For 20 years, the cultures of cartilage cells have been giving an important hope in the reconstruction by autografts of the cartilage defects. However, the impossibility until recently to obtain a real cartilaginous tissue did not allow a real graft. The development over 15 years, by the company Bio-Tissue in Freiburg (D) and Dr. Erggelet, has allowed the realization, from an autologous culture, of a real RESISTENT cartilaginous tissue, allowing a real implantation with fixation of the cartilaginous defects. We have been practicing this technique for 18 months and have now the experience of 10 cases. The technique consists in taking, under arthroscopy, from the external trochleocondylar junction, 6 to 8 small “rice grains” of cartilage and in cultivating them for 3 to 4 weeks, which allows to obtain 12 cm2 of graft; more important surfaces are obtained if necessary by extending the culture (18, 24, 30 cm2, etc…). Technically, the not very important defects can be performed under arthroscopy, but as soon as the extent is important we prefer an open-air approach. The intervention begins with the preparation of the sick zone, removing the remainders of damaged cartilage until the subchondral bone with a special sharp curet, realizing rectilinear edges. A “tracing” of the prepared zone is realized, allowing the precise cut-out of the graft; after testing, the graft is fixed by its 4 corners with Dexon passed through the transosseous tunnels, by special pins, blocked by a series of transosseous knots, flattening the graft against the subchondral bone. The technique is relatively simple and quick (pictures). Post-operatively, support is suppressed for 1 month, and the flexion is immediatley started on an electric splint in order to avoid adhesions. Careful walking with support is restarted after one month. Swimming is advised after the 6th week. An MRI control is performed after 3 months and after 6 months, which has always allowed us to visualized well the graft, its good thickness, the continuity with the healthy cartilage and its good adaptation to the subchondral bone. Sport can be restarted after 8 months, as well as carrying charges and physical activities. A biopsy performed 7 months after the implantation, has allowed us to verify that the graft had developed well into HYALIN cartilage (picture). The clinical results are satisfying with the hindsight that we have, which seems to corroborate the results of the longer series of Erggelet. This technique, real BIOSURGERY, is particularly satisfying and if the good results are confirmed in the long-term, it will be a real revolution in orthopedic surgery, all the more since its application to other joints than the knee is possible.
