Chondral Disease of the Knee
A Case-Based Approach
Associate Professor, Department of Orthopedics and Department of Anatomy and Cell Biology Director, Cartilage Restoration Center at Rush Rush University Medical Center, Chicago, Illinois
M. Mike Malek, MD
Director, Washington Orthopaedic and Knee Clinic, Fairfax, Virginia President, National Knee Research and Education Foundation, Clinton, Maryland
Springer
Brian J. Cole, MD, MBA Associate Professor, Department of Orthopedics and Department of Anatomy and Cell Biology; Director, Cartilage Restoration Center at Rush Rush University Medical Center Chicago, IL 60612 USA
M. Mike Malek, MD
Director, Washington Orthopaedic and
Knee Clinic, Fairfax, VA 22031 President, National Knee Research and Education Foundation Clinton, MD 20735 USA
Library of Congress Control Number: 2005937074
ISBN 10: 0-387-30830-X ISBN 13: 978-0387-30830-2
© 2006 Springer Science+Business Media, LLC
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Contents
Introduction to Case Studies ..........................................................vii
1 Osteochondritis dissecans of the medial femoral condyle with documented long-term natural history............................1
2 Avascular necrosis....................................................................4
3 Unstable in situ osteochondritis dissecans of the medial femoral condyle........................................................................6
4 Unstable in situ osteochondritis dissecans of the medial femoral condyle........................................................................10
5 Concomitant medial meniscus tear and focal chondral defect of the medial femoral condyle......................................14
6 Isolated focal chondral defect of the medial femoral condyle......................................................................................17
7 Symptomatic focal chondral defect of lateral femoral condyle......................................................................................20
8 Isolated small grade IV medial femoral condyle chondral lesion..........................................................................................23
9 Isolated medial compartment osteoarthritis ..........................25
10 Unicompartmental bipolar disease..........................................28
11 Medial femoral condyle focal chondral defect........................31
12 Lateral femoral condyle focal chondral defect ......................35
Focal chondral defect of the medial femoral condyle and patella............................................ 38
Lateral femoral condyle osteochondritis dissecans........ 42
Focal chondral defect of the lateral femoral condyle ...... 46
Contained focal chondral defect of the medial femoral condyle........................................... 50
Contained focal chondral defect of the medial femoral condyle........................................... 55
Osteochondritis dissecans of the medial femoral condyle........................................... 58
Osteochondritis dissecans of the lateral femoral condyle........................................... 62
Uncontained focal chondral defect of the lateral trochlea........................................... 66
Failed prior fresh osteochondral allograft of the medial femoral condyle.................................... 70
Lateral meniscus deficiency........................... 73
Prior medial meniscectomy and focal chondral defect medial femoral condyle.................................... 76
Failed anterior cruciate ligament reconstruction with medial meniscus deficiency ................................. 80
Advanced patellofemoral arthritis ..................... 84
Multiple chondral defects ............................ 87
Traumatic patellar instability with focal chondral defect of the patella......................................... 91
Focal chondral defect patella ......................... 95
Focal chondral defect medial femoral condyle and varus alignment ......................................... 98
ACL deficiency with symptomatic trochlear and medial femoral condyle chondral lesions...................... 102
Focal chondral defect of the medial femoral condyle in a previously meniscectomized knee...................... 107
32 Focal chondral defect lateral femoral condyle, prior lateral meniscectomy, and small focal chondral defect lateral tibial plateau ........................................... Ill
33 Bipolar focal chondral defects of the patellofemoral joint with patellar instability .............................. 116
34 Bipolar focal chondral defects of the patellofemoral joint.............................................. 120
35 Lateral compartment tibiofemoral degenerative arthrosis .......................................... 124
36 Isolated patellofemoral arthritis....................... 128
37 Posttraumatic medial femoral condyle defect, varus instability, and deformity with significant motion loss...... 132
38 Chondral defects with prior medial and lateral meniscectomy and varus alignment .................... 138
Index ................................................ 143
Section Editors
Department of Orthopedics
Department of Anatomy and Cell Biology
Cartilage Restoration Center at Rush
Rush University Medical Center
Chicago, IL 60612
Michael G. Dennis, MD Orthopaedic Care Center Aventura Hospital and Medical Center Aventura, FL 33180 USA
Contributors
Tim Bryant, RN Brian J. Cole, MD, MBA Jack Farr, MD Tom Minas, MD, MS
Introduction to Case Studies
The illustrated case studies were prepared to help solidify the decisionmaking required for patients who are diagnosed with chondral disease of the knee. The cases are organized by level of complexity, taking into consideration substantial comorbidities such as tibiofemoral and patellofemoral malalignment, ligament disruption, and meniscal deficiency. The cases are presented in increasing level of difficulty based upon the defect- and patient-specific factors considered in the final treatment recommendation. Similar to the way a downhill ski run is graded for its level of difficulty, the cases are rated using green circles (easiest decision-making), blue squares (intermediate decision-making), black diamonds (advanced decision-making), and double black diamonds (expert decision-making). Within each category, the cases are organized by increasing complexity as well. Based upon the reader's practice experience, some may feel more comfortable with the decisions made in one category versus another. We believe, however, that this is the best way to convey the implicit level of complexity, thereby allowing the reader to better understand how these cases fall within the treatment algorithm. When off-label usage of technology was implemented, it is clearly indicated within the body of the case. While mastering the techniques and performing a thorough evaluation of all patient- and defect-specific factors is a prerequisite to sound judgment, the bullet points at the end of each case that emphasize the final rationale for the treatment chosen will be of particular interest and value to the reader.
Genzyme Biosurgery is proud to have collaborated with Springer to support the publication of this book. We are committed to improving patient care through education, research and advancing the field of cartilage repair. We applaud the efforts of the book's contributors and believe this text will be a valuable reference for clinicians seeking expert guidance in this emerging field.
Genzyme Biosurgery A division of Genzyme Corporation Cambridge, MA
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