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

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668501
Author(s):  
Takehiko Matsushita ◽  
Shu Watanabe ◽  
Daisuke Araki ◽  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
...  
Keyword(s):  
Bone Graft ◽  
High Tibial Osteotomy ◽  
Cancellous Bone ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Tibial Osteotomy ◽  
Osteochondral Defects ◽  
Cancellous Bone Graft ◽  
Osteochondral Autograft ◽  
Osteochondral Autograft Transplantation

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.

scholarly journals Arthroscopic autologous osteochondral mosaicplasty for the treatment of subchondral cystic lesion in the medial femoral condyle in a horse

2000 ◽  
Vol 48 (3) ◽  
pp. 343-354 ◽  
Author(s):  
D. Girtler ◽  
G. Bodó ◽  
L. Hangody ◽  
Zsuzsa Szabó ◽  
Ch. Peham ◽  
...  
Keyword(s):  
Cystic Lesion ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Bone Cyst ◽  
Clinical Signs ◽  
Medial Femoral Condyle ◽  
Femoral Trochlea ◽  
Osteochondral Autograft ◽  
Osteochondral Autograft Transplantation ◽  
Successful Transplantation

An 11-year-old, Hungarian half-bred stallion was presented with a history of mixed left hindlimb lameness of 6 months duration. Subchondral bone cyst of the medial femoral condyle and injury of the medial meniscus were diagnosed. Osteochondral autograft transplantation (mosaic arthroplasty) was performed, taking grafts from the less weight-bearing medial border of the medial femoral trochlea of the affected limb, and transplanting them into the cyst during arthroscopy. The lameness was evaluated prior to and one year after the operation with a motion analysis system during treadmill exercise. Considerable improvement of the lameness and the clinical signs as well as successful transplantation of the grafts, and a new hard joint cartilage surface of the medial femoral condyle could be detected during follow-up arthroscopy. Osteochondral autograft transplantation seems to bee a possible alternative for treating subchondral cystic lesions of the medial femoral condyle in horses. A new technique for the surgical treatment of a subchondral cystic lesion of the medial femoral condyle in the horse is described.

Return to Sport Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation

2020 ◽  
Vol 48 (8) ◽  
pp. 1945-1952 ◽  
Author(s):  
Joseph N. Liu ◽  
Avinesh Agarwalla ◽  
David R. Christian ◽  
Grant H. Garcia ◽  
Michael L. Redondo ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Femoral Condyle ◽  
Varus Deformity ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Return To Sports ◽  
Tibial Osteotomy ◽  
Allograft Transplantation ◽  
Chondral Defects

Background: Young patients with symptomatic chondral defects in the medial compartment with varus malalignment may undergo opening wedge high tibial osteotomy (HTO) with concomitant osteochondral allograft transplantation (OCA) (HTO + OCA). Although patients have demonstrated favorable outcomes after HTO + OCA, limited information is available regarding return to sporting activities after this procedure. Purpose: To evaluate (1) the timeline to return to sports (RTS), (2) patient satisfaction, and (3) reasons for discontinuing sporting activity after HTO + OCA, and to identify predictive factors of RTS. Study Design: Case series; level of evidence, 4. Methods: Consecutive patients who underwent HTO + OCA for varus deformity and medial femoral condyle focal chondral defects with a minimum 2-year follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire, satisfaction questionnaire, visual analog scale for pain, and Single Assessment Numerical Evaluation. Results: Twenty-eight patients with a mean age of 36.97 ± 7.52 years were included at mean follow-up of 6.63 ± 4.06 years. Fourteen patients (50.0%) required reoperation during the follow-up period, with 3 (10.7%) undergoing knee arthroplasty. Twenty-four patients participated in sports within 3 years before surgery, with 19 patients (79.2%) able to return to at least 1 sport at a mean 11.41 ± 6.42 months postoperatively. However, only 41.7% (n = 10) were able to return to their preoperative level. The most common reasons for sports discontinuation (n = 20; 83.3%) were a desire to prevent further damage to the knee (70.0%), persistent pain (55.0%), persistent swelling (30.0%), and fear (25.0%). Conclusion: In young, active patients with varus deformity and focal medial femoral condyle chondral defects, HTO + OCA enabled 79.2% of patients to RTS by 11.41 ± 6.42 months postoperatively. However, only 41.7% of patients were able to return to their preinjury level or better. It is imperative that patients be appropriately educated to manage postoperative expectations regarding sports participation after HTO + OCA.

