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Abstract Presented at the 26th Annual Meeting of the Arthroscopy Association of North America| Volume 23, ISSUE 6, SUPPLEMENT , e22, June 2007

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Arthroscopic Autologous Chondrocyte Implantation: Three New Unique Arthroscopic Techniques Utilizing New Instrumentation (SS-44)

      Summary

      Utilizing newly developed instrumentation autologous chondrocyte implantation can be performed arthroscopically. Arthroscopic MACI can be implanted in sites where suturing of a periosteal flap is difficult or even impossible. An arthroscopic MACI technique can be an effective treatment for large chondral defects with minimally invasive arthroscopic technique as an outpatient procedure.

      Abstract

      Three new arthroscopic techniques of Autologous Chondrocyte Implantation have been developed. Autologous chondrocyte implantation (ACI) has yielded good to excellent results in greater than 77% of the cases of deep chondral lesions. As a periostal flap must be harvested, sutured in place, and cultred chondrocytes injected underneath the flap, a wide arthrotomy incision is often necessary. Until recently arthroscopic ACI implantation has been difficult or impossible. Matrix/Membrane Autologous Chondrocyte Implantation (MACI) is a new biotechnology allowing the impregnation of autologous cultured chondrocytes onto a bilayer, bioabsorbable, purified porcine collagen I/III membrane. The MACI implant is fixed in place with fibrin glue and can be performed arthroscopically.
      New arthroscopic techniques have been developed for MACI implantation. Utilizing specially designed cannulas, the defect is prepared with curettes, templated with a newly designed arthroscopic caliper, and glued in place. Articulated instruments have been developed to insure proper seating of the MACI graft. Another arthroscopic technique utilizing mini suture anchors and a modified arthroscopic cannula allow for the MACI implant to be guided into place by the sutures and then fixed inplace with fibrin glue. Histological sutdies show a hyaline-like cartilage with immature chondrocytes. MRI show progressive loss of subchondral edema. Patients report better than 70% good to excellent results (in spite of very large chondral lesions).

      Conclusions

      Arthroscopic MACI can be implanted in sites where suturing of a periosteal flap is difficult or even impossible. An arthroscopic MACI technique can be an effective treatment for large chondral defects with minimally invasive arthroscopic technique as an outpatient procedure.