Astur Diego Costa, Gracitelli Guilherme Conforto, Arliani Gustavo Gonçalves, Astur Nelson, Kaleka Camila Cohen, Pochini Alberto, Cohen Moises
Orthopaedic and Traumatology Department, Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, Vila Clementino, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur:
JBJS Essent Surg Tech. 2014 Sep 10;4(3):e17. doi: 10.2106/JBJS.ST.M.00066. eCollection 2014 Sep.
Autologous osteochondral transplantation for the treatment of patellar chondral injuries is a single-stage procedure through a single surgical approach that allows replacement of the chondral injury with an osteochondral plug that has the same cartilaginous hyaline characteristics as the site had before the injury.
STEP 1 PREOPERATIVE PLANNING: Make radiographs (anteroposterior, lateral, and Merchant patellofemoral views), computed tomography scans, and magnetic resonance imaging (MRI) of the knee for an anatomic study and to determine cartilage lesion details.
STEP 2 PERFORM KNEE ARTHROSCOPY AND LESION IDENTIFICATION: Classify and locate the cartilage lesion on the basis of the intraoperative arthroscopic knee evaluation.
STEP 3 USE A PARAPATELLAR APPROACH: Perform a parapatellar incision and patellar eversion as they are necessary to access cartilage lesions.
STEP 4 HARVEST THE OSTEOCHONDRAL PLUG AT THE DONATION SITE: Harvest an appropriate osteochondral graft, which is essential for a successful procedure. Perpendicular graft harvesting is crucial for a perfect cartilage surface match.
STEP 5 CHARACTERIZE AND PREPARE THE LESION: At this point, prepare the receptor area with a power drill.
STEP 6 INSERT THE OSTEOCHONDRAL PLUG INTO THE RECEPTOR SITE: Insert the graft with press-fit fixation.
STEP 7 POSTOPERATIVE CARE: Instruct all patients to follow a rehabilitation protocol.
Our clinical experience with this procedure has corresponded to the scores and MRI-based findings in our original study, in which we prospectively evaluated thirty-three knees in patients who underwent autologous osteochondral transplantation for a symptomatic full-thickness cartilaginous injury on the patellar articular surface.IndicationsContraindicationsPitfalls & Challenges.
自体骨软骨移植治疗髌骨软骨损伤是一种通过单一手术入路的单阶段手术，该手术可使用具有与损伤前部位相同软骨透明特性的骨软骨栓替代软骨损伤。
步骤1术前规划：拍摄膝关节的X线片（前后位、侧位和髌股关节Merchant位）、计算机断层扫描以及磁共振成像（MRI），用于解剖学研究并确定软骨损伤细节。
步骤2进行膝关节镜检查和损伤识别：根据术中膝关节镜评估对软骨损伤进行分类和定位。
步骤3采用髌旁入路：必要时做髌旁切口并外翻髌骨，以暴露软骨损伤部位。
步骤4在供区获取骨软骨栓：获取合适的骨软骨移植物，这对手术成功至关重要。垂直获取移植物对于实现完美的软骨表面匹配至关重要。
步骤5处理并准备损伤部位：此时，用动力钻准备受体区域。
步骤6将骨软骨栓插入受体部位：通过压配固定插入移植物。
步骤7术后护理：指导所有患者遵循康复方案。
我们对该手术的临床经验与我们原始研究中的评分及基于MRI的结果相符，在原始研究中，我们前瞻性评估了33例因髌骨关节面有症状的全层软骨损伤而接受自体骨软骨移植的患者的膝关节。适应证、禁忌证、陷阱与挑战。
