Fowler Donald E, Hart Joseph M, Hart Jennifer A, Miller Mark D
Sports Medicine Division, Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908-0159, USA.
J Knee Surg. 2009 Oct;22(4):372-4. doi: 10.1055/s-0030-1247779.
Osteochondral defects are common in younger, active patients. Multiple strategies have been used to treat these lesions, including microfracture and osteochondral plug transfer. We describe a patient experiencing chronic knee pain and a full-thickness cartilage defect on the lateral femoral condyle. After failing conservative management and microfracture surgery, the patient underwent osteochondral autograft plug transfer, with backfilling of the donor sites using synthetic bone graft substitute. Initial recovery was uncomplicated until the patient experienced pain following a twist of the knee. Magnetic resonance imaging for the subsequent knee injury revealed poor healing at the donor sites. The donor sites were debrided, and specimens revealed a foreign body giant cell reaction. Donor-site morbidity is of primary concern during osteochondral plug transfer; however, insufficient data exist to support the use of synthetic bone graft material. Our results indicate that off-label use of synthetic bone graft substitute during a primary procedure requires further investigation.
骨软骨缺损在年轻、活跃的患者中很常见。已经采用了多种策略来治疗这些损伤，包括微骨折和骨软骨栓移植。我们描述了一名患有慢性膝关节疼痛且股骨外侧髁存在全层软骨缺损的患者。在保守治疗和微骨折手术失败后，该患者接受了自体骨软骨栓移植，并使用合成骨移植替代物对供区进行回填。最初的恢复过程顺利，直到患者在膝关节扭转后出现疼痛。对随后膝关节损伤进行的磁共振成像显示供区愈合不佳。对供区进行清创，标本显示有异物巨细胞反应。在骨软骨栓移植过程中，供区并发症是主要关注点；然而，目前尚无足够的数据支持使用合成骨移植材料。我们的结果表明，在初次手术中不合规使用合成骨移植替代物需要进一步研究。
