Cotter Eric J, Sachs Jared P, Cole Brian J
Chicago, Illinois, U.S.A.
Arthroscopy. 2025 Mar;41(3):771-773. doi: 10.1016/j.arthro.2024.06.025. Epub 2024 Jun 21.
Articular cartilage defects in the knee are common and possess a limited ability to inherently heal. Many of the surgical management options for cartilage repair that result in a hyaline or hyaline-like chondral surface have donor-site morbidity, are resource intensive, are costly, and may require multiple surgeries. Autologous minced cartilage implantation is an encouraging, single-stage technique that can be safely and efficiently performed arthroscopically to address focal chondral defects in the knee. The limited morbidity and cost-effective nature of using autograft tissue have clear advantages, including the ability to treat patients at the time a clinically relevant defect is identified, increased availability of tissue, reduced patient morbidity with the use of an arthroscopic harvest technique, and the production of a hyaline cartilage repair product with active chondrocytes. Clinically, it has been demonstrated to be superior to microfracture. However, the mincing technique may compromise cell viability. A recent porcine model investigation demonstrated that arthroscopic cartilage harvest using a shaver contains a significantly lower median number of viable chondrocytes compared with open scalpel harvest, resulting in reduced proteoglycans, glycosaminoglycans, aggrecan, and COL2A1 expression, a result of fewer viable chondrocytes. The authors suggest that traditional open-scalpel harvest results in a superior single-stage autologous minced cartilage transplantation product with more hyaline-like tissue compared with arthroscopic mincing techniques. However, the findings of the study regarding cell viability after arthroscopic harvest are in stark contrast to previous findings, including our previous work. Pending future research, it is our view that an arthroscopic single-stage autologous cartilage transplant is more reproducible, efficient, and of lower morbidity than open harvest, and we and others have shown the arthroscopic technique to be both safe and effective.
膝关节软骨缺损很常见，其自身愈合能力有限。许多旨在修复软骨并形成透明软骨或类似透明软骨表面的手术治疗方案，都存在供区并发症，资源消耗大，成本高，且可能需要多次手术。自体碎软骨植入是一种令人鼓舞的单阶段技术，可通过关节镜安全有效地进行，以解决膝关节局灶性软骨缺损问题。使用自体移植组织的并发症有限且具有成本效益，具有明显优势，包括在发现临床相关缺损时即可治疗患者、组织可用性增加、采用关节镜采集技术可降低患者并发症，以及产生含有活性软骨细胞的透明软骨修复产物。临床上，已证明其优于微骨折术。然而，切碎技术可能会损害细胞活力。最近一项猪模型研究表明，与开放手术刀采集相比，使用刨刀进行关节镜软骨采集所获得的存活软骨细胞中位数显著更低，导致蛋白聚糖、糖胺聚糖、聚集蛋白聚糖和COL2A1表达减少，这是存活软骨细胞较少的结果。作者认为，与关节镜切碎技术相比，传统的开放手术刀采集可产生更优质的单阶段自体碎软骨移植产物，具有更多类似透明软骨的组织。然而，该研究关于关节镜采集后细胞活力的结果与之前的发现形成了鲜明对比，包括我们之前的研究。在未来研究结果出来之前，我们认为关节镜单阶段自体软骨移植比开放采集更具可重复性、效率更高且并发症更低，而且我们和其他人已经证明关节镜技术既安全又有效。
