleven cadaveric knees were utilized to create four 12-mm diameter defects in the anterior and posterior medial femoral condyles. Eleven fellowship-trained surgeons were asked to perform the following procedures: remove the CCL open, retain the CCL open, remove the CCL arthroscopically, and retain the CCL arthroscopically. Samples underwent histologic staining and analysis with 3-dimensional micro–computed tomography. The latter was used to calculate the percentage of the CCL that was removed or retained across the entire defect.
Results:When surgeons were asked to retain the CCL arthroscopically, 48% ± 41% (mean ± SD) remained. When surgeons were asked to remove the CCL arthroscopically, 24% ± 35% remained. There was no statistical difference between these groups (P > .05). When the CCL was retained during open preparation, 60% ± 39% remained. During attempts to remove the CCL in an open manner, 19% ± 28% remained. There was a significant difference in the amount of CCL remaining between the open removal and open retaining groups (P = .03). There were no significant differences in the percentage of CCL remaining between the open and arthroscopic preservation groups and between the open and arthroscopic removal groups.
Conclusion/Clinical Relevance:This study highlights the significant variability in surgeon ability to reliably retain or remove the CCL. However, there appears to be improved ability of surgeons to more reliably remove or retain the CCL in an open fashion as compared with the arthroscopic approach.
Yanke AB, Lee AS, Karas V, Abrams G, Riccio ML, Verma NN, Bach BR, Cole BJ. (2019). Surgeon Ability to Appropriately Address the Calcified Cartilage Layer: An In Vitro Study of Arthroscopic and Open Techniques. The American Journal of Sports Medicine, 47, 363546519859851.
Liu, J. N., Gowd, A. K., Redondo, M. L., Christian, D. R., Cabarcas, B. C., Yanke, A. B., & Cole, B. J. (2019). Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation. Orthopaedic Journal of Sports Medicine, 7(1), 2325967118818462.
Gowd AK, Cvetanovich GL, Liu JN, Christian DD, Cabarcas BC, Redondo ML, Verma NN, Yanke AB, Cole BJ. (2018). Management of Chondral Lesions of the Knee: Analysis of Trends and Short-Term Complications Using the National Surgical Quality Improvement Program Database. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Chahla J, Sweet MC, Okoroha KR, Nwachukwu BU, Hinckel B, Farr J, Yanke AB, Bugbee WD, Cole BJ. (2018). Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review. The American Journal of Sports Medicine, 19(3), 363546518814236.
Urita A, Cvetanovich GL, Madden BT, Verma NN, Inoue N, Cole BJ, Yanke AB. (2018). Topographic Matching of Osteochondral Allograft Transplantation Using Lateral Femoral Condyle for the Treatment of Medial Femoral Condyle Lesions: A Computer-Simulated Model Study. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 34(11), 3033–3042.
Saltzman, B. M., Redondo, M. L., Beer, A., Cotter, E. J., Frank, R. M., Yanke, A. B., & Cole, B. J. (2018). Wide Variation in Methodology in Level I and II Studies on Cartilage Repair: A Systematic Review of Available Clinical Trials Comparing Patient Demographics, Treatment Means, and Outcomes Reporting. Cartilage, 30(6), 1947603518809398.
Weber AE, Locker PH, Mayer EN, Cvetanovich GL, Tilton AK, Erickson BJ, Yanke AB, Cole BJ. (2018). Clinical Outcomes After Microfracture of the Knee: Midterm Follow-up. Orthopaedic Journal of Sports Medicine, 6(2), 2325967117753572.
Saltzman BM, Cotter EJ, Stephens JP, Cvetanovich GL, Madden B, Wang K, Yanke AB, Cole BJ. (2018). Preoperative Tibial Subchondral Bone Marrow Lesion Patterns and Associations With Outcomes After Isolated Meniscus Allograft Transplantation. The American Journal of Sports Medicine, 22, 363546517751690.
Yanke AB, Urita A, Shin JJ, Cvetanovich GL, Moran E, Bach BR, Cole BJ, Inoue N, Verma NN. Topographic Analysis of the Distal Femoral Condyle Articular Cartilage Surface: Adequacy of the Graft from Opposite Condyles of the Same or Different Size for the Osteochondral Allograft Transplantation. Cartilage, 91, 1947603517752056.
McCarthy, M. A., Meyer, M. A., Weber, A. E., Levy, D. M., Tilton, A. K., Yanke, A. B., & Cole, B. J. (2017). Can Competitive Athletes Return to High-Level Play After Osteochondral Allograft Transplantation of the Knee? Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 33(9), 1712–1717.
Lansdown, D. A., Riff, A. J., Meadows, M., Yanke, A. B., & Bach, B. R. (2017). What Factors Influence the Biomechanical Properties of Allograft Tissue for ACL Reconstruction? A Systematic Review. Clinical Orthopaedics and Related Research, 1–15.