Comparison of Clinical Outcome following Cartilage Repair for Patients with Underlying Varus Deformity with or without Additional High Tibial Osteotomy: A Propensity Score–Matched Study Based on the German Cartilage Registry (KnorpelRegister DGOU)

Cartilage ◽  
2020 ◽  
pp. 194760352098234
Author(s):  
Svea Faber ◽  
Peter Angele ◽  
Johannes Zellner ◽  
Gerrit Bode ◽  
Alfred Hochrein ◽  
...  
Keyword(s):  
Propensity Score ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Femoral Condyle ◽  
Varus Deformity ◽  
Medial Femoral Condyle ◽  
Cartilage Defects ◽  
Tibial Osteotomy ◽  
Matched Study

Background Even though realignment procedures have gained popularity as concomitant techniques in cartilage repair approaches with underlying malalignment, the clinical efficacy has not been proven to full extent. Methods Out of 5474 patients from the German Cartilage Registry, 788 patients with focal cartilage defects on the medial femoral condyle having received either no accompanying surgery or high tibial osteotomy (HTO) were identified. After a 1:1 propensity score matching, outcome of 440 patients was evaluated using KOOS (Knee Injury and Osteoarthritis Outcome Score), VAS (visual analogue scale), and satisfaction during the 3-year follow-up. Results Patients having received a concomitant HTO had significantly higher postoperative KOOS values (12 months: 67.26 ± 15.69 vs.75.10 ± 16.12, P = 0.001; 24 months: 67.14 ± 23.85 vs. 77.11 ± 16.50, P = 0.010; 36 months: 74.40 ± 16.57 vs. 81.75 ± 14.22, P = 0.023) and lower pain levels (6 months: 3.43 ± 2.18 vs. 2.89 ± 2.15, P = 0.009; 12 months: 3.64 ± 2.20 vs. 2.17 ± 1.96, P < 0.001; 24 months: 4.20 ± 3.12 vs. 2.94 ± 2.45, P = 0.005; 36 months: 3.20 ± 2.18 vs. 2.02 ± 1.98, P = 0.003). One and 3 years postoperatively, concomitant HTO led to significantly higher satisfaction in patients. These advantages of accompanying HTO were also seen in the group of patients with a varus deformity of 5° or more, in which pain levels without concomitant HTO even increased during the 3-year follow-up. Conclusion The results of the present study underline the importance and safety of concomitant HTO in patients with cartilage defects and varus deformity. HTO should therefore be considered and recommended generously in patients with focal cartilage defects of the medial femoral condyle and varus deformity.

scholarly journals Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure

Cartilage ◽  
2017 ◽  
Vol 9 (3) ◽  
pp. 248-254 ◽  
Author(s):  
Albert C. Hsu ◽  
Luis E. P. Tirico ◽  
Abraham G. Lin ◽  
Pamela A. Pulido ◽  
William D. Bugbee
Keyword(s):  
High Tibial Osteotomy ◽  
Femoral Condyle ◽  
Case Series ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Medial Femoral Condyle ◽  
Osteochondral Allograft ◽  
Tibial Osteotomy ◽  
Opening Wedge

Objective To evaluate the outcome of patients who have undergone simultaneous osteotomy and osteochondral allograft (OCA) transplantation. Our hypothesis is that use of high tibial osteotomy and fresh OCA in a combined procedure is safe and effective without increasing morbidity in comparison to OCA alone. Design A case series of 17 patients underwent tibial osteotomy and simultaneous OCA during a single surgery. Osteotomy was indicated when axial alignment was within the affected compartment. Patients had a minimum of 2 years of follow-up after surgery. The mean graft size was 8.7 cm2, with 82% located on the medial femoral condyle alone and 18% involving the medial femoral condyle and one or more other sites. Data collection included demographics, osteotomy correction, graft site(s) and area, and clinical evaluation. Failure was defined as conversion to arthroplasty. Results Two of 17 patients (12%) failed at a mean of 9.3 years. The remaining 15 patients (88%) had intact allografts with mean survival of 8.1 years (SD 3.3). Five patients (29%) had an additional procedure, all undergoing osteotomy hardware removal. Of those with surviving allografts, mean pain and function scores improved significantly from the preoperative to postoperative assessment and International Knee Documentation Committee total scores improved significantly from 40.9 ± 15.4 preoperative to 75.5 ± 24.0 at latest follow-up ( P = 0.003); 92% of patients were satisfied with the results of the surgery. No postoperative complications occurred. Conclusion Combining high tibial osteotomy and OCA in properly selected patients is safe and effective.

Sign in / Sign up

Export Citation Format

Share Document