Focal Knee Cartilage Defect Treatment With Nanofracture and All-Arthroscopic Autologous Matrix-Induced Chondrogenesis Using Dry Arthroscopy.

Autologous matrix-induced chondrogenesis (AMIC) combined with nanofracture had been shown to produce superior results in treating knee defects and has become increasingly popular. This technique can be achieved via open surgery or arthroscopy. The technical challenges to arthroscopic implantation of the scaffold include compromise of the operative view by soft tissue and fluid, difficult scaffold delivery through the portal, or scaffold damage. Carbon dioxide (CO) insufflation and special equipment have been reported to facilitate scaffold implantation with favorable outcomes. The authors describe their technique of scaffold implantation with a slotted cannula and a dissector through an enlarged working portal with no CO insufflation. Effective implantation of the scaffold is made possible through attention to soft tissue, equalization of the air pressure within and outside the joint, and the unique geometry of readily available instruments in the orthopaedic operating theatre.