PMC4274911_01
Axial (a), sagittal (b), and coronal (c) images from preoperative CT scan demonstrating a lytic lesion in the medial femoral condyle with lobulated well-defined margins and depression of the subchondral bone at the lesion border.
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Computerized tomography (CT) further defined a low-attenuation lesion in the medial femoral condyle measuring 13 mm by 16 mm with well-defined sclerotic margins and depression of the subchondral bone at the lesion border (Figure 1).
Mononuclear neoplastic cells with intermixed multinucleated giant cells (right), tumor cells surrounded by dark blue "chicken wire" calcifications (left center), and fibrochondroid islands (left) (hematoxylin and eosin stain, 20x magnification).
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CT showed no evidence of metastatic disease. Core needle biopsy (Figure 2) showed mononuclear neoplastic cells with intermixed multinucleated giant cells, tumor cells surrounded by dark blue "chicken wire" calcifications, and fibrochondroid islands all consistent with a chondroblastoma.
T1 TSE axial (a) and sagittal (b) images and T1 TSE w/FS axial (c) image showing a lytic lesion with sclerotic borders involving the posterior aspect of the medial femoral condyle and abutting the posterior articular surface with 3 mm collapse of the subchondral bone and breach of the chondral surface.
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MRI of the left knee was obtained to evaluate the extent of articular cartilage involvement and to determine reconstruction options after recommended intralesional curettage. MRI demonstrated a lytic lesion with sclerotic borders involving the posterior aspect of the medial femoral condyle and abutting the posterior articular surface with a 3 mm collapse of the subchondral bone and breach of the chondral surface (Figure 3).
STIR axial (a), sagittal (b), and coronal (c) images demonstrating associated medial femoral condyle marrow edema and adjacent soft tissue edema and joint effusion.
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T2 STIR images (Figure 4). The imaging and pathology were reviewed at multidisciplinary tumor board and the surgical approach and reconstructive options were discussed at the weekly orthopaedic departmental preoperative planning meeting.
Intraoperative photographs showing marginal excision and preparation of medial femoral condyle (a), osteochondral allograft preparation (b), and implantation (c).
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Transplant Foundation) to prepare the osteochondral plug. The graft was then inserted in a press fit fashion using clock face markings for orientation (Figure 5).
Five-month postoperative photos demonstrating full flexion (a) and extension (b).
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He demonstrated full active flexion and extension compared to the contralateral extremity (Figure 6).
One-year postoperative PD TSE sagittal (a) and T1 TSE coronal (b) images showing osteochondral allograft incorporation and congruency of chondral surface. No evidence of local recurrence.
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MRI and CT imaging of the left knee were obtained which demonstrated incorporation of the osteochondral allograft (Figures 7 and 8) and resolution of the previously associated medial condyle marrow edema.
One-year postoperative axial (a), sagittal (b), and coronal (c) CT scan demonstrating osteochondral allograft incorporation and congruency of chondral surface. No evidence of local recurrence.
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MRI and CT imaging of the left knee were obtained which demonstrated incorporation of the osteochondral allograft (Figures 7 and 8) and resolution of the previously associated medial condyle marrow edema.