Detaillierte Beitrags-Information
| Beitragstitel | Thirty-Month Follow-up after Combined Osteochondral and Meniscal Allograft Transplantation of a Lateral Tibial Plateau in a Young Patient |
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| Beitragscode | P071 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Introduction Malunion of a tibial plateau fracture is associated with a significant risk for posttraumatic osteoarthritis. This complication can be successfully treated with joint replacement in older patients. However, knee arthroplasty in younger patients is associated with a high risk of implant loosening or surgical revision. Therefore, combined osteochondral allograft (OCA) and meniscal allograft transplantation (MAT) has been reported in literature as an alternative to knee arthroplasty in this group of patients. Case A 33-year-old patient sustained a split depression type fracture of the proximal tibia (AO 41B3.1) in his right knee that was treated with open reduction and internal fixation (ORIF). At three months postoperative, the patient reported persisting pain with full weight-bearing and CT-scan showed a large and deep osteochondral defect of the lateral tibial plateau. On the other hand, MRI confirmed intact cartilage of the lateral femoral condyle. At six months postoperative, a combined OCA and MAT of the lateral tibial plateau was performed to prevent early degeneration of the lateral compartment. To get full access to the joint, an osteotomy of the lateral femoral epicondyle was associated with the anterolateral approach. At thirty-month follow-up, the patient was pain-free in all daily and sports activities. He took no medication. Flexion/Extension of the knee was 130-0-0° and the joint presented no effusion. Tegner and subjective IKDC scores were 7 and 92%, respectively. Additionally, X Ray and MRI of the knee performed two years postoperatively showed a complete osseous integration of the graft and an intact cartilage with a retained position and unaltered structure of the lateral meniscus. Discussion Combined OCA and MAT is an extremely rare surgical procedure associated with a reoperation rate of 50%. These reoperations were mostly simple arthroscopic procedures while failures requiring graft removal was reported in 12%-23% of patients. In patients with intact graft, all outcome scores were significantly improved after the surgery. Additionally, 78% of them were either extremely satisfied or satisfied with the operation. Therefore, the reported case confirm that combined OCA and MAT could be a useful alternative to joint replacement in young patients allowing them to return to a full active life. However, it remains a difficult surgical procedure with a high re-operative rate. |