一期联合逆行软骨下骨钻孔及原位自体或微粒化软骨修复（应用骨髓抽吸浓缩物）治疗局灶性髌股关节软骨损伤
简介
针对髌股关节局灶性软骨缺损，作者介绍了一种单阶段联合手术：逆行软骨下骨钻孔并结合原位自体或微粒化软骨修复，将软骨与骨髓血浓缩物混合形成可塑形支架，于干性关节镜下用纤维蛋白胶固定。该技术旨在保留钙化软骨层及缺损边缘活性软骨，并可通过外侧支持带松解改善髌骨轨迹，但目前缺乏疗效证据，临床价值有限。
英文摘要
Patellofemoral cartilage lesions are uniquely challenging to treat due to high joint contact pressures, complex tracking mechanics, and limited intrinsic healing potential. Conventional methods such as debridement, microfracture, or staged autologous chondrocyte implantation may disrupt the calcified cartilage layer, violate the subchondral bone, or require multiple procedures that may lead to fibrocartilage repair and poor long-term durability. We describe a single-stage approach for focal patellofemoral chondral defects that combines retrograde subchondral drilling with an "island-pattern," in situ crush cartilage preparation technique. This method preserves the calcified cartilage layer and viable chondrocytes at the lesion border while minimizing enlargement of the lesion. Autologous or micronized cartilage is mixed with bone marrow aspirate concentrate to create a moldable scaffold that is delivered arthroscopically or through a mini-open approach and secured with fibrin glue under dry arthroscopy. If indicated, a concomitant lateral retinacular release or lengthening will improve patellar tracking and prevent excess load of the repaired lesion.