Meyer, M. A., Leroux, T. S., Levy, D. M., Tilton, A. K., Lewis, P. B., Yanke, A. B., & Cole, B. J. (2017). Flexion Posteroanterior Radiographs Affect Both Enrollment for and Outcomes After Injection Therapy for Knee Osteoarthritis. Orthopaedic Journal of Sports Medicine, 5(5), 2325967117706692.
Meyer MA, McCarthy MA, Gitelis ME, Poland SG, Urita A, Chubinskaya S, Yanke AB, Cole BJ. (2016). Effectiveness of Lavage Techniques in Removing Immunogenic Elements from Osteochondral Allografts. Cartilage.
Saltzman BM, Meyer MA, Weber AE, Poland SG, Yanke AB, & Cole BJ. (2017). Prospective Clinical and Radiographic Outcomes After Concomitant Anterior Cruciate Ligament Reconstruction and Meniscal Allograft Transplantation at a Mean 5-Year Follow-up. The American Journal of Sports Medicine, 45(3), 550–562.
Saltzman BM, Griffin JW, Wetters N, Meyer MA, Cole BJ, Yanke AB. (2016) Concomitant Arthroscopic Meniscal Allograft Transplantation and Anterior Cruciate Ligament Reconstruction. Arthroscopy Techniques, 5(5), e1161–e1171.
Riboh, J. C., Saltzman, B. M., Yanke, A. B., & Cole, B. J. (2015). Human Amniotic Membrane-Derived Products in Sports Medicine: Basic Science, Early Results, and Potential Clinical Applications. The American Journal of Sports Medicine.
Saltzman BM, Kuhns BD, Weber AE, Yanke AB, Nho SJ. (2016). Stem Cells in Orthopedics: A Comprehensive Guide for the General Orthopedist. American Journal of Orthopedics (Belle Mead, N.J.), 45(5), 280–326.
Fillingham, Y. A., Riboh, J. C., Erickson, B. J., Bach, B. R., & Yanke, A. B. (2016). Inside-Out Versus All-Inside Repair of Isolated Meniscal Tears: An Updated Systematic Review. The American Journal of Sports Medicine.
Riboh JC, Saltzman BM, Yanke AB, Cole BJ. Human Amniotic Membrane-Derived Products in Sports Medicine: Basic Science, Early Results, and Potential Clinical Applications. The American Journal of Sports Medicine.
Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. The American Journal of Sports Medicine, 0363546515580787.
Shin, J. J., Haro, M., Yanke, A. B., Mascarenhas, R., Romeo, A. A., Cole, B. J., et al. (2015). Topographic Analysis of the Capitellum and Distal Femoral Condyle: Finding the Best Match for Treating Osteochondral Defects of the Humeral Capitellum. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. doi:10.1016/j.arthro.2014.11.039
Cvetanovich, G. L., Yanke, A. B., McCormick, F., Bach, B. R., & Cole, B. J. (2015). Trends in Meniscal Allograft Transplantation in the United States, 2007 to 2011. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. doi:10.1016/j.arthro.2014.12.020
Yanke AB, Chalmers PN, Frank RM, Friel NA, Karas V, Cole BJ. (2014). Clinical Outcome of Revision Meniscal Allograft Transplantation: Minimum 2-Year Follow-up. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. doi:10.1016/j.arthro.2014.06.027
Click here to download the article: Clinical Outcome of Revision Meniscal Allograft Transplantation: Minimum 2-Year Follow-up
Mascarenhas R, Yanke AB, Frank RM, Butty DC, Cole BJ. (2014). Meniscal Allograft Transplantation: Preoperative Assessment, Surgical Considerations, and Clinical Outcomes. The Journal of Knee Surgery. doi:10.1055/s-0034-1382080
Cvetanovich GL, Chalmers PN, Yanke AB, Gupta AK, Klosterman EL, Verma NN, Romeo AA. Feasibility of an osteochondral allograft for biologic glenoid resurfacing. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons … [et al.]. doi:10.1016/j.jse.2013.07.038
Gomoll AH, Yanke AB, Kang RW, Chubinskaya S, Williams JM, Bach BR, et al. Long-term effects of bupivacaine on cartilage in a rabbit shoulder model. Am J Sports Med. 2009 Jan.;37(1):72–77. PMID: 18832481
Rue J-PH, Yanke AB, Busam ML, McNickle AG, Cole BJ. Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair: minimum 2-year follow-up. Am J Sports Med. 2008 Sep.;36(9):1770–1778. PMID: 18483199
Chubinskaya S, Hakimiyan A, Rappoport L, Yanke A, Rueger DC, Cole BJ. Response of Human Chondrocytes Prepared for Autologous Implantation to Growth Factors. Journal of Knee Surgery, 2008 Jul;21(3):192-9. PMID: 18686480
