Nadine Ott, Michael Hackl, Lars Peter Müller, Tim Leschinger
{"title":"[自体碎软骨植入治疗肱骨岬局灶性软骨损伤]。","authors":"Nadine Ott, Michael Hackl, Lars Peter Müller, Tim Leschinger","doi":"10.1007/s00064-024-00849-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The goal of minced cartilage implantation (MCI) is to restore an intact cartilage surface in focal osteochondral lesions of the humeral capitellum.</p><p><strong>Indications: </strong>The indications for MCI are limited osteochondral lesions at the humeral capitellum, also at the head of the radius, with intact cartilage border as well as in situ or a completely detached fragment, and free joint bodies (grade II-grade V according to Hefti).</p><p><strong>Contraindications: </strong>Contraindications for MCI are already concomitant or associated cartilage damage as well as bilateral osteochondral lesions and insufficient available cartilage material.</p><p><strong>Surgical technique: </strong>After diagnostic arthroscopy to detect possible concomitant pathologies and to exclude already corresponding cartilage lesions, the arthroscope is flipped posterolaterally over the high posterolateral portal and a second portal is created under visualization via the soft spot. Initially, debridement of the focal cartilage defect, assessment of the marginal zone, and/or salvage of free joint bodies. Using a smooth shaver and the filter provided, the partially or even completely detached cartilage fragment is unidirectionally fragmented under continuous suction. The remaining defect with a stable marginal zone is cleanly curetted, and the joint is completely dried. The fragmented cartilage collected in the filter is bonded to a membrane using autologous conditioned plasma (ACP) and then arthroscopically applied to the defect via a cannula, sealed using thrombin and fibrin.</p><p><strong>Postoperative management: </strong>Postoperative immobilization in a cast for at least 24 h is required. Afterwards, free exercise of the joint is possible, but no loading should be maintained for 6 weeks. Return to sport after 3 months.</p><p><strong>Results: </strong>Good to very good clinical and MRI morphologic results are already evident in the short-term course. Prospective and retrospective multicenter studies are needed to evaluate future long-term results.</p>","PeriodicalId":54677,"journal":{"name":"Operative Orthopadie Und Traumatologie","volume":" ","pages":"188-197"},"PeriodicalIF":1.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Autologous minced cartilage implantation for focal cartilage lesions of the humeral capitellum].\",\"authors\":\"Nadine Ott, Michael Hackl, Lars Peter Müller, Tim Leschinger\",\"doi\":\"10.1007/s00064-024-00849-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The goal of minced cartilage implantation (MCI) is to restore an intact cartilage surface in focal osteochondral lesions of the humeral capitellum.</p><p><strong>Indications: </strong>The indications for MCI are limited osteochondral lesions at the humeral capitellum, also at the head of the radius, with intact cartilage border as well as in situ or a completely detached fragment, and free joint bodies (grade II-grade V according to Hefti).</p><p><strong>Contraindications: </strong>Contraindications for MCI are already concomitant or associated cartilage damage as well as bilateral osteochondral lesions and insufficient available cartilage material.</p><p><strong>Surgical technique: </strong>After diagnostic arthroscopy to detect possible concomitant pathologies and to exclude already corresponding cartilage lesions, the arthroscope is flipped posterolaterally over the high posterolateral portal and a second portal is created under visualization via the soft spot. Initially, debridement of the focal cartilage defect, assessment of the marginal zone, and/or salvage of free joint bodies. Using a smooth shaver and the filter provided, the partially or even completely detached cartilage fragment is unidirectionally fragmented under continuous suction. The remaining defect with a stable marginal zone is cleanly curetted, and the joint is completely dried. The fragmented cartilage collected in the filter is bonded to a membrane using autologous conditioned plasma (ACP) and then arthroscopically applied to the defect via a cannula, sealed using thrombin and fibrin.</p><p><strong>Postoperative management: </strong>Postoperative immobilization in a cast for at least 24 h is required. Afterwards, free exercise of the joint is possible, but no loading should be maintained for 6 weeks. Return to sport after 3 months.</p><p><strong>Results: </strong>Good to very good clinical and MRI morphologic results are already evident in the short-term course. 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[Autologous minced cartilage implantation for focal cartilage lesions of the humeral capitellum].
Objective: The goal of minced cartilage implantation (MCI) is to restore an intact cartilage surface in focal osteochondral lesions of the humeral capitellum.
Indications: The indications for MCI are limited osteochondral lesions at the humeral capitellum, also at the head of the radius, with intact cartilage border as well as in situ or a completely detached fragment, and free joint bodies (grade II-grade V according to Hefti).
Contraindications: Contraindications for MCI are already concomitant or associated cartilage damage as well as bilateral osteochondral lesions and insufficient available cartilage material.
Surgical technique: After diagnostic arthroscopy to detect possible concomitant pathologies and to exclude already corresponding cartilage lesions, the arthroscope is flipped posterolaterally over the high posterolateral portal and a second portal is created under visualization via the soft spot. Initially, debridement of the focal cartilage defect, assessment of the marginal zone, and/or salvage of free joint bodies. Using a smooth shaver and the filter provided, the partially or even completely detached cartilage fragment is unidirectionally fragmented under continuous suction. The remaining defect with a stable marginal zone is cleanly curetted, and the joint is completely dried. The fragmented cartilage collected in the filter is bonded to a membrane using autologous conditioned plasma (ACP) and then arthroscopically applied to the defect via a cannula, sealed using thrombin and fibrin.
Postoperative management: Postoperative immobilization in a cast for at least 24 h is required. Afterwards, free exercise of the joint is possible, but no loading should be maintained for 6 weeks. Return to sport after 3 months.
Results: Good to very good clinical and MRI morphologic results are already evident in the short-term course. Prospective and retrospective multicenter studies are needed to evaluate future long-term results.
期刊介绍：
Orthopedics and Traumatology is directed toward all orthopedic surgeons, trauma-tologists, hand surgeons, specialists in sports injuries, orthopedics and rheumatology as well as gene-al surgeons who require access to reliable information on current operative methods to ensure the quality of patient advice, preoperative planning, and postoperative care.
The journal presents established and new operative procedures in uniformly structured and extensively illustrated contributions. All aspects are presented step-by-step from indications, contraindications, patient education, and preparation of the operation right through to postoperative care. The advantages and disadvantages, possible complications, deficiencies and risks of the methods as well as significant results with their evaluation criteria are discussed. To allow the reader to assess the outcome, results are detailed and based on internationally recognized scoring systems.
Orthopedics and Traumatology facilitates effective advancement and further education for all those active in both special and conservative fields of orthopedics, traumatology, and general surgery, offers sup-port for therapeutic decision-making, and provides – more than 30 years after its first publication – constantly expanding and up-to-date teaching on operative techniques.
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