Jones Deryk G, Grilliot Jordan M
The University of Queensland, Brisbane, Queensland, Australia.
Department of Orthopaedic Surgery, Section of Sports Medicine, Ochsner Clinical School, New Orleans, Louisiana, USA.
Video J Sports Med. 2023 Jul 3;3(4):26350254231173700. doi: 10.1177/26350254231173700. eCollection 2023 Jul-Aug.
There are several techniques for knee exposure in treating chondral defects with restorative procedures. The medial subvastus knee exposure is often overlooked when choosing the surgical approach. When properly performed, the medial subvastus approach can allow for the treatment of a wide range of pathology while preserving the extensor mechanism.
We present a case of an active 40-year-old man with persistent left knee pain noted to have a full-thickness medial femoral condylar articular cartilage defect in an otherwise healthy appearing knee.
The rationale and considerations for the medial subvastus knee exposure in treating a chondral defect with an autologous chondrocyte implant are discussed. Careful consideration of the approach, intra-articular exposure, and closure are emphasized to achieve optimal outcomes.
At 18 months postoperative, the patient reported no knee pain with improvements made in Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and International Knee Documentation Committee (IKDC) scores. These results are consistent with our institutions larger cohort of 26 patients undergoing matrix-induced autologous chondrocyte implantation (MACI) using the subvastus approach. These improvements in patient-reported outcomes are maintained at 2 years postoperative and are consistent with other published outcomes of the MACI procedure.
DISCUSSION/CONCLUSION: Excellent results in addressing chondral pathology about the knee can be achieved by selecting the appropriate surgical access. The subvastus approach has several advantages such as preserving the quadriceps mechanism, improving postoperative quadriceps muscle strength, conservation of the patellar genicular blood supply and possibly reducing postoperative pain that can result in a faster rehabilitation. When performed systematically and carefully, complete exposure of the knee can be achieved to facilitate a wide variety of surgical interventions. In patients undergoing cartilage restoration procedures, the medial subvastus approach should be considered in the surgeon's armamentarium.
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.
在采用修复手术治疗软骨缺损时，有多种膝关节暴露技术。在选择手术入路时，股内侧肌下入路常常被忽视。如果操作得当，股内侧肌下入路能够在保留伸膝机制的同时，治疗多种病变。
我们报告一例40岁活跃男性病例，其左膝持续疼痛，在外观健康的膝关节中发现股骨内侧髁全层关节软骨缺损。
讨论了股内侧肌下入路在自体软骨细胞植入治疗软骨缺损中的原理及注意事项。强调仔细考虑入路、关节内暴露及缝合，以实现最佳效果。
术后18个月，患者报告无膝关节疼痛，膝关节损伤和骨关节炎疗效评分（KOOS）、Lysholm评分及国际膝关节文献委员会（IKDC）评分均有所改善。这些结果与我们机构采用股内侧肌下入路进行基质诱导自体软骨细胞植入（MACI）的26例更大队列患者一致。患者报告的这些疗效改善在术后2年得以维持，且与MACI手术的其他已发表疗效一致。
讨论/结论：选择合适的手术入路能够在处理膝关节软骨病变方面取得优异结果。股内侧肌下入路具有多种优势，如保留股四头肌机制、改善术后股四头肌肌力、保留髌周血供以及可能减轻术后疼痛，从而可实现更快康复。当系统且仔细地操作时，能够实现膝关节的完全暴露，便于进行各种手术干预。在接受软骨修复手术的患者中，外科医生应将股内侧肌下入路纳入其手术方法中。
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。
