Belk John W, Bravman Jonathan T, Frank Rachel M, Dragoo Jason L, McCarty Eric C
Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA.
Video J Sports Med. 2023 Jan 3;3(1):26350254221131054. doi: 10.1177/26350254221131054. eCollection 2023 Jan-Feb.
Articular cartilage lesions are a significant cause of morbidity and impaired knee function, and attempts to surgically repair damaged cartilage have failed to reliably reproduce native cartilage. Thus, osteochondral allograft transplantation is an effective one-step procedure to repair large cartilage defects.
Osteochondral allograft transplantation is indicated for young active patients with large focal defects, those with a history of previous cartilage repair, and those with cartilage-related degenerative disorders such as osteonecrosis, osteochondritis dissecans, and/or post-traumatic osteochondral defects.
In short, after the focal chondral defect is identified, a socket is created with specific dimensions in depth and diameter. The donor cartilage is then secured in a graft station, and a sizing guide is placed through a bushing to confirm the allograft harvest location. Using stabilization from the graft station arm, a coring reamer is then advanced through the donor cartilage, and a saw is used to allow for easy removal of the graft from the donor condyle. The plug is then fashioned to fit the exact dimensions of the socket created earlier in the procedure. A cut on the donor plug is made to fashion the plug to the appropriate depth. A rongeur is used to make the plug more bullet shaped at the end to allow the plug to enter the socket more easily. Small holes are then drilled into the base of the socket to help promote incorporation of the plug into the socket during the healing process. After the socket is irrigated, the plug is then placed into the socket, and a tamp is used to gently tap the cartilage until it is flush with the surrounding surface.
After an appropriate rehabilitation protocol is followed for up to 10 months postoperatively, osteochondral allograft transplantation allows for near-to-complete restoration of patient functionality and strength, with return to full activity possible within 1 year.
Acute repair of large focal chondral defects is effective in restoring knee strength and functionality and is associated with high patient satisfaction.The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
关节软骨损伤是导致发病和膝关节功能受损的重要原因，手术修复受损软骨的尝试未能可靠地再生天然软骨。因此，异体骨软骨移植是修复大面积软骨缺损的一种有效的一步法手术。
异体骨软骨移植适用于有大面积局灶性缺损的年轻活跃患者、有既往软骨修复史的患者以及患有与软骨相关的退行性疾病（如骨坏死、剥脱性骨软骨炎和/或创伤后骨软骨缺损）的患者。
简而言之，确定局灶性软骨缺损后，创建一个具有特定深度和直径尺寸的骨槽。然后将供体软骨固定在移植台上，通过套管放置尺寸测量导向器以确认异体移植物的取材位置。利用移植台臂的稳定作用，使用取芯铰刀穿过供体软骨，并用锯子便于从供体髁上取下移植物。然后将栓体修整成适合该手术早期创建的骨槽的确切尺寸。在供体栓体上进行切割以使其达到合适的深度。使用咬骨钳使栓体末端更呈子弹形，以便栓体更容易进入骨槽。然后在骨槽底部钻孔，以帮助在愈合过程中促进栓体与骨槽的融合。冲洗骨槽后，将栓体放入骨槽中，并用压塞器轻轻敲击软骨，直到其与周围表面齐平。
术后遵循适当的康复方案长达10个月后，异体骨软骨移植可使患者功能和力量接近完全恢复，有可能在1年内恢复完全活动。
大面积局灶性软骨缺损的急性修复在恢复膝关节力量和功能方面是有效的，并具有较高的患者满意度。作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
