DeFroda Steven F, Cregar William, Vadhera Amar, Singh Harsh, Perry Allison, Chahla Jorge
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthrosc Tech. 2021 Feb 22;10(3):e861-e865. doi: 10.1016/j.eats.2020.10.078. eCollection 2021 Mar.
Tibial plateau chondral defects can be difficult to diagnose and treat. Although grafting of femoral and patella chondral defects has become relatively commonplace, the tibial plateau offers unique challenges for some of the grafting techniques used in these locations, mostly because of limitations with exposure even in an open approach. Arthroscopic surgery makes treatment of these lesions more feasible, as it affords better access and visualization of tibial defects. The purpose of this article is to describe the arthroscopic management of a lateral tibial plateau chondral defect via autologous chondrocyte bone grafting. The technique consists of harvest of autologous cartilage from the intercondylar notch and repair of the tibial plateau defect with a slurry of autologous chondrocytes and bone marrow aspirate concentrate. In addition, CO is used as a medium to distend the joint in a tight compartment to keep the chondral defect dry. This technique is technically simple and does not require an extensive open technique or an expensive osteochondral allograft. It also avoids the staged management required in other types of autologous chondrocyte implantation, which require cartilage biopsy to produce a final product for implantation.
胫骨平台软骨缺损可能难以诊断和治疗。尽管股骨和髌骨软骨缺损的移植已相对常见，但胫骨平台对这些部位使用的一些移植技术提出了独特挑战，主要是因为即使采用开放手术入路，暴露也存在局限性。关节镜手术使这些病变的治疗更可行，因为它能更好地显露和观察胫骨缺损。本文的目的是描述通过自体软骨细胞骨移植对外侧胫骨平台软骨缺损进行关节镜下处理。该技术包括从髁间切迹获取自体软骨，并用自体软骨细胞和骨髓抽吸浓缩物的混悬液修复胫骨平台缺损。此外，使用二氧化碳作为介质在狭窄间隙中扩张关节，以保持软骨缺损干燥。该技术在技术上简单，不需要广泛切开手术或昂贵的异体骨软骨移植。它还避免了其他类型自体软骨细胞植入所需的分期处理，后者需要进行软骨活检以制备最终用于植入的产品。
