PMC5535727_01
Composition of figures demonstrating the initial injury and surgical treatment. (a) Preoperative axial T1-sequence MRI demonstrating the osteochondral injury (white arrow). (b) Intraoperative picture demonstrating the debrided defect in the lateral femoral condyle. (c) Intraoperative picture demonstrating the autologous matrix before implantation. (d) Arthroscopic view of the filled defect at the end of the procedure.
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fig1
The patient did not improve and a magnetic resonance imaging (MRI) was requested at 3 months, demonstrating an osteochondritis dissecans of the lateral femoral condyle at the level of the trochlea of 20 x 18 mm diameter and 8 mm depth (Figure 1(a)). Knee arthroscopy was performed five days later and a KOL was confirmed (Figure 1(b)). CaCl2 following the rate of 0.02 ml per milliliter of plasma, maintaining the tube at room temperature. Cartilage chips were combined with the mixed PPP-PRP and left for at least 30 minutes until a semisolid matrix was formed (Figure 1(c)). Then this matrix was placed in the KOL, which has to be slightly below the healthy surrounding articular cartilage to avoid overgrowth (Figure 1(d)).
Two views of the second-look arthroscopy. ((a) and (b)) Intra-articular view of the femoral trochlea demonstrating the formed cartilage flush with the surrounding cartilage, adequate filling of the defect, and adequate transition between the healthy and formed cartilage.
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fig2
The defect was completely filled with the new tissue, which had a similar color and consistency (Figure 2(a)) and was smooth compared to the surrounding healthy cartilage (Figure 2(b)).
PMC5535727_02
Composition of figures demonstrating the initial injury, surgical treatment, and postoperative MRI 6 months after surgery. (a) Preoperative sagittal T1-sequence MRI demonstrating an osteochondral injury (white arrow). (b) Intraoperative picture demonstrating the debrided defect in the lateral femoral condyle. The small picture shows the injury seen during the diagnostic arthroscopy. (c) Intraoperative picture demonstrating the filled defect after the autologous matrix had been applied. (d) Postoperative sagittal T1-sequence MRI demonstrating adequate filling and incorporation of the matrix in the lateral femoral condyle and absence of subchondral oedema (white arrow).
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fig3
The MRI showed the same osteochondral injury and bone oedema in the lateral femoral condyle (Figure 3(a)). Knee arthroscopy demonstrated a rounded 1.7 cm diameter osteochondral injury in the lateral femoral condyle (Figure 3(b)). The surgical procedure and postoperative protocol detailed above were repeated for this patient (Figure 3(c)). At six months, he still had significant quadriceps tone asymmetry and a follow-up MRI demonstrated an almost complete filling of the defect without still complete maturation but with no other significant associated lesions (Figure 3(d)).