Peñalver Juan Manuel, Villalba Jordi, Yela-Verdú Christian P, Sánchez Joel, Balaguer-Castro Mariano
Knee Unit, Department of Orthopedic Surgery and Traumatology, Parc Taulí University Hospital Institut d'Investigació i Innovació Parc Taulí CSPT, Autonomous University of Barcelona, Sabadell, Spain.
Arthrosc Tech. 2020 May 14;9(6):e755-e759. doi: 10.1016/j.eats.2020.02.007. eCollection 2020 Jun.
Nanofractured autologous matrix-induced chondrogenesis (NAMIC©) is a 1-step technique that combines nanofracture needling to induce bone marrow stimulation (BMS) and the use of cell-free collagen matrix to optimize cartilage regeneration. In this Technical Note, we describe a modification of the NAMIC procedure using mosaicplasty trephines to prepare the lesion surface and to shape collagen implants in an all-arthroscopic approach (A-NAMIC). This technique is indicated for the treatment of International Cartilage Repair Society grade III to IV knee chondral lesions of ≤4 cm. After damaged cartilage is debrided, trephines are used to create a flat, circular lesion surfaces. Subsequently, BMS is performed with nanofracture, eliciting reproducible and stop-controlled subchondral bone perforations of 9-mm depth and 1-mm width. The collagen membrane is then cut to size with the trephine, placed over the prepared defect, and secured with fibrin glue, preventing loss of regenerating cells and growth factors to the joint space. Using trephines allows the rapid and precise creation of smooth defect surfaces with known dimensions, ensuring optimal lesion coverage. Additionally, nanofracture reduces trabecular compaction and allows for a deeper access to subchondral bone in comparison with conventional microfracture, improving lesion filling and production of cartilage with higher hyaline content.
纳米骨折自体基质诱导软骨形成术（NAMIC©）是一种一步法技术，它结合了纳米骨折针刺以诱导骨髓刺激（BMS）和使用无细胞胶原基质来优化软骨再生。在本技术说明中，我们描述了一种对NAMIC手术的改良方法，即使用镶嵌成形环钻在全关节镜手术入路（A-NAMIC）中制备损伤表面并塑造胶原植入物。该技术适用于治疗国际软骨修复协会III至IV级、直径≤4 cm的膝关节软骨损伤。在清理受损软骨后，使用环钻创建平坦的圆形损伤表面。随后，通过纳米骨折进行骨髓刺激，引发可重复且可控的深度为9 mm、宽度为1 mm的软骨下骨穿孔。然后用环钻将胶原膜裁剪成合适尺寸，放置在准备好的缺损处，并用纤维蛋白胶固定，防止再生细胞和生长因子流失到关节腔。使用环钻能够快速精确地创建具有已知尺寸的光滑缺损表面，确保最佳的损伤覆盖。此外，与传统微骨折相比，纳米骨折减少了小梁压实，并能更深入地进入软骨下骨，改善损伤填充以及生成具有更高透明质酸含量的软骨。
