Girgis Mina Y, Carey James L
Temple University Hospital, Philadelphia, Pennsylvania, USA.
University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Video J Sports Med. 2023 Jun 13;3(3):26350254231161057. doi: 10.1177/26350254231161057. eCollection 2023 May-Jun.
A known complication following autologous chondrocyte implantation (ACI) for the repair of cartilage defects is graft hypertrophy. Although hypertrophic tissue can sometimes be asymptomatic, it may cause pain, catching, or effusion prompting a debridement operation-the most common cause for reoperation.
Second-look arthroscopy is required for debridement of symptomatic hypertrophic or delaminated tissue.
First, the graft is distinguished from the surrounding tissue. Visually, the graft has a lighter white color than the surrounding egg-shell-colored native cartilage. With a probe, it can be appreciated that the graft also has a softer texture than the firmer surrounding cartilage. Once the graft is identified, hypertrophy can be appreciated by the extent of raised margins from the surrounding cartilage. Delamination can also be seen by visualizing separated strands of graft on the surface or separation of the graft at the margins. A probe may then be used to gently assess the extent of the delamination. After diagnosing hypertrophy or delamination, a shaver is used to gently debride the tissue back so that it becomes flush with the surrounding tissue. Special care must be taken as to not over-debride the tissue, as this can subsequently lead to recurrent cartilage defect.
Patients are expected to have resolved pain, catching, and clicking sensations as well as resolved graft-associated effusion following this procedure.
DISCUSSION/CONCLUSION: Due to the incidence of symptomatic graft hypertrophy and delamination following ACI, second-look arthroscopy may be necessary to evaluate and possibly treat a cartilage defect following its repair.
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.
自体软骨细胞移植（ACI）修复软骨缺损后已知的一种并发症是移植物肥大。尽管肥大组织有时可能无症状，但它可能会引起疼痛、卡顿或积液，从而促使进行清创手术，这是再次手术最常见的原因。
对于有症状的肥大或分层组织进行清创需要二期关节镜检查。
首先，将移植物与周围组织区分开来。从视觉上看，移植物的白色比周围蛋壳色的天然软骨更浅。用探针可以感觉到，移植物的质地也比周围坚硬的软骨更软。一旦识别出移植物，可通过其与周围软骨边缘升高的程度来判断肥大情况。通过观察移植物表面分离的条带或移植物边缘的分离情况也可以看到分层。然后可以使用探针轻轻评估分层的程度。在诊断为肥大或分层后，使用刨刀轻轻清除组织，使其与周围组织齐平。必须特别小心不要过度清除组织，因为这可能随后导致复发性软骨缺损。
预计患者在此手术后疼痛、卡顿和弹响感会消失，与移植物相关的积液也会消退。
讨论/结论：由于 ACI 后有症状的移植物肥大和分层的发生率，可能需要二期关节镜检查来评估并可能治疗软骨缺损修复后的情况。
作者证明已获得本出版物中出现的任何患者的同意。如果个人可能被识别，作者已随此提交的出版物包含患者的豁免声明或其他书面批准形式。
