PMC8282393_01
Representative images of case 1. Preoperative anteroposterior (a) and lateral (b) radiography and axial computerized tomography of the knee showing no abnormality (c) and a chondral fragment with no bony element (d). Preoperative sagittal (e) T2-weighted and axial (f) T2-weighted, fat-suppressed magnetic resonance imaging showing a chondral defect in the lateral femoral condyle and a loose chondral fragment in the medial suprapatellar pouch.
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Radiography showed no abnormal findings (Figures 1(a) and 1(b)). Computerized tomography (CT) revealed no bony abnormalities and a chondral fragment without bony elements (Figures 1(c) and 1(d)). Magnetic resonance imaging (MRI) of the right knee showed a chondral defect in his lateral femoral condyle and a loose chondral fragment in the medial suprapatellar pouch (Figures 1(e) and 1(f)).
Intraoperative findings of case 1: (a) the chondral fragment measuring 2.5 x 2.6 cm in size, appearing to contain no bony element; (b) the chondral defect at the lateral femoral condyle after the microfracture drilling procedure; (c) fixation of the chondral fragment with two 6 x 13 mm two osteochondral pegs; (d) schematic overview of surgical technique. Initially, the mother floor was drilled by Kirshner wire and then, the fragment was press-fitted by two osteochondral bone pegs which were harvested from the lateral femoral condyle.
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The size of the fragment was 2.5 cm x 2.6 cm, and it appeared to have no bony tissue (Figure 2(a)). We found the defect in the anterior aspect of the lateral femoral condyle, which corresponded to the size of the chondral fragment, and drill holes, along with 1.6 mm Kirshner wire, were introduced to promote repair of the chondral layer at the site through bone marrow stimulation (Figure 2(b)). The chondral fragment was anatomically refixed using two osteochondral bone pegs (6.0 mm in diameter and 13 mm in depth) harvested from the lateral femoral condyle using the OATS (Figures 2(c) and 2(d)).
Postoperative axial (a) computerized tomography and sagittal (b) T2-weighted and axial (c) T2-weighted, fat-suppressed magnetic resonance image showing a smooth, healing chondral surface with osteochondral peg in place 2 months after osteochondral peg fixation.
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At two months postoperatively, radiography, CT, and MRI scans confirmed the union of the chondral fragment and osteochondral peg, with smooth continuity of the articular surface (Figure 3).
PMC8282393_02
Representative images of case 2. Preoperative anteroposterior (a) and lateral (b) radiography and axial computerized tomography (c) of the knee showing no bony injury. Preoperative sagittal (d) and axial (e) T2-weighted, fat-suppressed magnetic resonance imaging showing a chondral defect in the lateral femoral condyle and a loose chondral fragment in the medial suprapatellar pouch.
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Radiography and CT scans showed no abnormalities (Figures 4(a) and 4(b)), although MRI of the left knee showed a chondral defect in the lateral femoral condyle and a loose chondral fragment in the medial suprapatellar pouch (Figures 4(c) and 4(d)).
Postoperative sagittal (a) and axial (b) T2-weighted, fat-suppressed magnetic resonance images taken 2 months after osteochondral peg fixation showing a complete bony and chondral union and a continuous articular surface.
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At two months, radiography, CT, and MRI studies revealed healing and integration of the fragment with the surrounding cartilage and the osteochondral pegs (Figure 5).