PMC9826562_01
Pre-operative clinical photograph showing localized redness and soft-tissue swelling on the proximal medial tibial metaphyseal region. Full knee ROM could be seen.
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F1
On inspection, the left medial proximal tibial region showed redness and swelling (Fig. 1).
Radiographic evaluation of the left knee in AP and lateral views.
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F2
Clinical findings were confirmed by radiographs in anterior posterior (AP) and lateral views (Fig. 2).
Magnetic resonance imaging films suggestive of a well localized, non-articular lesion of proximal medial, and posteromedial tibial metaphysis of the left side in (a) T1-weighted sagittal image, (b) T2-weighted sagittal image, (c) T2 weighted coronal image, and (d) PD-FAT-SAT coronal image.
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F3
It was concluded that the lesion was suggestive of either an osteoblastoma or a hemangioma (Fig. 3).
Exposed involved bone through a medial incision. Sclerotic bone with formation of pores over the cortical surface.
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F4
Further, deeper portions were removed using a cross-action nibbler and a scoop (Figs. 4 and 5).
Sequential creation of a rectangular window and excision of the diseased bone using a scoop and cross-action nibbler.
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F5
Further, deeper portions were removed using a cross-action nibbler and a scoop (Figs. 4 and 5).
Sequential fluoroscopic intraoperative AP and lateral views showing complete excision of the lesion.
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F6
Resection was confirmed sequentially on fluoroscopy (Fig. 6).
Sequential fluoroscopic intraoperative views showing filling of the void with an allograft. Post impaction of allograft, an HA block was applied on the cortex and a three-hole Polyethyl Ether Ketone plate was applied. Last fluoroscopic picture is suggestive of final fixation of the proximal tibia.
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F7
After impaction of the allograft, breach in the cortical outline was supplemented using hydroxyapatite block and a three-hole medial support plate made of polyethyl ether ketone (PEEK) (Fig. 7).
Immediate post-operative radiograph.
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F8
Construct integrity was acceptable under fluoroscopy in AP and lateral views (Fig. 8).
(a) Four weeks post-operative radiograph and (b) 6 months post-operative radiographs suggestive of good incorporation of bone allograft and regained continuity of the cortical outline.
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F9
Radiographic union with incorporation of the bone allograft was observed (Fig. 9). The patient had been followed up for the next 6 months with no complaints and no recurrence of the lesion and the radiograph showing complete consolidation of the allograft with no obvious cortical defect (Fig. 9).
Clinical photographs at 6 months postoperatively showing (a) good scar healing (b) sitting cross-legged, and (c) complete flexion.
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F10
At 8 weeks, the patient started walking with full weight-bearing and had regained almost full ranges of motion at the knee joint and was able to sit cross-legged too (Fig. 10).