Cartilage Surgery

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Starting in the periphery and progressing centrally, place multiple drill holes into the defect, penetrating the subchondral bone plate (Fig. 4A-7). The drill hole should be placed 3 to 4 mm apart, and convergence should be avoided (Fig. 4A-8). Confirm the presence of bleeding from drill holes. If applicable, the tourniquet should be released and water flow stopped (Fig. 4A-9). Drill holes that are not bleeding may need to be drilled deeper. 29 30 CARTILAGE SURGERY: An Operative Manual Arthroscopic drilling of small holes 3-4 mm apart FIGURE 4A-7 K-wire penetrating the subchondral bone plate of defect.

They may be of traumatic or hereditary origin (osteochondrosis dissecans). The original hyaline cartilage may as yet not be restored, so a permanent loss of the original cartilaginous surface is inevitable and responsible for premature arthritis and eventually destruction of the affected joint. However, a stable fibrous cartilage may develop from mesenchymal stem cells invading the defects from the underlying blood vessels, which will yield the patient pain free and slow down the process of joint destruction.

61 62 CARTILAGE SURGERY: An Operative Manual Tip: Leave a slightly oblique cut with a 1-mm step at one side, as this will allow the plug to bottom out early and will prevent overinsertion. Step 10 The plug is then delivered into the knee within the delivery device and pressfit into the defect, by pushing on the measuring tamp, either manually or by lightly tapping the plug with a mallet (Fig. 4D-14). To achieve a flush surface, either the tamp or the metal sizing rod can be used. Tip: If one edge of the plug is slightly proud, then a smaller metal sizing rod can be used as this can be manipulated to round off the surface prominence.

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