PMC6369132_01
A. Cartilage defect on the femoral lateral condyle with a diameter of 3 cm (pointed by the arrow). B. Articular cartilage defect on posteromedial patella with a diameter of 2.5 cm (pointed by the arrow). C. Lateral retinaculum dissection/lateral release using an electrocautery (pointed by the arrow).
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We found articular cartilage defects on the lateral condyle of the femur with a diameter of 3 cm (Fig. 1A), and on the postero-medial with a diameter of 2.5 cm (Fig. 1B), and the depth of both was more than 50% of the cartilage thickness. We performed a dissection of lateral retinaculum (lateral release) (Fig. 1C) using an electrocautery, continued by incising the medial side of tibia tuberosity and detaching the patellar tendon by using an oblique osteotomy procedure on tibia tuberosity, where the fragment slide 1 cm antero-medially and fixed with two 3.5 mm (length 40 mm) partial threaded cancellous screw, followed by percutaneous plication on the medial side of the patella using non-absorbable string (Fig. 2A).
A. Percutaenous medial plication using non-absorbable string no.2. B. Post-operative anteroposterior and lateral projection of plain radiograph imaging. C. Post-operative CT scan.
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We performed a dissection of lateral retinaculum (lateral release) (Fig. 1C) using an electrocautery, continued by incising the medial side of tibia tuberosity and detaching the patellar tendon by using an oblique osteotomy procedure on tibia tuberosity, where the fragment slide 1 cm antero-medially and fixed with two 3.5 mm (length 40 mm) partial threaded cancellous screw, followed by percutaneous plication on the medial side of the patella using non-absorbable string (Fig. 2A). Post-operative ROM was 90  flexion without any dislocation (Fig. 2B) and the position of the screws was good (Fig. 2C).
A. Arthroscopic microfracture on cartilage defect using an awl, with a depth of +-4 cm. B. The mesenchymal stem cell culture after day 22 showing fibroblast-like cell/spindle shaped cells that 100% confluent.
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Eighteen month after that surgery, we performed an iliac crest bone marrow aspiration; arthroscopic microfracture by using an awl until 4 mm depth was reached on the site located +-3-4 mm from the articular cartilage defect on the posteromedial patella and femoral lateral condyle (Fig. 3A); and tibial tuberosity screw removal. The buffy coat was washed and cultivated for 3-4 weeks until reaching the required amount (107 MSCs/mL) (Fig. 3B).
MRI FSE cor T2-weighted signal in different slice. Left image showing cartilage defect (pointed by the arrow). Right image showing cartilage growth was found in the defect (pointed by the arrow).
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T2-weighted signal (cartilage sequence) showed a significant growth of articular cartilage covering most of the defect (Fig. 4). Two years after the MSCs implantation, there was no complaint and full ROM was reached.