One-step arthroscopic technique for the treatment of osteochondral lesions of the knee with bone-marrow-derived cells: three years results.
Background Osteochondritis dissecans (OCD) is an idiopathic disease due to a subchondral bone necrosis that generally affects the medial femoral condyle as well as above lying cartilage. The incidence of patients with OCD of the knee aged 6 to 19 years was 9.5 per 100,000 overall and 15.4 and 3.3 per 100,000 for male and female patients, respectively. Bilateral lesions occur in at least 10-12 % of the OCD patients. The typical patient is male (70%), between 6 and 19 years of age who has participated in organized sports, and overall 20-40% of all cases have a history of knee trauma. The etiology has been hypothesized as being multi-factored due to traumas or microtraumas along with metabolic, endocrine and genetic disorders leading to subchondral necrosis. Description of case A 15-year old male amateur soccer player presented to our department complaining of recurrent episodes of pain at rest in both knees, swelling and articular blockage occurring over the past three years. RX and MRI revealed bilateral lesions on both medial condyles. An innovative one-time surgical technique was performed to resolve the disease. Conclusion Here, we describe a rare case of bilateral OCD of the knees where each of the osteochondral lesions was evaluated taking into account results from a physical exam, imaging, and arthroscopy. The patient underwent a surgical approach that incorporated both the withdrawal and transplant of stems into the lesions, the rationale of the "one-time technique" is based on the idea to transfer into the lesion site the entire bone marrow cellular pool; this allows not to loose "regenerative potential" present in the bone marrow and cells to be processed directly in the operating room without the need for a laboratory phase. A radiograph performed at six months showed remarkable results concerning tissue response. This case further highlights past cases regarding results, while it distinguishes itself for the fact that it has been performed on bilateral knees lesions.