Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
Medicina (Kaunas). 2022 Oct 26;58(11):1528. doi: 10.3390/medicina58111528.
Osteochondral lesion (OCL) of the patellofemoral (PF) joint is not an uncommon cause of knee pain, and surgery is needed when conservative treatment fails. However, there is a lack of evidence regarding the optimal surgical treatment for OCL of the PF joint. Fixation of OCLs using autogenous osteochondral grafts has been reported to be effective for OCL of the knee. However, in this surgical technique, the biomechanical strength of osteochondral grafts may not be sufficient in patients with open physes due to the specific quality of the cartilage and subchondral bone given their age. There is a lack of studies reporting fixation of the OCL located in the PF joint using autogenous osteochondral grafts. We herein report a case of OCL of the femoral intercondylar groove where autogenous osteochondral grafts augmented with bioabsorbable pins were used to fix the lesion in a 14-year-old patient with open physes. Preoperative MRI revealed a completely detached OCL of the intercondylar groove (36 mm × 20 mm). Although a total of four osteochondral grafts were harvested from the non-weightbearing area of the lateral femoral condyle, cartilage detached from one of the grafts. The quality of the osteochondral grafts was considered to be insufficient for stabilization of the OCL; thus, two bioabsorbable pins were additionally inserted following fixation of the lesion using three osteochondral grafts. After two years of follow-up, postoperative functional scores were favorable without knee pain. The present case suggests that fixation of the OCL using autogenous osteochondral grafts may not be appropriate for young patients with open physes.
髌股（PF）关节的骨软骨损伤（OCL）不是引起膝关节疼痛的常见原因，当保守治疗失败时需要手术治疗。然而，对于 PF 关节的 OCL，缺乏最佳手术治疗的证据。使用自体骨软骨移植物固定 OCL 已被报道对膝关节的 OCL 有效。然而，在这种手术技术中，由于软骨和软骨下骨的特定质量以及其年龄，骺板未闭的患者的骨软骨移植物的生物力学强度可能不足。缺乏使用自体骨软骨移植物固定 PF 关节 OCL 的研究报告。我们在此报告一例骺板未闭的股骨髁间窝 OCL 病例，使用自体骨软骨移植物和可吸收钉固定病变，患者为 14 岁，骺板未闭。术前 MRI 显示完全分离的髁间窝 OCL（36mm×20mm）。尽管总共从外侧股骨髁非负重区采集了四块骨软骨移植物，但其中一块移植物上的软骨脱落。考虑到骨软骨移植物的质量不足以稳定 OCL，因此在使用三块骨软骨移植物固定病变后，另外插入两根可吸收钉。随访两年后，膝关节无疼痛，功能评分良好。本病例提示，对于骺板未闭的年轻患者，使用自体骨软骨移植物固定 OCL 可能不合适。
