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. 2018 May 14;7(6):e617-e622.
doi: 10.1016/j.eats.2018.04.001. eCollection 2018 Jun.

Fresh Osteochondral Patellar Allograft Resurfacing

Pablo E Gelber  1   2 , Simone Perelli  2 , Maximiliano Ibañez  2 , Eduard Ramírez-Bermejo  1 , Oscar Fariñas  3 , Juan C Monllau  2   4 , Vicente Sanchis-Alfonso  5
Affiliations

Fresh Osteochondral Patellar Allograft Resurfacing

Pablo E Gelber et al. Arthrosc Tech. .

Abstract

The treatment of articular cartilage lesions in young patients is certainly a complex matter and subject of continuous research, particularly for those located at the patellofemoral joint, given its peculiar biomechanical characteristics. Osteochondral grafts can be of relatively small size when the defect is focal and in an area that allows good stability and consequently the graft's integration. In case of large or multifocal lesions, it is possible to consider an osteochondral transplantation of the entire articular surface of the patella. We present a simple and reproducible technique to perform a patellar fresh osteochondral allograft resurfacing attempting to reduce the symptoms and delay a prosthetic implant in young patients with advanced patellar chondral injuries.

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Figures

Fig 1
Fig 1
Right knee. A standard short medial parapatellar approach is preferably used. The knee is maintained at around 45° of knee flexion.
Fig 2
Fig 2
Right knee. Circumferential denervation of the patella is being performed to decrease postoperative anterior knee pain.
Fig 3
Fig 3
Right knee. Six to eight millimeters of the subchondral bone is removed with the help of a standard patellar guide.
Fig 4
Fig 4
The patellar graft is being prepared with the help of a standard patellar guide. The thickness of the fresh allograft should be between 8 mm and 12 mm.
Fig 5
Fig 5
Using a caliper, measure the thickness of the graft. The graft, together with the remaining host patella, must match the original patellar thickness.
Fig 6
Fig 6
The graft is generously washed with a high-pressure pulsate irrigation system with saline solution to decrease its immunogenicity. The graft is placed at the bottom of a long plastic recipient to help the washing procedure.
Fig 7
Fig 7
Right knee. The graft is temporally fixed with two 1.8-mm Kirschner wires positioned on the dorsal aspect of the patella (anterior to posterior) while taking care to avoid cartilage tissue perforation.
Fig 8
Fig 8
Right knee. An absorbable pin is being placed from the articular side in the medial aspect of a right patella. Four pins are usually used to reliably fix the graft.
See this image and copyright information in PMC

References

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