This lecture is on matrix-induced autologous chondrocyte implantation. I'm Theodore Ganley from the Children's Hospital of Philadelphia. My disclosures are on the website. We'll start with a case, 15-year-old Catcher. She fell and hit her knee. Her past medical history is significant for right knee pain and swelling for a period of one year. She went to an urgent care center, had radiographs, neumobilizer, an MRI, and followed up in the office, plain radiographs and MR shown here. Patient had a defect between 2 1⁄2 and 3 centimeters in size. Our goals and objectives are to discuss matrix-induced autologous chondrocyte implantation. As a brief introduction, we showed a lesion at the lateral aspect medial femoral condyle, which is the most common location. Osteongravis descans literally means bone cartilage dissection or separation. Catabaric studies have shown that there's a watershed area in terms of blood supply, which is more tenuous. This is an arthroscopic photo. Perhaps chronic repetitive microtrauma helps lead to a focal area of ischemia to predispose to this condition. We have algorithms or treatment for intact, intact but marginated, and not intact lesions. We're describing here a hefty stage 5 completely detached lesion. Also described in our radiographic feature reliability study as fully displaced. In our arthroscopic feature classification, this is a crater, which is detached and unsalvageable. There are certainly options for large lesions. We'll be discussing matrix-induced chondrocyte implantation, and I'll discuss bone grafting here as well. Stage 1 arthroscopy will confirm the OCD lesion as unsalvageable, remove fragments, smooth edges, harvest cartilage biopsy from either the lateral trochlea or the notch, and send the biopsy, which will be grown 10,000-fold. A knee positioner will be used to maintain knee flexion when an arthrotomy is performed. We'll prepare the OCD lesion by removing unhealthy cartilage, bone, and fibrous tissue. For lesions over 5 millimeters in depth, we'll harvest autologous cancellous bone. We'll like to do that from the ipsilateral tibia, distal to the intermedial joint line. We'll drill the parent bone with a 6-2K wire and rethread absorbable anchors with 5-0 absorbable sutures, which will be placed circumferentially in the parent bone, 1-2 millimeters deep to the cartilage-bone interface. Bone graft is then tamped into the defect. A porcine-derived collagen cover is then cut. It's secured over the bone graft with the sutures described. We'll place fibrin sealant deep to the membrane at the periphery to separate marrow and bleeding from the implanted chondrocytes. Previously ACI, now matrix-induced autologous chondrocyte implantation is then performed in the usual manner. If a lesion is uncontained in regions such as the adjacent notch, it may require anchors and suturing. Case of ACI is shown on the left, where anchors are placed, or sutures I should say, are placed at every hour on the face of a clock. This collagen-derived sponge is secured with fibrin sealant. Certainly if they're uncontained areas, suture can be used as well. In terms of post-operative management, crutches are used for six weeks. At three months, elliptical trainer or stationary bike is used. Return to jogging, running, and contact sports can be between 9 and 12 months, depending on the location and size of the lesion. In terms of pearls and pitfalls, we advocate for avoid building a house on a bad foundation and treating unsalvageable OCD lesions with Macy and use bone graft when the bone involvement is over 5 millimeters. We always advocate addressing the principles to address alignment. For intact lesions with wide-open physes, guided growth is used. Full thickness defects with closed physes, acute osteotomies are performed. Hopefully we've addressed all of our goals and objectives. Thank you for your time. Look forward to interacting with the course. This lecture is on matrix-induced autologous chondrocyte implantation. I'm Theodore Ganley from the Children's Hospital of Philadelphia.

matrix-induced autologous chondrocyte implantation

ACI

knee injury

osteochondritis dissecans

surgical procedure