Ihn Hansel E, Nestorovski Douglas, Cho Austin, Hatch George F
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Video J Sports Med. 2023 Aug 25;3(4):26350254231186440. doi: 10.1177/26350254231186440. eCollection 2023 Jul-Aug.
Symptomatic, full-thickness chondral defects often are associated with meniscal deficiencies. These are difficult problems to manage in the young, high-demand patient population. A number of differing techniques have been published with no consensus. While more recent techniques have favored minimally invasive approaches, an open approach with tubercle osteotomy to maximize visualization of all knee compartments can still provide favorable outcomes when using a careful technique and postoperative protocol.
Young, high-demand patients with long-standing meniscal deficiency and resultant chondral defects are indicated for cartilage restoration and preservation procedures. A meniscal allograft transplantation is indicated in symptomatic patients with prior total or subtotal meniscectomy. It is important to address other concomitant pathology such as instability, alignment, and chondral defects. Concomitant procedures are often performed with meniscal transplants, including osteochondral allograft transplantation for larger defects.
This surgical technique video demonstrates a tibial tubercle osteotomy approach to gain access to both the medial and lateral tibiofemoral compartments. An arthroscopic-assisted bone slot technique was performed for meniscal allograft transplantation. Appropriately sized osteochondral allograft bone plugs were then transplanted onto the medial and femoral condyles with a press fit technique.
At 1-year follow-up, the presented patient has regained full motion and are back to full activities.
DISCUSSION/CONCLUSION: Full-thickness chondral defects associated with meniscal deficiency in a young, high-demand patient is a difficult problem to manage. Recent results using minimally invasive approaches have demonstrated favorable mid- and long-term outcomes. In patients with pathology that may preclude a minimally invasive approach, an open technique with osteotomy can still have a promising outcome.
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.
有症状的全层软骨缺损常与半月板损伤相关。在年轻、活动量大的患者群体中，这些是难以处理的问题。已经发表了许多不同的技术，但尚未达成共识。虽然最近的技术倾向于微创方法，但在使用精细技术和术后方案时，采用结节截骨的开放方法以最大限度地观察所有膝关节腔仍可提供良好的结果。
有长期半月板损伤及由此导致软骨缺损的年轻、活动量大的患者适合进行软骨修复和保留手术。有症状的曾行半月板全切或次全切的患者适合进行同种异体半月板移植。处理其他伴随病变如不稳定、对线不良和软骨缺损很重要。同种异体半月板移植时通常会同时进行其他手术，包括对较大缺损进行异体骨软骨移植。
本手术技术视频展示了一种通过胫骨结节截骨入路来进入内侧和外侧胫股关节腔的方法。同种异体半月板移植采用关节镜辅助骨槽技术。然后采用压配技术将尺寸合适的异体骨软骨移植骨栓移植到内侧和股骨髁上。
在1年的随访中，该患者已恢复完全活动度并重新开始全面活动。
讨论/结论：年轻、活动量大的患者中与半月板损伤相关的全层软骨缺损是一个难以处理的问题。最近使用微创方法的结果显示了良好的中长期疗效。对于可能无法采用微创方法的病变患者，截骨开放技术仍可能有良好的结果。
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，作者已随本投稿发表包含患者的豁免声明或其他书面批准形式。
