Case Report: Correction of Extensive Osteochondral Defect with Structured Bone Graft Associated with Collagen Membrane Coating in Knee Due to Sequelae of Osteochondritis Dissecans

Abstract

Objectives

Case report of the treatment of a 35-year-old woman with sequelae of an extensive osteochondral lesion in the Medial Femoral Condyle of the Right Knee. This report presents the clinical and radiological results after using the structured cancellous bone grafting technique from the Iliac bone with the aid of instruments for mosaicplasty associated with coverage with Collagen Membrane (Chondro-Gide®).

Methods

We removed the entire remaining osteochondral fragment down to the healthy cancellous bone and made perforations with the Mosaicplasty instrument designed to remove the recipient area to receive the cancellous bone plugs. We inserted the cancellous bone plugs into the defect of the Medial Femoral Condyle so that they filled the entire defect, remaining stable through the press-fit. After fixing and modeling the cancellous bone graft, the bone was covered with a collagen membrane (Chondro-Gide®).

Results

12 months after surgery, the patient performed weight training without complaints, returned to all previous usual activities and had a range of motion of 0-120˚. 18 months post-operatively, the IKDC score went from 5 pre-operatively to 52 out of a possible 87 (59.8%). Magnetic Resonance Imaging was performed 12 months after surgery for follow-up evaluation and the images showed the filling of the bone defect and the formation of fibrous scar tissue.

Conclusion

The presented technique proved to be a satisfactory option available in our country for the treatment of extensive osteochondral lesions with significant involvement of the subchondral bone when allografting is impossible. The presented patient is in good clinical function after an 18-month follow-up, with no recurrence of the preoperative clinical condition.