A Novel Posterior Arthrotomy Approach for the Treatment of a Large Osteochondral Defect of the Posterior Aspect of the Lateral Femoral Condyle of the Knee: A Case Report and Technical Note.

Abstract

Symptomatic osteochondral lesions of the knee pose a considerable treatment challenge to orthopaedic surgeons, particularly when they occur in young active patients1,2. The prognosis of osteochondral defects is worse when the defect is sizable, when it is located in a weight-bearing portion of the knee, and when there is considerable bone loss3,4. Hyaline cartilage is unable to heal spontaneously because of its unique structure and distinctive properties. As a result, many chondral resurfacing techniques have been employed for the treatment of osteochondral injuries5-7. Osteochondral autograft transplantation is successful in covering relatively small defects, but has considerable technical limitations and has been associated with increased donor-site morbidity for larger defects (>2 × 2 cm)8,9. Therefore, allografts have been proposed for the management of larger defects10,11. One of the critical issues regarding surgical technique is the perpendicular placement of the bone plug3. Incongruency, resulting from proud graft placement, can give rise to a “kissing lesion” on the contralateral surface12. We report the case of a patient with a large osteochondral lesion of the posterior aspect of the lateral femoral condyle of the knee. We also outline the surgical technique for a knee arthrotomy with a posterior approach to gain access to this difficult-to-reach area. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. An eighteen-year-old female high-school elite-level ice hockey goalie presented with an eighteen-month history of left lateral knee pain, exacerbated by assuming the butterfly position (Fig. 1). There was no history of any specific injury, and the symptoms had increased gradually over time. The pain prevented her from effectively performing the role of goalie. Conservative measures, including …