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Chapter 42 Video 1: Autologous Chondrocyte Implantation

January 23, 2017

Contributors: Jack Farr II, MD

The medial femoral condyle is approached through a medial parapatellar arthrotomy. Care is taken not to harm the medial meniscus or articular surfaces. Retractors are placed, and the knee flexed to view the defect. A fifteen blade is used to create vertical walls, and a curette clears the base. At this point, the defect is measured, the tourniquet is deflated, fibrin glue is applied, and digital pressure is maintained to achieve hemostasis. The measurements are transferred to a template. The template is cut to fit the exact dimensions of the defect, and is marked for orientation. The collagen (1, 3) patch has been hydrated; there is a rough surface and a smooth surface. The smooth surface is labeled with “UP.” The template is then transferred to the hydrated collagen (1, 3) patch, and the patch cut to fit. Maintenance of adequate hydration is necessary. Cells are resuspended, and in this case, they will be seeded on the rough surface of the collagen (1, 3) patch. After ten minutes, the cells will be adherent. During that time, they are protected. Hemostasis has now been achieved and reconfirmed. The seeded patch is then placed into the defect with the rough seeded area facing bone. Any extraneous patch is removed, and then the patch is sutured into place with 6.0 absorbable suture. Sutures are placed at 3-4mm intervals, and then are further sealed with fibrin glue. A second vial of cells is injected, and the injection site is then sutured and further sealed with fibrin glue. After approximately 10 minutes, the area is irrigated, and the incision closed in layers.

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