Fresh Osteochondral Patellar Allograft Resurfacing

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Presentation transcript:

Fresh Osteochondral Patellar Allograft Resurfacing Pablo E. Gelber, M.D., Ph.D., Simone Perelli, M.D., Maximiliano Ibañez, M.D., Eduard Ramírez-Bermejo, M.D., Oscar Fariñas, M.D., Juan C. Monllau, M.D., Ph.D., Vicente Sanchis-Alfonso, M.D., Ph.D. Arthroscopy Techniques Volume 7, Issue 6, Pages e617-e622 (June 2018) DOI: 10.1016/j.eats.2018.04.001 Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 1 Right knee. A standard short medial parapatellar approach is preferably used. The knee is maintained at around 45° of knee flexion. Arthroscopy Techniques 2018 7, e617-e622DOI: (10.1016/j.eats.2018.04.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 2 Right knee. Circumferential denervation of the patella is being performed to decrease postoperative anterior knee pain. Arthroscopy Techniques 2018 7, e617-e622DOI: (10.1016/j.eats.2018.04.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 3 Right knee. Six to eight millimeters of the subchondral bone is removed with the help of a standard patellar guide. Arthroscopy Techniques 2018 7, e617-e622DOI: (10.1016/j.eats.2018.04.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

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. Arthroscopy Techniques 2018 7, e617-e622DOI: (10.1016/j.eats.2018.04.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

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. Arthroscopy Techniques 2018 7, e617-e622DOI: (10.1016/j.eats.2018.04.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

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. Arthroscopy Techniques 2018 7, e617-e622DOI: (10.1016/j.eats.2018.04.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

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. Arthroscopy Techniques 2018 7, e617-e622DOI: (10.1016/j.eats.2018.04.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

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. Arthroscopy Techniques 2018 7, e617-e622DOI: (10.1016/j.eats.2018.04.001) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions