Focal inlay resurfacing for full-thickness chondral defects of the femoral medial condyle may delay the progression to varus deformity

Abstract

Introduction Full-thickness chondral defects at the knee joint predispose to the beginning of a degenerative process which final consequence is the compartment collapse and finally the deviation to varus, because the cartilage of the medial femoral condyle is the most frequently affected area. Likewise, people with these chondral defects are more likely to develop tricompartmental osteoarthritis, reason why early surgical management should be the treatment of choice. The aim of this study was to compare the pre-and post-operative lower limb alignment (mechanical axis), in cases of full-thickness chondral defects of the femoral medial condyle that have been managed by means of a prosthetic focal inlay resurfacing, at a minimum follow-up of five years. Methods A retrospective study of patients treated for chondral defects in the medial femoral condyle was performed. The inclusion criteria were patients who had undergone a focal inlay resurfacing and minimum follow-up of 5 years. Patients that required a concomitant valguizing tibial osteotomy were finally excluded. The follow-up analysis was performed by means of radiological examinations performed prior to surgery and at the last follow-up visit. The mean limb mechanical axis of the operated knees was calculated both pre-and post-operatively, and comparisons between these two settings were performed. Results Ten patients were included: eight men and two women. The mean age at the time of surgery was 55 (40-65) years. The mean follow-up was 9 years (range 5-15). The mean limb mechanical axis was 1.33 ± 4.16 in the pre-operative setting and 2.40 ± 5.50 in the post-operative setting (p = 0.441). ConclusionIn the setting of small to moderate size, unique femoral medial condyle full-thickness chondral lesions, filling the defect with an inlay prosthetic resurfacing may protect against the progression to varus deformity. Level of evidence Therapeutic case series, Level IV.

High degree of consensus amongst an expert panel regarding focal resurfacing of chondral and osteochondral lesions of the femur with mini-implants

“…2-20 (unanimous agreement in 14 of them), along with statement no.1 strive to provide clear guidelines to help the clinician regarding the use of mini-implants; hence, they are suggested to be consulted during the decision-making process. As supported in other reports, the panel agreed that patients between 40 1 3 and 60 years, with ICRS 3-4 cartilage lesions and no knee instability or signiicant axis deviation are good candidates for this procedure [8,9,18]; however in some instances, patients above or below this age range could beneit from this limited invasive procedure [19,29].…”

“…The rationale for using these implants as a primary or secondary treatment option for chondral and osteochondral lesions of the knee is still under debate, with some authors supporting delay of varus deformity [8] and others that osteoarthritis progression is not completely avoided with this technique [21]. Some clinical studies, and data from the Australian Knee Arthroplasty Registry, report a relatively high revision rate [1, 6, 18, 21].…”

Limited metal implant applications in cartilage lesions

“…Tibia tarafında kıkırdak lezyonu var ise, ilk olarak lezyonun tam ortasından çıkacak şekilde retrograd drilleme ardından hepsi içerde ön çapraz bağ cerrahi tekniğinde kullanılan oyucularla polietilen insertin oturacağı yer hazırlanıp polietilen insert sementle tibia kıkırdağıyla aynı seviyede olacak şekilde yerleştirilir. [14,15] Cerrahi teknikte en önemli konu, implantın sağlıklı kıkırdak yüzeyle aynı veya 1 mm altında kalacak şekilde yerleştirilmesidir.…”