Ronga Mario, Grassi Federico A, Bulgheroni Paolo
Institute of Orthopaedics and Traumatology, University of Insubria, Ospedale di Circolo, Varese, Italy.
Arthroscopy. 2004 Jan;20(1):79-84. doi: 10.1016/j.arthro.2003.11.012.
The matrix-induced autologous chondrocyte implantation (MACI; Verigen, Leverküsen, Germany) is a tissue engineering technique for the treatment of deep chondral lesions. Cultured chondrocytes are seeded on a collagen membrane that can be implanted into the defect using exclusively fibrin glue. These features imply some surgical advantages with respect to the traditional ACI technique, such as the possibility of performing the procedure in articular sites, in which putting stitches for the periosteal patch is impossible. We report on the arthroscopic MACI technique for the treatment of a chondral defect of the knee. A 25-year-old man suffered persistent pain at the left knee after a violent direct trauma. Magnetic resonance imaging (MRI) and arthroscopic examination at the time of cartilage biopsy revealed a 2-cm2 chondral lesion in the posterior portion of the lateral tibial plateau. The implantation procedure was performed through traditional arthroscopic portals, and the seeded membrane was fixed with fibrin glue, excluding water flow temporarily. Implant stability was verified intraoperatively, and filling of the defect was shown 12 months after surgery by MRI, which showed a hyaline-like cartilage signal. In this specific case, the arthroscopic approach allowed to achieve an optimal view of the lesion, without sacrificing any tendinous or ligamentous structure of the knee.
基质诱导自体软骨细胞植入术（MACI；德国勒沃库森的Verigen公司）是一种用于治疗深层软骨损伤的组织工程技术。将培养的软骨细胞接种在胶原膜上，该胶原膜可仅使用纤维蛋白胶植入缺损处。这些特点相对于传统的ACI技术具有一些手术优势，比如有可能在关节部位进行该手术，而在这些部位无法为骨膜补片缝合。我们报告了关节镜下MACI技术治疗膝关节软骨缺损的情况。一名25岁男性在遭受剧烈直接创伤后左膝持续疼痛。在软骨活检时进行的磁共振成像（MRI）和关节镜检查显示，胫骨外侧平台后部有一个2平方厘米的软骨损伤。植入手术通过传统关节镜入路进行，接种的膜用纤维蛋白胶固定，暂时排除水流。术中验证了植入物的稳定性，术后12个月的MRI显示缺损处已填充，呈现出类似透明软骨的信号。在这个特定病例中，关节镜入路能够实现对损伤的最佳视野观察，而不牺牲膝关节的任何肌腱或韧带结构。
