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Knee pain patient, procedures and results 01

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A 24-year-old male patient presented with knee pain during physical activity. X-rays and MRI revealed an osteochondral defect (OCD) in the lateral femoral condyle. The patient underwent an arthroscopic osteochondral allograft transplantation (OATS) procedure using a 20mm bone allograft to repair the defect. Post-operatively, the patient will undergo rehabilitation and be restricted from sports for at least 3 months, with follow-up x-rays and MRI scheduled to assess healing.

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Patient case 01 Summary 14.11.2017 Gleb Gavrilkin, Orthopaedics & Trauma OYS
? Male, 24 years old ? Normal physiological alignment in leg ? Physiological femoral and tibial torsions ? Active sports activity ? BMI 22 ? Knee pain with physical activity ? Hydrops, swelling ? CRP, Leuk level normal
? X-rays: ? Lateral femoral condyle¨s large osteochondral defect ? Sagital x-rays: anteriorly 1.5cm bone fragment ? Secundar OA in lateral femoral condyle, osteophytes ? OCD?
? MRI: ? 2.3 x 1.6 mm OCD bone fragment anteriorly in Hoffa ? 2.4 x 2.2 OCD defect in lateral condyle ? ACL, PCL, MCL, LCL, menisci normal
? MRI axial: ? 20 x 30 mm defect in lateral condyle
? Lateral parapatellar arthrotomy ? Arthrex Mega-OATS instrumentation ? 20mm - bone allograft ? FOCA (fresh osteochondral allograft) technique ? Tapping fixation, no need for extra fixation devices
? Postop X-rays
? Active range of motion ? Full weight bearing ? Quadriceps rehab ? No sport activity at least 3 months ? Follow up with x-rays in 3 months ? Follow up with MRI in 6-12 month (to achive remodeling of the graft bone by the host bone)
? Focal osteochondral defects of the knee in young, active patients can be a debilitating condition posing a complex treatment challenge. Due to their young age and high demands in their activity level, arthroplasty or arthrodesis surgery are not generally regarded reasonable solutions. ? For posttraumatic osteochondral defects, more biologic options to date have included realignment osteotomy, microfracturing, mosaicplasty, periosteal grafts, autologous chondrocyte transplantation, and osteochondral allograft transplantation. ? These procedures offer a biologic solution rather than an arti?cial bearing surface replacement with its inherent risks of early loosening and loss of bone stock for future surgeries.

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Knee pain patient, procedures and results 01

  • 1. Patient case 01 Summary 14.11.2017 Gleb Gavrilkin, Orthopaedics & Trauma OYS
  • 2. ? Male, 24 years old ? Normal physiological alignment in leg ? Physiological femoral and tibial torsions ? Active sports activity ? BMI 22 ? Knee pain with physical activity ? Hydrops, swelling ? CRP, Leuk level normal
  • 3. ? X-rays: ? Lateral femoral condyle¨s large osteochondral defect ? Sagital x-rays: anteriorly 1.5cm bone fragment ? Secundar OA in lateral femoral condyle, osteophytes ? OCD?
  • 4. ? MRI: ? 2.3 x 1.6 mm OCD bone fragment anteriorly in Hoffa ? 2.4 x 2.2 OCD defect in lateral condyle ? ACL, PCL, MCL, LCL, menisci normal
  • 5. ? MRI axial: ? 20 x 30 mm defect in lateral condyle
  • 6. ? Lateral parapatellar arthrotomy ? Arthrex Mega-OATS instrumentation ? 20mm - bone allograft ? FOCA (fresh osteochondral allograft) technique ? Tapping fixation, no need for extra fixation devices
  • 8. ? Active range of motion ? Full weight bearing ? Quadriceps rehab ? No sport activity at least 3 months ? Follow up with x-rays in 3 months ? Follow up with MRI in 6-12 month (to achive remodeling of the graft bone by the host bone)
  • 9. ? Focal osteochondral defects of the knee in young, active patients can be a debilitating condition posing a complex treatment challenge. Due to their young age and high demands in their activity level, arthroplasty or arthrodesis surgery are not generally regarded reasonable solutions. ? For posttraumatic osteochondral defects, more biologic options to date have included realignment osteotomy, microfracturing, mosaicplasty, periosteal grafts, autologous chondrocyte transplantation, and osteochondral allograft transplantation. ? These procedures offer a biologic solution rather than an arti?cial bearing surface replacement with its inherent risks of early loosening and loss of bone stock for future surgeries.