关节镜下MACI（猪胶原膜上自体培养软骨细胞）移植术治疗股骨内侧髁及滑车软骨缺损并同期行胫骨结节截骨术
简介
该文介绍一种关节镜下递送MACI（自体软骨细胞-猪胶原膜复合物）治疗股骨髁及滑车软骨缺损的技术，可同期行胫骨结节截骨术（TTO）。技术要点包括专用刮匙、软骨刻痕器及V型 shuttle 膜递送装置，并强调髌骨抬高显露滑车、精确病灶准备及止血管理。作者认为该微创入路较开放手术创伤小、恢复快，且可与TTO联合处理多部位软骨病变，适合熟练关节镜医师采用。
英文摘要
BACKGROUND: Chondral pathology of the knee-specifically involving the femoral condyles and trochlea-is commonly observed during knee arthroscopies. This condition may necessitate supplementary interventions, such as a concomitant tibial tuberosity osteotomy (TTO). Approaching this patient population with a straightforward, less invasive arthroscopic technique may offer an advanced solution. INDICATIONS: Arthro matrix-induced autologous chondrocyte implantation (MACI; autologous cultured chondrocytes on a porcine collagen membrane) targets symptomatic chondral lesions in the knee that are consistent with magnetic resonance imaging findings, which range in size from 2 to 4 cm2, are contained within a stable rim, and are classified as grade 3 to 4a according to the International Cartilage Repair Society. TECHNIQUE DESCRIPTION: This technique for the arthroscopic delivery of MACI for defects located on the trochlea and femoral condyles has been developed as a progressive advancement in the evolution of autologous chondrocyte implantation technology. The described technique addresses these defect locations by utilizing the same arthroscopic approach for both cartilage defect locations and a separate incision for TTO. The instruments used include 3 varieties of curettes, an arthroscopic cutter to score the cartilage, and the V-shuttle membrane delivery device. Furthermore, attention is dedicated to the medial and lateral approaches, patellar elevation for trochlear access, meticulous defect preparation, hemostasis and fluid management, and implant delivery. Arthroscopic surgical procedures generally result in reduced postoperative pain, necessitating a decreased analgesic requirement, an earlier and enhanced joint mobility, less postoperative muscle inhibition, and expedited recovery. Moreover, an arthroscopic approach may reduce the length of the surgical incision for patients concerned about cosmetic outcomes. RESULTS: In contrast to various other arthroscopic procedures related to knee ligaments or meniscal injuries, the implementation of arthroscopic delivery of MACI for defects on the trochlea and femoral condyles of the knee offers a persuasive and readily executable alternative for a proficient surgeon, even when performed in conjunction with TTO. DISCUSSION/CONCLUSION: This arthroscopic technique for the delivery of the MACI implant can effectively treat multiple knee chondral lesions in different compartments when paired with TTO. Advantages of this approach include minimal surgical disruption, the ability to perform combined knee arthroscopic procedures, a more desirable cosmetic appearance, and improved early postoperative recovery. PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.