On the Cover: Toward a complete knee repair: ACL reconstruction, high tibial osteotomy, gel-based autologous chondrocyte implantation, and cartilage biopsy site. A 47-year-old farmer was injured in a farm accident that caused a complete ACL tear, a complex medial meniscus tear, and a major chondral piece separating from the medial femoral condyle. On evaluation, it was found that he also had an existing varus deformity of the knee with a required correction angle of 10° using the Fujisawa method. The first stage of surgery involved partial meniscectomy, ACL reconstruction, and cartilage biopsy (4-mm OC cylinder, as per company guidelines). After 1 month, when the chondrocytes were ready for implantation, the second stage surgery was performed to correct the varus deformity with an open-wedge medial HTO and implantation of the cultured chondrocytes using gel-based autologous chondrocyte implantation technique. This was performed using two syringesdone with cells and the other with fibrin glue. The liquid solidifies in 5 to 7 minutes. This image reminds us that multiple simultaneous repairs are possible and may be demanded in the present time. See accompanying video at www.arthroscopyjournal.org. Courtesy of Deepak Goyal, M.B., M.S., and Binoy Palkhiwala, M.B., M.S.
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© 2013 Published by Elsevier Inc. All rights reserved.
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