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Using the Nose to Repair the Knee?

Harvesting of the chondrocytes involved a Killian incision in the septum under local anesthesia and obtaining autologous cartilage of 6-mm diameter. In addition, 72 ml of blood was obtained for preparation of serum.

The chondrocytes were then cultured for 2 weeks in serum, fibroblast growth factor 2, and transforming growth factor beta 1, and the expanded chondrocytes were then cultured onto a collagen membrane.

The procedure itself was a mini-arthrotomy, during which the area of the defect was debrided to expose the subchondral bone. After being trimmed to fit the defect, the graft was placed with the cell layer facing the subchondral bone and secured by sutures and fibrin glue. Patients were required to immobilize the joint in extension for the subsequent 2 weeks.

Follow-up involved MRI assessment of the tissue at 6 and 24 months. The composition of the repaired tissue, reflecting the glycosaminoglycan content, was determined with delayed gadolinium-enhanced MRI, with a relative change in relaxation rate (DeltaR1) less than 1 representing a high glycosaminoglycan content, a change more than 1 being a lower glycosaminoglycan content, and 1 being considered normal.

Patients also were asked to assess their knee function on the International Knee Documentation Committee form and on the five subscales of the Knee Injury and Osteoarthritis Outcome Score, which rate pain, function, and quality of life.

At the time of the report, nine of the patients had 24 months of follow-up, and one was excluded from the analysis because of additional injuries requiring multiple surgeries. In two patients, the treatment consisted of two separate cartilage defects.

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