Combined reconstruction of femoral condylar osteochondral defects in adolescents: clinical cases and a review

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Abstract

BACKGROUND: A leading cause of femoral condylar lesions in children and adolescents is dystrophic processes resulting in subchondral bone destruction followed by overlying cartilage involvement. The most common pathological conditions include osteochondritis dissecans and corticosteroid-induced osteonecrosis. Currently, there is no consensus on the optimal surgical approach for treating osteochondral defects of the femoral condyles.

CASE DESCRIPTIONS: Two clinical cases of adolescents with extensive osteochondral defects of the femoral condyles are presented.

DISCUSSION: This article provides a review, existing classification systems, and an overview of surgical options for deep osteochondral defects of the femoral condyles. Existing methods induce good to excellent clinical outcomes. However, the absence of randomized and comparative studies of these treatment approaches does not allow for a clear determination of the optimal surgical strategy. In most contemporary studies, outcomes are assessed using indirect imaging methods, which negatively correlate with clinical results and may distort accuracy of treatment outcome interpretation.

CONCLUSION: Osteochondral defects of the femoral condyles remain a critical problem in pediatric and adolescent orthopedics and traumatology. Considering the variety of existing surgical techniques (from revascularization osteoperforation to joint replacement), combined reconstruction using autologous bone grafts and collagen membranes may offer stable and favorable clinical and functional outcomes.

About the authors

Sergey Y. Semenov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: sergey2810@yandex.ru
ORCID iD: 0000-0002-7743-2050
SPIN-code: 8093-3924

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Vyacheslav I. Zorin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov

Email: zoringlu@yandex.ru
ORCID iD: 0000-0002-9712-5509
SPIN-code: 4651-8232

MD, PhD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg; Saint Petersburg

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Supplementary files

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2. Fig. 1. Diagnostic imaging of patient B (age: 17 years at admission): a, X-ray of the right knee joint in anteroposterior and axial views; b, computed tomography scans exhibiting frontal, sagittal, and axial slices through the lesion; c, magnetic resonance imaging scans, frontal and sagittal views through the lesion. The area of destruction is indicated by an arrow.

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3. Fig. 2. Intraoperative images of patient B. a, arthrotomy, lesion is marked by an arrow; b, view of the defect after sequestrectomy, site is indicated by an arrow; the removed sequestrum is shown; c, autologous bone grafting of the defect; d, collagen membrane placed over the defect.

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4. Fig. 3. Patient B. Arthroscopic view 8 months after reconstruction.

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5. Fig. 4. Follow-up clinical and imaging evaluation of patient B at 2.5 years after reconstruction: a, range of motion in the right knee joint; b, magnetic resonance images in the frontal and sagittal planes.

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6. Fig. 5. Imaging of patient M.: a, magnetic resonance imaging, sagittal slice; b, spiral computed tomography, sagittal slice through the osteochondral defect of the lateral femoral condyle; c, spiral computed tomography, 3D reconstruction illustrating the size of the defect and the presence of a loose osteochondral fragment in the lateral femoral condyle. Arrows indicate the osteochondral defect region and the loose osteochondral fragment.

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7. Fig. 6. Intraoperative images of patient M.: a, osteochondral defect of the lateral femoral condyle, with the removed osteochondral body; b, post-resection defect filled with an autologous bone graft; c, the area of bone grafting was covered with a collagen membrane secured with interrupted sutures.

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8. Fig. 7. Patient M. Computed tomography of the left knee joint with three standard projections. The bone graft zone is indicated by an arrow.

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