Cartilage Fragment Implantation

Published on 11/03/2015 by admin

Filed under Orthopaedics

Last modified 22/04/2025

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Chapter 11 Cartilage Fragment Implantation

Harvest and Collection of Cartilage Fragments

Cartilage can be harvested arthroscopically from healthy, low-weight-bearing areas (the lateral femoral trochlea, medial femoral trochlea, sulcus terminalis, or intercondylar notch). A minimum of 200 mg of tissue is required.

The CAIS disperser is prepared by placing the CAIS scaffold into the bottom of the disperser with the clear side of the cartridge ring facing up and the blue side facing down. The top tube is then assembled to the disperser base using alignment arrows and rotating clockwise to a hard stop. The disperser spring is then compressed by depressing the disperser cap until an audible click is heard (Fig. 11-2, A-E).

The CAIS harvester is prepared by loading the battery pack into the device. The fragment collector tube is inserted into the harvester and rotated clockwise to a hard stop (Fig. 11-3, A-E). Following attachment of surgical vacuum, the harvester is then inserted through the portal and placed with its tip near the cartilage harvest site (Fig. 11-4).

The outer sheath that covers the tip during portal insertion is removed, and the harvester blade tip is placed against the cartilage and the motor is started.

Full thickness cartilage is harvested down to the calcified layer. Cartilage is harvested until the flange of the yellow basket in the collector aligns with the black demarcation line on the tube, indicating a minimum harvest quantity of 200 mg has been collected.

The collector is then disconnected from the harvester by rotating it counterclockwise and pulling outward. The collector is placed into the disperser with its Luer fitting facing up. Fragments are dislodged from collector and transferred to the disperser using two saline flushes (60 cc each) and a small, blunt Kirschner wire.

The collector is then removed and the disperser connection is closed. The disperser is activated by compressing the plunger retaining ring. The cap springs upward to suspend the cartilage fragments in the saline solution. The fragments then settle because of gravity and disperse uniformly across the surface of the scaffold. The dispersion step is performed two times.

The scaffold is examined to confirm a uniform tissue fragment dispersion (Fig. 11-5, A-E, and Fig. 11-6). Provided the distribution of fragments is acceptable, the scaffold is removed from base of the disperser.

Fibrin sealant is applied over the fragments to hold them in place during preparation and implantation. The cartridge rings are then unsnapped, and the scaffold is placed in a safe location or specimen cup until templating is performed.