Use of an autogenous cancellous bone graft in the treatment of subchondral bone cysts in the medial femoral condyle of the horse

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.

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The Effect of Compacted Cancellous Bone Grafting on the Healing of Subchondral Bone Defects of the Medial Femoral Condyle in Horses

Veterinary Surgery ◽

10.1111/j.1532-950x.2000.00008.x ◽

2000 ◽

Vol 29 (1) ◽

pp. 8-16 ◽

Cited By ~ 39

Author(s):

W.A. Jackson ◽

J.A. Stick ◽

Arnoczky S.P. ◽

F.A. Nickels

Keyword(s):

Subchondral Bone ◽

Cancellous Bone ◽

Bone Grafting ◽

Femoral Condyle ◽

Bone Defects ◽

Medial Femoral Condyle ◽

Cancellous Bone Grafting

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Impact of Size and Shape of Equine Femoral Subchondral Bone Cysts With a Transcondylar Screw on Predicted Bone Formation Area in a Finite Element Model

Journal of Biomechanical Engineering ◽

10.1115/1.4045892 ◽

2020 ◽

Vol 142 (6) ◽

Cited By ~ 1

Author(s):

Lance L. Frazer ◽

Elizabeth M. Santschi ◽

Scott J. Ring ◽

Ross E. Hewitt ◽

Kenneth J. Fischer

Keyword(s):

Finite Element ◽

Bone Formation ◽

Subchondral Bone ◽

Femoral Condyle ◽

Element Model ◽

Bone Cysts ◽

Bone Apposition ◽

Element Analysis ◽

Subchondral Bone Cysts ◽

Secondary Injuries

Abstract Equine subchondral bone cysts (SBCs) develop most often in the medial femoral condyle (MFC) of yearlings intended for performance. SBCs often cause lameness and can cause secondary injuries to the meniscus and tibial cartilage. A novel surgical technique using a transcondylar lag screw (TLS) across an MFC SBC has shown success in lameness resolution and radiographic healing of MFC SBC. In a previous study using finite element analysis, our lab showed that a TLS stimulated bone formation on the inner surface of the SBC and altered third principal stress vectors to change the direction of surface compression to align with the screw axis. This work extended the previous study, which was limited by the use of only one idealized SBC. Our objective was to test SBCs of several sizes and shapes in a newly developed equine stifle FEM with a TLS to determine how cyst size affects bone formation stimulation. This study found that a transcondylar screw is most effective in stimulating bone formation in cysts of greater height (proximal-distal). The TLS increases stress stimulus in the bone around the cyst to promote bone apposition and directs compression across the cyst. If full penetration of the screw through the cyst is possible, it is recommended that the transcondylar screw be used to treat subchondral bone cysts. For the treatment of smaller cysts that are not accessible by the current screw surgical approach, future work could study the efficacy of a dual-pitch headless screw that may reach smaller cysts.

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Knee subchondroplasty for management of subchondral bone cysts: a novel treatment method

Singapore Medical Journal ◽

10.11622/smedj.2021145 ◽

2021 ◽

Vol 62 (9) ◽

pp. 492-496

Author(s):

GJ Zeng ◽

FS Foong ◽

DTT Lie

Keyword(s):

Subchondral Bone ◽

Femoral Condyle ◽

Weight Bearing ◽

Bone Allograft ◽

Treatment Method ◽

Bone Cysts ◽

Synthetic Bone Substitute ◽

Good Pain Relief ◽

Subchondral Bone Cysts ◽

Minimally Invasive Methods

Knee subchondroplasty (SCP) is one of the most novel minimally invasive methods for treating bone marrow lesions. The literature suggests that it is safe, with few complications and good outcomes. However, no studies have documented its usage for managing large subchondral bone cysts. This article outlines a case report and details the pearls and pitfalls of SCP in treating large subchondral bone cysts. Our patient underwent arthroscopic debridement with medial femoral condyle SCP. Mild posterior extravasation of synthetic bone substitute was observed on Postoperative Day 1, which was immediately rectified on revision arthroscopy. Gradual escalation of weight bearing and good pain relief were subsequently achieved, and the patient has remained complication-free after two years. No further extravasation were observed on repeat radiography. SCP is a feasible temporising measure that may help to delay the need for bone allograft or immediate knee arthroplasty in younger patients while retaining function and delaying loss of productivity.

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Arthrodesis of the Distal Two Tarsal Joints in the Horse Using Perforated Stainless Steel Cylinders and Cancellous Bone Graft

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633245 ◽

1991 ◽

Vol 4 (01) ◽

pp. 21-27 ◽

Cited By ~ 2

Author(s):

R. M. Archer ◽

R. K. Schneider

Keyword(s):

Stainless Steel ◽

Bone Graft ◽

Cancellous Bone ◽

Cancellous Bone Graft ◽

The Third ◽

Partial Fusion

SummaryTwo perforated stainless steel cylinders and autogenous cancellous bone were implanted into each of the distal intertarsal and tarsometatarsal joints of seven horses. In two control horses holes were drilled into each joint and autogenous cancellous bone was implanted without stainless steel cylinders. Horses which had cylinders implanted in the distal tarsal joints exhibited less lameness and were more comfortable following surgery than were the control horses. Fracture of the third tarsal, central tarsal, or third metatarsal occurred in five of the seven horses implanted with stainless steel cylinders within 45 days of surgery. Two implanted horses and two control horses were observed for five months after surgery. Partial fusion of the distal tarsal joints occurred in all four horses. Control horses were more lame than the implanted horses and developed a large bony exostosis over the medial distal tarsus.

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