High tibial osteotomy combined with cancellous bone graft and osteochondral autograft transplantation in a patient with massive osteochondral defects in the medial femoral condyle

Abstract

Treatment of massive osteochondral defects of the medial femoral condyle is challenging. A 46-year-old man who had a medial femoral condyle fracture on his left knee underwent osteosynthesis in a hospital, but the pain remained and the patient was referred to our hospital 8 months after the surgery. Radiographs showed a varus alignment of the leg, and magnetic resonance image showed a massive necrotic area in the medial femoral condyle. The patient received high tibial osteotomy (HTO) combined with iliac cancellous bone graft and an osteochondral autograft transplantation. Pain and the knee function markedly improved 2 years after the surgery. A second look arthroscopy showed a well-covered bone graft site with cartilaginous tissue and a well-integrated osteochondral plug. HTO combined with cancellous bone autograft and osteochondral autograft transplantation could be an effective treatment for patients presenting with a varus knee deformity associated with massive osteochondral defects in the medial femoral condyle.

Role of High Tibial Osteotomy in Cartilage Regeneration – Is Correction of Malalignment Mandatory for Success?

“…In 2017, Matsushita et al . 55 reported on a single case (aged 46 years) with osteonecrosis of the medial femoral condyle with a varus deformity and chondral lesion following trauma, in which an MOWHTO was performed with OATS. Second-look arthroscopy at 2 years showed complete coverage of the chondral lesion with regenerated cartilage and a well-integrated osteochondral plug, with an area of fibrillation.…”

Successful treatment of avascular necrosis of the distal femoral condyle with osteochondral autograft in an HIV positive woman: A case report

“…We, therefore, considered all alternative treatments for late-stage osteonecrosis in both hip and knee joints. On the basis of limited previous experience, but utilizing experience of osteochondral allografting and autografting (Ahmad und Jones, 2016; Fitzpatrick und Morgan, 1998; Matsushita et al, 2017; Weinrauch et al, 2013) [1,6,14,27] , we felt knee Joint reconstruction using an osteochondral autograft represented a promising alternative to arthroplasty in a young patient such as ours, in the presence of multiple joint osteonecroses. Autogenous osteochondral grafts can significantly decrease further surgical treatment in pre-and post-collapse AVN of the knee (Lieberman et al, 2014) [13] .…”