OCD. Knee pain. FOCA.

1. Patient case 01
Summary 14.11.2017
Gleb Gavrilkin,
Orthopaedics & Trauma
OYS

2.  Male, 24 years old
 Normal physiological alignment in leg
 Physiological femoral and tibial torsions
 Active sports activity
 BMI 22
 Knee pain with physical activity
 Hydrops, swelling
 CRP, Leuk level normal

3.  X-rays:
 Lateral femoral condyle’s large osteochondral defect
 Sagital x-rays: anteriorly 1.5cm bone fragment
 Secundar OA in lateral femoral condyle, osteophytes
 OCD?

4.  MRI:
 2.3 x 1.6 mm OCD bone fragment anteriorly in Hoffa
 2.4 x 2.2 OCD defect in lateral condyle
 ACL, PCL, MCL, LCL, menisci normal

5.  MRI axial:
 20 x 30 mm defect in lateral condyle

6.  Lateral parapatellar arthrotomy
 Arthrex Mega-OATS instrumentation
 20mm - bone allograft
 FOCA (fresh osteochondral allograft) technique
 Tapping fixation, no need for extra fixation
devices

7.  Postop X-rays

8.  Active range of motion
 Full weight bearing
 Quadriceps rehab
 No sport activity at least 3 months
 Follow up with x-rays in 3 months
 Follow up with MRI in 6-12 month (to achive
remodeling of the graft bone by the host bone)

9.  Focal osteochondral defects of the knee in young, active
patients can be a debilitating condition posing a complex
treatment challenge. Due to their young age and high
demands in their activity level, arthroplasty or arthrodesis
surgery are not generally regarded reasonable solutions.
 For posttraumatic osteochondral defects, more biologic
options to date have included realignment osteotomy,
microfracturing, mosaicplasty, periosteal grafts, autologous
chondrocyte transplantation, and osteochondral allograft
transplantation.
 These procedures offer a biologic solution rather than an
artificial bearing surface replacement with its inherent risks
of early loosening and loss of bone stock for future
surgeries.