注射器辅助关节镜下植入微粒幼年关节软骨治疗滑车软骨缺损
简介
该研究介绍了一种全关节镜下使用注射器辅助植入微粒化幼年同种异体关节软骨（PJAC）治疗滑车软骨缺损的技术。通过标准1mL注射器实现可控、均匀的移植物输送，并在代表性病例中展示了缺损准备、干燥视野下移植物放置及纤维蛋白胶固定的步骤。术后MRI显示移植物整合良好，无分层或软骨下骨破坏，提示该方法利用常规器械降低了滑车区域微创软骨修复的技术门槛。
英文摘要
Particulated juvenile articular cartilage (PJAC) allograft has emerged as a single-stage biologic option for treatment of focal full-thickness cartilage defects, including isolated trochlear lesions. Open techniques are most commonly described, and although a small number of arthroscopic techniques have been reported, precise placement of particulate graft material within the curved geometry of the trochlea remains technically challenging due to high local shear forces, limited working angles, and difficulty maintaining a dry arthroscopic field. We describe a fully arthroscopic technique for the implantation of PJAC allograft in a trochlear cartilage defect using a standard 1-mL disposable tuberculin syringe to facilitate controlled, titratable graft delivery and uniform particulate distribution. The technique is demonstrated in a representative case and includes defect preparation with creation of stable vertical cartilage shoulders, removal of the calcified cartilage layer, transition to a dry arthroscopic field, syringe-assisted graft placement, and stabilization with fibrin sealant. Syringe-assisted delivery enabled controlled placement of cartilage particulates with uniform distribution under direct arthroscopic visualization, facilitating creation of a thin monolayer flush with the surrounding articular surface. The patient initially progressed through rehabilitation without wound or infectious complications and maintained full knee motion. Postoperative magnetic resonance imaging demonstrated incorporation of the lateral trochlear PJAC implant without delamination or subchondral bone plate disruption. In the setting of a complex prior surgical history, multifocal patellofemoral chondral disease, and persistent activity-related mechanical symptoms, the patient later underwent repeat diagnostic arthroscopy approximately 16 months after PJAC implantation. A standard disposable tuberculin syringe provides a simple, reproducible, and cost-efficient method for improving graft control during arthroscopic PJAC implantation in the trochlea, leveraging widely available instrumentation rather than specialized delivery systems. This technique may help reduce technical barriers to minimally invasive cartilage restoration in anatomically constrained regions of the patellofemoral joint.