Knee

• Lesion preparation should be performed with a tourniquet to limit bleeding
• The knee joint is opened using a standard minimal invasive anterior approach aimed at the lesion site
• After joint inspection, the chondral or osteochondral lesion is carefully debrided removing unstable cartilage using a curette and/or spoon and/or a motorized abrader, until a stable shoulder surrounds the defect and a well-contained defect is achieved

• Defect size can be assessed by a sterile template (eg. with the aluminum of the suture); the imprint can be cut and transferred onto the HYALOFAST pad
• HYALOFAST can be cut with sterile scissors or scalpel to fit the lesion shape

Note: cutting dry HYALOFAST is easier than when it is wet from containing fluid

• If you would like to use HYALOFAST + microfracture/nanofracture, perform microfracture according to the approved clinical practice or use nanofracture procedure according to the specific protocol
• If you would like to use HYALOFAST + bone marrow aspirate, the bone marrow aspirate should be first loaded onto the scaffold

• Gently apply the HYALOFAST patch that has been correctly sized on the lesion bed with sterile forceps

Note 1: It is important that the product be confined inside the lesion margins, not overlapping the adjacent cartilage.
Note 2: The pad can be applied on either side (there is no a specific direction of application of the product).

Thanks to its characteristic properties, HYALOFAST generally remains firmly in place after grafting and no fixation is required. However, related to the position or size of the lesion, it may be necessary to use additional fixing systems (fibrin glue and/or suture or pins):

• In the case of larger defects (>4 cm²) or defects without a well-defined shoulder, it is advisable, after HYALOFAST® application, to use fibrin glue only around the edges of the graft;
• Extensive lesions on the trochlea or patella may require Hyalofast® to be sutured and/or pinned in place

In case of Platelet Rich Plasma (PRP) use, the gel will also contribute to Hyalofast® immobilization to the lesion bed

Before and after tourniquet release, the joint is mobilized to ensure adherence and stability of the applied.

At the surgeon’s discretion an articular drainage and a compressive bandage may be applied for 24 hours post-implantation. Subsequent immobilization is recommended for 24 hours post-surgery, after which a postoperative rehabilitation program can be initiated.