Abstract
We report the 8-year clinical and radiographic outcome of an adolescent patient with a large osteochondral defect of the lateral femoral condyle, and ipsilateral genu valgum secondary to an epiphyseal injury, managed with autologous chondrocyte implantation (ACI) and supracondylar re-alignment femoral osteotomy. Long-term clinical success was achieved using this method, illustrating the effective use of re-alignment osteotomy in correcting mal-alignment of the knee, protecting the ACI graft site and providing the optimum environment for cartilage repair and regeneration. This is the first report of the combined use of ACI and femoral osteotomy for such a case.
Highlights
Injury to long bones in the lower extremities with involvement of the pyseal growth-plate is common in children and adolescents [1]
* Correspondence: s_vijayan@hotmail.com 1Joint Reconstruction and Cartilage Transplantation Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK Full list of author information is available at the end of the article high tibial osteotomy in the treatment of osteochondral defects in the adolescent knee. 2011 Submitted]. In this case distal femoral supracondylar osteotomy, to correct a valgus deformity at the knee caused by presumed trauma-related physeal arrest and subsequent dysplasia of the lateral femoral condyle was performed following autologous chondrocyte implantation (ACI) for a large 4 cm × 5 cm osteochondral defect
Biomechanical malalignment may lead to increased compressive loading of the joint, thereby damaging induced repair tissue produced by cartilage regeneration techniques such as ACI [13]
Summary
Injury to long bones in the lower extremities with involvement of the pyseal growth-plate is common in children and adolescents [1]. The use of combined techniques for cartilage repair is becoming commoner, especially in younger patients [Parratt MTR et al: Chondrocyte transplantation combined with In this case distal femoral supracondylar osteotomy, to correct a valgus deformity at the knee caused by presumed trauma-related physeal arrest and subsequent dysplasia of the lateral femoral condyle was performed following ACI for a large 4 cm × 5 cm osteochondral defect. After six months of protected weight-bearing and active mobilisation, when he had recovered from the chondrocyte transplantation procedure, the valgus deformity was corrected to restore the mechanical axis This was achieved by a supracondylar medial closing-wedge femoral osteotomy and internal fixation with a bladeplate. The right knee had a full range of unrestricted movement, there was no evidence of quadriceps wasting and there was equal leg length His Modified Cincinnati Score was 92, Bentley score 0 and VAS 0. After debridement and trimming of the lateral meniscus the patient was pain free
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