: INTRODUCTION. An evolution of the traditional autologous chondrocyte implantation (ACI) technique is represented by the matrix-induced autologous chondrocyte implantation (MACI®). This method requires seeding of autologous chondrocytes on a type I-III collagene membrane, which is implanted in the chondral defect using exclusively fibrin glue. The authors report the arthroscopic MACI® technique, which was adopted for the treatment of a chondral defect in the posterior part of the lateral tibial plateau. SURGICAL TECHNIQUE. The chondral defect was studied preoperatively by MRI (FSE Fat-Sat T2, GE T2) and accurately defined during arthroscopic harvesting of chondrocytes. The patient was a 25-year old man presenting a deep chondral lesion (2.5 mm x 10 mm in size) at the posterior portion of the lateral tibial plate of the left knee. A pneumatic tourniquet was placed on the proximal thigh and a 30° oblique arthroscope was inserted through the standard anteromedial portal. Operative instruments were inserted through the anterolateral portal, in which a 7.0 mm arthroscopic cannula was placed. After debridement with curettes and shaver (full radius blade 5.5 mm), haemostasis was carried out using an acromioplasty electrode. The chondral defect was sized with a measuring rod and the dimensions transferred onto the seeded collagen membrane, which was subsequently cut reproducing the shape of the lesion. The membrane was folded and inserted into the joint using atraumatic arthroscopic forceps. Saline solution flow was stopped and fibrin glue was injected through a Tuohy needle (17 G), inserted previously under the middle third of the lateral meniscus, in order to reach the chondral defect. Pressure on the membrane was applied with the probe in order to achieve optimal contact with the underlying bone. Saline solution flow was restored and stability of the implant was checked with repeated flexion/extension movements of the knee. RESULTS. No complications were observed in the postoperative period. At 6 months, the ICRS score was normal from preoperative severely abnormal; modified Cincinnati knee score was 7/10 points from preoperative 4/10 points. The implant was evaluated by MRI at 3 and 6 months postoperatively. At 3 months the graft filled the chondral defect and its signal was hyperintense in T2-weighted fat-suppressed and gradient echo scans. Subchondral bone showed reduction of the edema that was observed preoperatively. At 6 months, subchondral edema was further reduced and the thickness of the implant appeared increased with restoration of a regular articular surface. DISCUSSION. In the ACI technique the need of suturing the periosteal flap to the margin of the chondral lesion did not allow to carry out the procedure arthroscopically. The use of fibrin glue for fixating the seeded membrane has permitted to perform the procedure arthroscopically in a simple and safe way. In the reported case, no specifically designed instruments were used and the posterior portion of the lateral tibial plate was approached according to a standard arthroscopic procedure. Even though the MACI® technique is mostly performed with an open procedure, the site of this lesion could not be reached without sacrifying tendinous and ligamentous structures of the knee, and even in this case the sight and operating space could not compare with an arthroscopic approach. There are several procedure that can be performed arthroscopically for treating cartilage lesions, but the size of this defect was too large for bone marrow stimulation techniques and/or osteochondral grafts to be successful. Consequently, the arthroscopic MACI® technique appeared the best solution for this patient.

Artrhoscopic autologous chondrocyte implantation for the treatment of a chondral defect in the tibial plateau. case report.

RONGA, MARIO;CHERUBINO, PAOLO
2003-01-01

Abstract

: INTRODUCTION. An evolution of the traditional autologous chondrocyte implantation (ACI) technique is represented by the matrix-induced autologous chondrocyte implantation (MACI®). This method requires seeding of autologous chondrocytes on a type I-III collagene membrane, which is implanted in the chondral defect using exclusively fibrin glue. The authors report the arthroscopic MACI® technique, which was adopted for the treatment of a chondral defect in the posterior part of the lateral tibial plateau. SURGICAL TECHNIQUE. The chondral defect was studied preoperatively by MRI (FSE Fat-Sat T2, GE T2) and accurately defined during arthroscopic harvesting of chondrocytes. The patient was a 25-year old man presenting a deep chondral lesion (2.5 mm x 10 mm in size) at the posterior portion of the lateral tibial plate of the left knee. A pneumatic tourniquet was placed on the proximal thigh and a 30° oblique arthroscope was inserted through the standard anteromedial portal. Operative instruments were inserted through the anterolateral portal, in which a 7.0 mm arthroscopic cannula was placed. After debridement with curettes and shaver (full radius blade 5.5 mm), haemostasis was carried out using an acromioplasty electrode. The chondral defect was sized with a measuring rod and the dimensions transferred onto the seeded collagen membrane, which was subsequently cut reproducing the shape of the lesion. The membrane was folded and inserted into the joint using atraumatic arthroscopic forceps. Saline solution flow was stopped and fibrin glue was injected through a Tuohy needle (17 G), inserted previously under the middle third of the lateral meniscus, in order to reach the chondral defect. Pressure on the membrane was applied with the probe in order to achieve optimal contact with the underlying bone. Saline solution flow was restored and stability of the implant was checked with repeated flexion/extension movements of the knee. RESULTS. No complications were observed in the postoperative period. At 6 months, the ICRS score was normal from preoperative severely abnormal; modified Cincinnati knee score was 7/10 points from preoperative 4/10 points. The implant was evaluated by MRI at 3 and 6 months postoperatively. At 3 months the graft filled the chondral defect and its signal was hyperintense in T2-weighted fat-suppressed and gradient echo scans. Subchondral bone showed reduction of the edema that was observed preoperatively. At 6 months, subchondral edema was further reduced and the thickness of the implant appeared increased with restoration of a regular articular surface. DISCUSSION. In the ACI technique the need of suturing the periosteal flap to the margin of the chondral lesion did not allow to carry out the procedure arthroscopically. The use of fibrin glue for fixating the seeded membrane has permitted to perform the procedure arthroscopically in a simple and safe way. In the reported case, no specifically designed instruments were used and the posterior portion of the lateral tibial plate was approached according to a standard arthroscopic procedure. Even though the MACI® technique is mostly performed with an open procedure, the site of this lesion could not be reached without sacrifying tendinous and ligamentous structures of the knee, and even in this case the sight and operating space could not compare with an arthroscopic approach. There are several procedure that can be performed arthroscopically for treating cartilage lesions, but the size of this defect was too large for bone marrow stimulation techniques and/or osteochondral grafts to be successful. Consequently, the arthroscopic MACI® technique appeared the best solution for this patient.
2003
Bulgheroni, P.; Ronga, Mario; Grassi, F.; Cherubino, Paolo
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/1793572
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact