课件：关节软骨损伤手术-wolfe教授.ppt

Treatment Recommendations High demand patient Small focal lesion (2cm) Debridement plus drilling / fx 75% success with all 50% success with sports Osteochondral grafting or chondrocyte transplant if failure Treatment Recommendations Low demand patient Large lesion (2cm) Debridement or microfracture with chondrocyte harvest If persistent pain - osteochondral or chondrocyte transplant Treatment Recommendations High demand patients Large lesion (2cm.) Chondrocyte transplant 1st line treatment yields 90% success Long HistoryNo Acute SymptomsVarus KneeMarked DJD Arthroscopic Results Unpredictable Little Improvement Conclusions Articular cartilage does not repair itself Numerous treatments with varying results Most treatments fail in the long term due to articular cartilage’s inability to produce hyaline cartilage Conclusions Osteochondral auto grafts and chondrocyte transplants show promising results Osteochondral auto grafts allow transplantation of bone capped with hyaline cartilage Autologous chondrocyte implantation allows near normal hyaline cartilage growth into defects Meniscal Allograft Indications Patient age - young - 20-40 Previous meniscectomy Painful compartment Minimal Arthritic Changes Correct alignment Stable knee Sterilization Viral contamination risk 1:1.6 million to 1:1.2 billion Radiation 2.5 mrads destroys collagen 2.5 mrads does not kill viruses Sterile harvest and storage with donor screening Meniscal Allograft Technique Bone anchors for anterior and posterior horns Plugs for medial meniscus Slot for lateral meniscus Increases the difficulty Meniscal Allograft Technique Open Easier Arthroscopic Less morbidity More technically demanding Collateral ligament release if necessary Increases exposure facilitates graft passage under condyles Allograft Meniscal Transplant Postoperative protocol Not completely elucidated Reflect meniscal repair protocols Most incorporate early full ROM Restricted weight bearing (6 weeks) CPM early in post operative