Lewis PB, Williams JM, Hallab N, Virdi A, Yanke AB, Cole BJ. Multiple freeze-thaw cycled meniscal allograft tissue: A biomechanical, biochemical, and histologic analysis. J Orthop Res. 2008 Jan.;26(1):49–55. PMID: 17676620
Chubinskaya S, Hakimiyan A, Pacione C, Yanke A, Rappoport L, Aigner T, Rueger D, Loeser RF. Synergistic Effect of IGF-1 and OP-1 on Matrix Formation by Normal and OA Chondrocytes Cultured in Alginate Beads. Osteoarthritis and Cartilage, Apr; 15(4):421-30, 2007. PMID: 1894688
Landis WJ, Jacquet R, Hillyer J, Lowder E, Yanke A, Siperko L, Asamura S, Kusuhara H, Enjo M, Chubinskaya S, Potter K, and Isogai N: Design and assessment of a tissue-engineered model of human phalanges and a small joint. Orthod Craniofac Res, Nov; 8(4): 303-12, 2005. PMID: 16238611
Patellofemoral Disorders – Yanke AB, Wuerz T, Saltzman BM, Butty D, Cole BJ. (2014). Management of Patellofemoral Chondral Injuries. Clinics in Sports Medicine, 33(3), 477–500. doi:10.1016/j.csm.2014.03.004
Yanke AB, Bell R, Lee A, Mather C, Shewman E, Wang VM, Bach BR. Regional mechanical properties of human patellar tendon allografts. Knee surgery, sports traumatology, arthroscopy : official journal of theESSKA. doi:10.1007/s00167-013-2768-5
Yanke AB, Ellman MB, Sherman SL, Bach BR Jr. Graft-Tunnel Mismatch in Bone-Tendon-Bone ACL Reconstruction. Techniques in Orthopaedics. 2012 Jun.;27(2):153–7.
Yanke AB, Bell RL, Lee AS, Shewman E, Wang VM, Bach BR. Central-Third Bone-Patellar Tendon-Bone Allografts Demonstrate Superior Biomechanical Failure Characteristics Compared With Hemi-Patellar Tendon Grafts. Am J Sports Med. Volume 41 Issue 11 November 2013 pp. 2521 – 2526, doi:10.1177/0363546513501780
Chalmers PN, Mall NA, Yanke AB, Bach BR. Contemporary Anterior Cruciate Ligament Outcomes: Does Technique Really Matter? Operative Techniques in Sports Medicine 21(1), 55–63. doi:10.1053/j.otsm.2012.10.008.
Yanke AB, Mall N, Sherman SL, Bach BR. 5 Points On: Endoscopic Anterior Cruciate Ligament Reconstruction. Am J Orthop. 2013;42(7):305-308
Yanke AB, Bell R, Lee A, Kang RW, Mather RC, Shewman EF, et al. The Biomechanical Effects of 1.0 to 1.2 Mrad of Gamma Irradiation on Human Bone-Patellar Tendon-Bone Allografts. Am J Sports Med. 2013 Feb 6. PMID: 23388672
Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR, Yanke AB, Cole BJ. (2016). The Therapeutic Effect of Intra-articular Normal Saline Injections for Knee Osteoarthritis. The American Journal of Sports Medicine, 363546516680607
Harris JD, Abrams GD, Yanke AB, Hellman MD, Erickson BJ, Bach BR. Suture Anchor-Based Quadriceps Tendon Repair
Surgical Technique and Review of Literature. Orthopedics, 2014; 37(3):183-186
Sherman SL, Chalmers PN, Yanke AB, Bush-Joseph CA, Verma NN, Cole BJ, et al. Graft tensioning during knee ligament reconstruction: principles and practice. J Am Acad Orthop Surg. 2012 Oct.;20(10):633–45. PMID: 23027693
Nemani VM, Frank RM, Reinhardt KR, Pascual-Garrido C, Yanke AB, Drakos M, Warren RF. Popliteal venotomy during posterior cruciate ligament reconstruction in the setting of a popliteal artery bypass graft. Arthroscopy. 2012 Feb.;28(2):294–299. PMID: 22244104
Koyonos L, Yanke AB, McNickle AG, Kirk SS, Kang RW, Lewis PB, et al. A randomized, prospective, double-blind study to investigate the effectiveness of adding DepoMedrol to a local anesthetic injection in postmeniscectomy patients with osteoarthritis of the knee. Am J Sports Med. 2009 Jun. p. 1077–1082. PMID: 19279226
Chalmers PN, Frank RM, Gupta AK, Yanke AB, Trenhaile SW, Romeo AA, Bach BR Jr, Verma NN. All-arthroscopic patch augmentation of a massive rotator cuff tear: surgical technique. Arthroscopy Techniques, 2013. 2(4), e447–51. doi:10.1016/j.eats.2013.07.003
Ferry AT, Provencher MT, Yanke AB, Verma NN, Bach BR, Romeo AA. Double-Row Rotator Cuff Repairs: Biomechanical Rationale and Techniques to Optimize Outcomes. Techniques in Shoulder/Elbow Surgery 9(1):1-9, March 2008.
