Kuhn Michael A
Middlesex Orthopedic & Spine Associates and Middlesex Health, Middletown, Connecticut, USA.
Video J Sports Med. 2025 Jul 29;5(4):26350254251317218. doi: 10.1177/26350254251317218. eCollection 2025 Jul-Aug.
Knee femoral chondral pathology is frequently encountered during knee arthroscopies. Based on previous studies, the unaddressed, painful, poor knee function progresses into arthritis. Addressing this scenario with a simple, less invasive arthroscopic procedure may provide a simple solution for this cohort of patients.
The arthroscopic autologous cultured chondrocytes on a porcine collagen membrane (matrix-induced autologous chondrocyte implantation [MACI]) procedure is indicated when chondral lesions are located on the femoral condyles, with symptoms consistent with the location that corresponds to magnetic resonance imaging findings between 2 and 4 cm, contained with a stable rim, and grade 3 to 4a International Cartilage Repair Society defects.
This novel technique for arthroscopic delivery of MACI for defects on femoral condyles was developed as the next step in the evolution of the autologous chondrocyte implantation technology. The technique describes the newly developed instruments-a unique measuring probe, 3 types of curettes, the arthroscopic and MACI membrane cutters, and the V-shuttle delivery device. Also, attention is paid to the medial and lateral approach, defect preparation, fluid control, implant and fibrin sealant delivery, and simple closure. Arthroscopic surgical procedures typically result in less pain after surgery, requiring fewer pain medications, earlier and improved range of motion/function, less postoperative muscle weakness, and faster recovery, and for patients concerned about cosmesis, arthroscopic joint repair may reduce scarring. Discussed are the special differences between open and arthroscopic delivery of MACI, summarizing the pros and cons.
Compared to many other knee ligament or meniscus arthroscopic procedures, the addition of arthroscopic delivery of MACI for defects on knee femoral condyles is appealing and easy to implement by an experienced surgeon. The development of instruments simplified the procedure and elevated it to an art form.
DISCUSSION/CONCLUSION: Chondral lesions of the femoral condyles of the knee can effectively be treated with the arthroscopic MACI technique. Potential benefits include minimal surgery disruption, concomitant knee arthroscopic procedures, cosmetic appeal, improved quality of life, and level of function.
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.
膝关节镜检查时经常会遇到膝关节股骨软骨病变。根据以往的研究，未经处理的、疼痛的、膝关节功能不佳的情况会发展为关节炎。用一种简单、侵入性较小的关节镜手术来解决这种情况，可能为这类患者提供一个简单的解决方案。
当软骨损伤位于股骨髁，症状与磁共振成像结果相符，位于2至4厘米之间，边缘稳定，且为国际软骨修复协会3至4a级缺损时，可采用关节镜下将自体培养软骨细胞置于猪胶原膜上的手术（基质诱导自体软骨细胞植入术[MACI]）。
这种用于关节镜下将MACI植入股骨髁缺损处的新技术是自体软骨细胞植入技术发展的下一步。该技术介绍了新开发的器械——一种独特的测量探针、3种刮匙、关节镜和MACI膜切割器以及V形穿梭输送装置。此外，还关注了内侧和外侧入路、缺损准备、液体控制、植入物和纤维蛋白密封剂的输送以及简单缝合。关节镜手术通常术后疼痛较轻，所需止痛药较少，活动范围/功能恢复更早且更好，术后肌肉无力较轻，恢复更快，对于关注美观的患者，关节镜下关节修复可能会减少疤痕。文中讨论了MACI开放输送和关节镜输送之间的特殊差异，总结了优缺点。
与许多其他膝关节韧带或半月板关节镜手术相比，增加关节镜下将MACI植入膝关节股骨髁缺损处的手术很有吸引力，且经验丰富的外科医生易于实施。器械的开发简化了手术过程，并将其提升为一种艺术形式。
讨论/结论：膝关节股骨髁软骨损伤可用关节镜MACI技术有效治疗。潜在益处包括手术干扰最小、可同时进行膝关节镜手术、美观、生活质量提高和功能水平改善。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者已随本投稿发表包含患者发布声明或其他书面批准形式。
