Clinical case. Tennis player with locked knee. Osteochondritis dissecans (OCD). 9

Clinical case. Tennis player with locked knee. Osteochondritis dissecans (OCD). 9

Clinical case. Tennis player with locked knee. Osteochondritis dissecans (OCD). 9

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Professor Steinwachs, is there a patient’s story you could discuss that illustrates topics that we discussed today? Perhaps a composite of clinical cases that you often encounter in your clinical practice? Yes, for example, I saw yesterday a patient who is a professional tennis player. He came up three months ago. He has a locked knee injury. He could not play tennis again. We see on the MRI that he has a huge Osteochondritis dissecans (OCD) on the lateral femur condyle. This Osteochondritis dissecans (OCD) was mostly based on the cartilage surface. So there was a very small [rare] volume of bone under the cartilage. Normally, we see this problem in the following way. If a patient does not have enough bone under the cartilage, then the repaired cartilage does not integrate into the old normal place. But this tennis player’s knee cartilage defect was so huge. It was 2.5 centimeters long and about two centimeters wide. So I would not remove that cartilage defect completely. So I took the risk, and I removed all the bone particles on the subchondral bone. I did drillings deep in the bone to recruit a maximum number of cartilage stem cells. I then put some cancellous bone on the defect in the bone area. Then I put the cartilage back into its place, and I sutured that cartilage around to the intact cartilage. I also put some screws into repaired cartilage to press these cartilage pieces completely back into normal place. I know that it is a risky method of treatment. Because in the published medical literature, we see that if the cartilage pieces are not similar in shape and surface area to a big part of the underlying bone, you risk a failure of treatment. But in that case, I saw the patient yesterday. I see that the repaired cartilage tissue is completely integrated and held in place. Next week, I will remove the screws, and then I hope the patient will grow back his original cartilage, which is the best cartilage repair that you can get. He can go back to go playing tennis, I think, in the next three to six months. So this is a typical characteristic knee cartilage injury situation. You can sometimes go to the limit of treatment methods. But you can address all biological aspects of cartilage repair that are important for success. Then there is a chance to heal the injury in the situation, which initially looks much worse. And OCD means Osteochondral Defect? What does OCD abbreviation stand for? Yes, OCD means an osteochondral defect. It means osteochondrosis dissecans. That is the term that means there is a nutrition problem in the subchondral bone. Over time patients with OCD (osteochondrosis dissecans) lose a big part of the femoral condyle. So OCD is damage to the cartilage plus subchondral bone. OCD is like a necrotic area between the cartilage and bone. And even after such extensive injury, this professional tennis athlete can return to the competitive play? I think the key factor in this patient is the healing of the subchondral bone. That looks very good on the MRI when I saw it. So repaired cartilage is completely integrated. There is no gap between the transplanted or implanted cartilage [and uninjured cartilage]. Repaired cartilage is attached to the subchondral bone. That’s the main point. And this patient has kept his original tissue, which is the best possible [method to treat cartilage injury]. So for that reason, I expect that he can go back to professional sport. Yes.

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