Abstract
Untreated leg length discrepancy can cause spontaneous osteonecrosis of the knee, which is associated with subchondral insufficiency fractures of the knee and progression or onset of osteoarthritis of the knee. Spontaneous osteonecrosis of the knee can be secondary to cartilage loss or additional subchondral changes. A 40-year-old female underwent opening-wedge high tibial osteotomy and osteochondral grafting for osteonecrosis of the femoral medial condyle and osteoarthritis of the knee caused by leg length discrepancy after a traffic accident. High tibial osteotomy and cartilage restoration are often considered for the treatment of knee osteonecrosis with cartilage damage in younger patients.
Highlights
Risk factors for osteoarthritis (OA) can be divided into person-level factors, such as age, sex, obesity, genetics, and race/ethnicity, and joint-level factors, including injury, malalignment, and abnormal loading of the joints [1, 2]
We present a case of opening-wedge high tibial osteotomy (HTO) and osteochondral grafting for osteonecrosis of the femoral medial condyle and OA of the knee caused by leg length discrepancy after a traffic accident
We considered autologous chondrocyte implantation (ACI) and HTO as surgical treatment
Summary
Risk factors for osteoarthritis (OA) can be divided into person-level factors, such as age, sex, obesity, genetics, and race/ethnicity, and joint-level factors, including injury, malalignment, and abnormal loading of the joints [1, 2]. The patient had had a bilateral femoral fracture and left ankle fracture in a car accident, and undergone femoral osteosynthesis with intramedullary nails 16 years previously After the treatment, she had had no symptoms in her left knee, but developed progressive pain in the left knee five years previously. She was diagnosed with OA and started receiving hyaluronic acid injections, but the treatment was ineffective and her left knee pain worsened She was referred to our department for surgery. Magnetic resonance imaging (MRI) revealed degeneration of the medial meniscus, joint effusion, edematous area in the bone marrow of the left medial femoral condyle, and articular cartilage defect in the femoral medial cartilage (Fig. 2A and B) We diagnosed her with osteonecrosis of the femoral medial condyle and osteoarthritis of the knee. The ROM was from 0° to 145° and the HSS score was 98
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