Varone Bruno Butturi, Leal Daniel Peixoto, Gobbi Riccardo Gomes, Tirico Luís Eduardo Passarelli
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Video J Sports Med. 2023 Nov 6;3(6):26350254231193031. doi: 10.1177/26350254231193031. eCollection 2023 Nov-Dec.
This is a case report of a 41-year-old man with torsional knee trauma in 2019 and chondral lesions. Previous microfracture had failed, and the patient presented with a dull pain and knee effusion. Imaging revealed multiple focal lesions including trochlea, patella, medial condyle, and lateral condyle. Fresh osteochondral allograft (OCA) transplantation is a versatile treatment for large defects as it is based on mature, living hyaline cartilage attached to a bone interface. A patient with multiple chondral lesions is rare, and this report presents a case with multiple symptomatic large focal lesions in the knee that underwent a fresh OCA in all 3 knee compartments.
Osteochondral allograft is indicated for patients who present with activity-related pain and recurrent knee effusion. Contraindications are patient clinical conditions that may lead to complications, such as tobacco use, inflammatory arthritis, or septic arthritis.
After the chondral defect is exposed, an appropriate allograft Mega-OATS sizer (15-30 mm) is chosen. Cartilage and the subchondral bone are drilled until the desired depth. The donor allograft is drilled in the desired diameter, and excess bone is removed according to the previous measurements of the recipient site. The graft is advanced with firm pressure into the created socket. Postoperative rehabilitation includes a limited range of motion and proprioceptive weightbearing in the first 2 weeks but expected total weightbearing and a full range of motion by the sixth week.
Range of motion was full by 6 weeks of surgery. The effusion lasted for 2 months after the surgery. Fresh OCA is a good surgical option for patients with multiple large chondral defects.
DISCUSSION/CONCLUSION: Patient satisfaction is high since the mature cartilage leads to a fast rehabilitation compared with the other surgical procedures for large chondral defects. This technique appears to be effective also for multiple focal lesions as presented in this article.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.
本文报告一例2019年发生膝关节扭转创伤并伴有软骨损伤的41岁男性病例。此前微骨折治疗失败，患者出现隐痛和膝关节积液。影像学检查发现包括滑车、髌骨、内侧髁和外侧髁在内的多处局灶性病变。新鲜骨软骨异体移植（OCA）是治疗大面积缺损的一种通用方法，因为它基于附着在骨界面上的成熟活透明软骨。患有多处软骨损伤的患者较为罕见，本报告介绍了一例膝关节出现多处有症状的大面积局灶性病变且在所有三个膝关节腔均接受新鲜OCA移植的病例。
骨软骨异体移植适用于出现与活动相关疼痛和反复膝关节积液的患者。禁忌症是可能导致并发症的患者临床情况，如吸烟、炎性关节炎或化脓性关节炎。
暴露软骨缺损后，选择合适的异体移植Mega - OATS测量器（15 - 30毫米）。对软骨和软骨下骨进行钻孔直至所需深度。供体异体移植物按所需直径钻孔，并根据先前对受体部位的测量去除多余骨质。将移植物用力推进所制备的骨槽内。术后康复包括前两周有限的活动范围和本体感觉负重，但预计到第六周可完全负重并恢复全范围活动。
术后6周活动范围恢复正常。积液在术后持续了2个月。新鲜OCA对于患有多处大面积软骨缺损的患者是一种良好的手术选择。
讨论/结论：患者满意度较高，因为与其他治疗大面积软骨缺损的手术方法相比，成熟软骨可实现快速康复。本文介绍的这项技术对于多处局灶性病变似乎也有效。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已包含豁免声明或其他书面形式。
