Table 1.

Pearls and Pitfalls of Dry Arthroscopic WJ-MSC–Embedded Scaffold Cartilage Repair

Pearls

Complete visualization of the cartilage lesion and access of instrumentation to the entire defect periphery are necessary for proper lesion preparation.

The surgeon should ensure cartilage defect preparation achieves perpendicularity of the cartilage walls about the lesion and prepare the base of the defect by removing the calcified cartilage layer.

The long axis of the compacted collagen layer of the bilayer type I/III collagen scaffold should be marked to ensure the porous collagen layer is positioned facing the subchondral plate and in the correct orientation at the time of graft implantation.

Obliquely oriented access to the lesion from the working portal is recommended for ease of graft implantation.

During dry arthroscopy, minor fogging of the lens can be addressed by touching the camera to fatty tissue; when there is extensive fogging, a swab can be introduced from the working portal to clean the lens.

Pitfalls

When there is inadequate arthroscopic access to the entirety of the cartilage lesion (or lesions), additional retraction plates may be introduced or a mini-open surgical approach should be performed.

The surgeon should avoid excessive handling and manipulation of the WJ-MSC–embedded scaffold to maximize cell viability at the time of graft implantation.

Security of graft fixation should be confirmed with direct arthroscopic visualization to minimize the risk of graft delamination in the early postoperative period.

WJ-MSC, Wharton's jelly–derived mesenchymal stem cell.