Okamoto Yukihiro, Nakagawa Yasuaki, Maekawa Masaki, Kobayashi Masahiko, Nakamura Takashi
Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan.
Arthroscopy. 2007 Sep;23(9):1024.e1-4. doi: 10.1016/j.arthro.2006.07.019. Epub 2006 Dec 8.
We report the case of a 28-year-old woman who underwent osteochondral grafting and anterior cruciate ligament (ACL) reconstruction for treatment of a massive cartilage defect in a knee joint with ACL deficit. Arthroscopy showed a full-thickness degenerative cartilage defect measuring 22 x 35 mm in the weight-bearing area of the medial femoral condyle, a totally resected lateral meniscus, and a loosened ACL. Therefore we performed osteochondral autograft transplantation and ACL reconstruction. Osteochondral plugs were harvested from a donor site in the patellofemoral joint of the contralateral knee and grafted into the recipient site in a "skipping" manner. Arthroscopic examination 1 year after surgery showed good preservation of the grafts and satisfactory bridging of the gaps between the plugs with fibrocartilage-like tissue. A recent follow-up examination, performed 36 months after surgery, has shown an excellent result, with a Lysholm score of 100, an International Knee Documentation Committee score of 95.4, and full range of knee motion with no symptoms. Plain radiographs at that time showed preservation of the medial joint space on the weighted anteroposterior view. No osteoarthritic changes were evident in the patellofemoral joint.
我们报告了一例28岁女性患者的病例，该患者因膝关节存在大面积软骨缺损且伴有前交叉韧带（ACL）损伤，接受了骨软骨移植和前交叉韧带重建手术。关节镜检查显示，在股骨内侧髁的负重区域存在一个全层退行性软骨缺损，尺寸为22×35毫米，外侧半月板已完全切除，ACL松弛。因此，我们进行了骨软骨自体移植和ACL重建。骨软骨栓取自对侧膝关节髌股关节的供体部位，并以“跳跃”方式移植到受体部位。术后1年的关节镜检查显示移植组织保存良好，栓之间的间隙被纤维软骨样组织满意地桥接。最近在术后36个月进行的随访检查显示结果极佳，Lysholm评分为100分，国际膝关节文献委员会评分为95.4分，膝关节活动范围正常且无症状。当时的X线平片在负重前后位片上显示内侧关节间隙得以保留。髌股关节未见骨关节炎改变。
