Chondral Disease of the Knee - part 2 ppsx

... subchondral edema and violation of the chondral surface of the lateral femoral condyle (Figure CI .2) . SURGICAL INTERVENTION At the time of arthroscopy, a full-thickness 10mm by 16 mm chondral ... to squat. She noted the sudden onset of right knee pain and locking along the medial aspect of her knee. Her pain did not remit despite the passage of approxi-mately 12 weeks time, and she ... integration of the 2. The ability to achieve anatomic fixation major fragment (Figure C4.5). DECISION-MAKING FACTORS 1. In situ defect with a viable plate of sub- chondral bone attached to the defect....

... dissecans of the lateral femoral condyle 62 20 Uncontained focal chondral defect of the lateral trochlea 66 21 Failed prior fresh osteochondral allograft of the medial femoral condyle 70 22 Lateral ... Clinton, MD 20 735 Rush University Medical Center USA Chicago, IL 606 12 USA Library of Congress Control Number: 20 05937074 ISBN 10: 0-3 8 7-3 0830-X ISBN 13: 97 8-0 38 7-3 083 0 -2 © 20 06 Springer ... versionwww.adultpdf.com Chondral Disease of the Knee A Case-Based Approach Brian J. Cole, MD, MBA Associate Professor, Department of Orthopedics and Department of Anatomy and Cell Biology...

... FIGURE C 12. 2. Index microfracture treatment of iso-lated 12 mm by 12 mm defect of the lateral femoral condyle. Arthroscopic view of the lesion (A) before microfracture and (B) after microfracture ... lesion of the lateral femoral condyle measuring approximately 12 mm by 12 mm. This lesion was treated with a formal microfrac-ture technique (Figure C 12. 2). Following the microfracture, the ... time of surgery, there was significant fibro-cartilage fill of the medial femoral condyle, which was replaced with a 10-mm osteochon-dral autograft harvested from the lateral aspect of the...

... mm of subchondral bone at the base of the defect (Figure C14 .2) . SURGICAL INTERVENTION Because of the size, location, and depth of the lesion, the patient was indicated for fresh osteochondral ... versionwww.adultpdf.comCase 14 DECISION-MAKING FACTORS 1. A young high-demand patient with osteo-chondritis dissecans of the weight-bearing zone of the lateral femoral condyle. 2. Failure of previous treatment ... AND HISTORY OF PRESENT ILLNESS The patient is a 44-year-old woman with a chief complaint of anterior knee pain and pain with weight bearing along the medial aspect of her right knee. Additionally,...

... photograph of the medial femoral condyle defect, taken at the time of biopsy. FIGURE C18 .2. MRI demonstrates loss of convexity of the medial femoral condyle in the region of the intercondylar ... posteroanterior 45-degree flexion weight-bearing and (B) lateral radiographs demon-strate flattening and loss of contour of the lateral femoral condyle of the right knee with minimal loss of subchondral ... evidence of a small area of periosteal detachment on the medial aspect of the defect. (B) Bar graph demonstrates the relative differences of the native articular car-tilage compared to the ...

... versionwww.adultpdf.comCase 21 71 FIGURE C21.1. Flexion weight-bearing radiograph demonstrates collapse of the medial femoral condyle osteochondral allograft of the left knee and well-incor-porated osteochondral ... per-mitted at 6 months. FOLLOW-UP At the 2- year follow-up visit, she demonstrates no progression of joint space narrowing and excellent integration of the osteochondral plug (Figure C23.4). ... mechan-ical symptoms. Note the small area of degeneration at the posterior horn of the meniscus allograft. This is trial versionwww.adultpdf.com 72 Case 21 FIGURE 21 .4. Eighteen-month radi-ograph...

... with a staple on the tibia and a Ugament button on the femur due to slight graft mis-match and partial compromise of the posterior cortex of the femur (Figure C24.2D,E). Postop-erative rehabilitation ... positioning of the ACL graft and proper seating of the meniscus trans-plant bone plugs. No evidence of joint space narrowing was present (Figure C24.3). Repeat KT -2 0 00 evaluation revealed a 2- mm ... focal chondral defect of the patella TREATMENT Autologous chondrocyte implantation of the patella with distal realignment (Note that the use of ACI for the patella is considered off-label...