Wang VM, Wang FC, McNickle AG, Friel NA, Yanke AB, Chubinskaya S, et al. Medial versus lateral supraspinatus tendon properties: implications for double-row rotator cuff repair. Am J Sports Med. 2010 Dec.;38(12):2456–2463. PMID: 20929937
Cole BJ, Gomoll AH, Yanke A, Pylawka T, Lewis P, Macgillivray JD, and Williams JM: Biocompatibility of a polymer patch for rotator cuff repair. Knee Surg Sports Traumatol Arthrosc, May; 15(5):632-7, 2007. PMID: 16964514
We recently just published an article that showed we can avoid the cost and irradiation associated with CT scans through using automated 3D MRI technology that we developed at our institution. If you want to take a look you can download the article for free here. Thank you to all my co-authors especially Dr. Landsdown and Dr. Dawe.
Yanke AB, Shin J, Pearson I, Bach BR Jr, Romeo A, Cole BJ, , Verma N. Glenoid Bone Loss: Three Dimensional MRI versus CT Reconstructions. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association.
Shin JJ, Mascarenhas R, Patel AV, Yanke AB, Nicholson GP, Cole BJ, Romeo AA, Verma NN. (2015). Clinical outcomes following revision anterior shoulder arthroscopic capsulolabral stabilization. Archives of Orthopaedic and Trauma Surgery, 1–7.
Mellano CR, Shin JJ, Yanke AB, Verma NN. Disorders of the Long Head of the Biceps Tendon. Instr Course Lect 2015; 64: Journal of Bone and Joint Surgery
Chalmers PN, Yanke AB, Cvetanovich GL, Verma NN, Romeo AA: Arthroscopic and open biceps tenodesis distal to the intertubercular groove. Orthopaedic Knowledge Online Journal 2013;11(7): Accessed July 1, 2013.
Ellman MB, Yanke AB, Juhan T, Verma NN, Nicholson GP, Bush-Joseph C, Bach BR, Romeo AA. Open repair of an acute latissimus tendon avulsion in a Major League Baseball pitcher. Journal of Shoulder and Elbow Surgery: 22(7), e19–23. doi:10.1016/j.jse.2013.03.013
Bhatia S, Chalmers PN, Yanke AB, Romeo AA, Verma NN. (2012). Arthroscopic suprascapular nerve decompression: transarticular and subacromial approach. Arthroscopy Techniques, 1(2), e187–92. doi:10.1016/j.eats.2012.07.004
Yanke AB, Ghodadra N, Sherman SL, Romeo A, Verma MV. Arthroscopic Suprascapular Nerve Decompression: Etiology, Diagnosis, and Surgical Technique. American Academy of Orthopaedic Surgeons Web site: Orthopaedic Knowledge Online 2012 10(2): Accessed February 1, 2012
Singaraju VM, Kang RW, Yanke AB, McNickle AG, Lewis PB, Wang VM, Williams JM, Chubinskaya S, Romeo AA, Cole BJ. Biceps Tendinitis in Chronic Rotator Cuff Tears: A Histological Perspective. Journal of Shoulder and Elbow Surgery, 2008 Nov-Dec;17(6):898-904. PMID: 18786837
Alpert JM, Verma NN, Wysocki R, Yanke AB, Romeo AA. Arthroscopic Treatment of Multidirectional Shoulder Instability with Minimum 270° Labral Repair: Minimum 2 year follow-up. Arthroscopy, 2008 Jun;24(6):704-11. PMID: 18514115
McCormick F, Alpaugh K, Nwachukwu BU, Yanke AB, Martin SD. Endoscopic Repair of Full-Thickness Abductor Tendon Tears: Surgical Technique and Outcome at Minimum of 1-Year Follow-up. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. doi:10.1016/j.arthro.2013.08.024
Kang RW, Yanke AB, Orias AE, Inoue N, Nho SJ. Emerging Ideas: Novel 3-D Quantification and Classification of Cam Lesions in Patients With Femoroacetabular Impingement. Clin. Orthop. Relat. Res. 2012 Nov.6. PMID: 23129477
Leopold SS. Editor’s Spotlight/Take 5: Novel 3-D Quantification and Classification of Cam Lesions in Patients with Femoroacetabular Impingement (DOI 10.1007/s11999-012-2693-9). Clin. Orthop. Relat. Res. 2013 Feb;471(2):355–7.