Knee Joint Cartilage Defects: Large Cartilage Defect Treatment

Knee Joint Cartilage Defects: Large Cartilage Defect Treatment

This cadaveric surgical video demonstrates a cartilage graft transplantation procedure used to treat a large cartilage defect in the knee. In this procedure, a cartilage graft is taken from a donor knee and placed over the area of the patient’s cartilage defect. Here, we see a left knee, with the inner side of the knee on the left side of the screen.

The surgeon has already made an incision along the front of the knee, which is bent to expose the surface of the inner end of the femur, or thigh bone. Here, the surgeon is pointing out a large cartilage defect. The surgeon first uses a metal sizing instrument to mark out the size of the cartilage defect. With the defect measured, the surgeon will turn their attention to the donor and harvest the new cartilage graft.

Here, we see the inner half of the bottom of a femur, covered in articular cartilage. The surgeon uses the same metal sizing instrument to mark out the size of the cartilage graft that will be needed to cover the cartilage defect. The surgeon will make sure that all edges lay completely flat to get the best shape and fit of the graft. Next, the surgeon positions a cutting device of the same size over the marked area, and a guide pin is inserted to hold it in place.

The cutting guide is then impacted to cut out a piece of cartilage from the femur. Then, a cutting guide of the same size is placed over the marked piece of cartilage. A saw is inserted into the side of the guide to remove the cartilage with attached bone. Here is the graft that was harvested from the donor. The surgeon uses a solution to clean the graft and then soaks the graft in a solution made from the patient’s own blood or blood components.

These blood products are rich in compounds that can help improve healing. Now that the graft is harvested, the surgeon will prepare the cartilage defect to receive the graft. The surgeon uses a positioning instrument over the cartilage defect and inserts 2 guide pins into the bottom of the femur. Then, an instrument called a scorer is placed over the guide pins and used to cut away damaged cartilage. A reamer is then placed over the guide pins to drill away bone.

Lastly, the surgeon uses a scraper to remove the remaining cartilage between the 2 drilled sections. To ensure the graft will fit properly, a dilator is tapped into the defect. If needed, any final adjustments can then be made. Before placing the final graft, small holes are made in the exposed bone. This helps stimulate the underlying bone marrow, which will help with healing. Finally, the surgeon positions the graft over the prepared area and taps it in place.