Figs. 11-A, 11-B, and 11-C Suturing techniques for large femoral condylar defects. (Reproduced, with permission of Elsevier, from: Minas T. A primer in cartilage repair and joint preservation of the knee. Expert consult. Philadelphia: Elsevier Saunders; 2011.).

Fig. 11-A.

The suture is placed through the membrane and then the cartilage to obtain good purchase of both tissues. The knot is tied on the side of the membrane to evert the membrane flush to the cartilage side wall and make it watertight, acting like a washer.

Fig. 11-B.

For femoral condylar defects that are long in an anterior-to-posterior direction, it is important for the suturing technique to maintain a uniform cavity throughout the length of the defect. If medial-to-lateral suturing is not performed through the length of the defect from anterior to posterior, the membrane may bottom out on the center aspect of the length of the curve. This site is more likely to undergo premature breakdown.

Fig. 11-C.

If the collagen membrane is oversized in the anterior-to-posterior direction, suturing is started at the center of the defect in a medial-to-lateral direction, and then anterior to posterior. The chamber cavity will maintain a uniform depth and will more likely undergo full, even cartilage filling for the length of the defect.