title: Comparison of Collagen Graft Fixation Methods in the Porcine Knee: Implications for Matrix-Assisted Chondrocyte Implantation and Second-Generation Autologous Chondrocyte Implantation.
abstract: To evaluate the fixation integrity at time zero of a type I/III collagen patch secured to a chondral defect in the porcine knee using methods typically employed in autologous chondrocyte implantation (ACI) and matrix-assisted chondrocyte implantation.
  
  
  
  Twenty-four porcine knee specimens underwent a medial parapatellar arthrotomy. A prefabricated template was used to create cartilage defects of 2 cm(2) in the medial femoral condyle. A size-matched collagen patch was fashioned. Four methods of fixation to the chondral defect were analyzed: group 1-saline, group 2-fibrin glue around the periphery of the patch, group 3-fibrin glue applied to the base of the defect and around the periphery of the patch, group 4-6-0 vicryl suture and fibrin glue around the periphery of the patch. Collagen patch fixation was assessed at intervals of 60, 300, 600, 900, and 1,200 cycles from full extension to 90° of flexion, performed manually without application of axial force. Patch fixation was evaluated by 2 independent observers using a customized scoring scale.
  
  
  
  Mean peripheral detachment of the patch and chondral defect uncovering remained less than 25% for all groups. Area of defect uncovering was significantly increased in group 2 compared with group 4 after 900 and 1,200 cycles (P = .0014 and P = .0025, respectively). Fibrin glue applied to the base of the defect, or suturing of the patch, reduced deformation significantly after 900 cycles.
  
  
  
  Suture increases the stability of fixation of a type I/III collagen patch to a chondral defect better than fibrin glue alone in the porcine knee after repetitive cycling, with respect to patch detachment and chondral defect uncovering. Application of fibrin glue to the base of the defect, or securing the patch with suture, decreases collagen patch deformation.
  
  
  
  In cases where minimally invasive techniques do not allow suture fixation of the collagen patch, scaffold fixation may be compromised during articular motion protocols typically used after second- and third-generation ACI procedures.
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, U.S.A.. Electronic address: gphwhyte@gmail.com.
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Whyte
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, U.S.A.
authors.forename: Alan
authors.initials: A
authors.lastname: McGee
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, U.S.A.
authors.forename: Laith
authors.initials: L
authors.lastname: Jazrawi
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, U.S.A.
authors.forename: Robert
authors.initials: R
authors.lastname: Meislin
mesh_terms: D000818:Animals; D003094:Collagen; D015718:Fibrin Tissue Adhesive; D023421:Models, Animal; D013264:Stifle / Q000601:surgery*; D013537:Sutures; D013552:Swine; D014014:Tissue Adhesives; D054457:Tissue Scaffolds
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D003094:Collagen