48yo male pt who had had an Gustilo IIIb open fracture of the left patella and lateral tibial plateau, including a large loss of soft tissue and most of the lateral femoral condyle. A soft tissue vascularized flap was needed to cover the defect.
The surgical steps were:
-Tibial tuberosity osteotomy to enlarge the approach
-Fresh osteochondral allograft transplantation of the LFC
-The lateral fibular ligament and the popliteus tendon was kept in the graft, and fixed distally in the fibular head and in the posterolateral corner of the tibia, respectively.
-The TT was fixed back
-Postoperatively, the patient was non-weightbearing for 3 months, and full ROM was encouraged from day 1.
This is the surgical technique performed in a 36-year-old patient who, after a medial subtotal meniscectomy performed 4 years ago, began with invalidating medial knee pain. In this compartment she developed early osteoarthritis and a varus deviation of 4º. As such, the following surgical techniques were performed:
a) FRESH osteochondral transplantation with the Arthrex BioUni instrumentation specifically designed for asymmetric lesions of the femoral condyles.
In cases of contained injuries of the articular cartilage of the knee, many treatment’s alternatives can be considered. Some involve 2 surgical procedures. A technique that can be performed in a single surgery is the use of scaffolds that help the different products that are combined to stay in the injury space without getting leaked in other sides of the joint. This mesh can be mixed with stem cells, PRP, iliac crest concentrates, or other biologic products. However, no differences have been established with the simplest nanofractures. In this technique, a refinement of the popular and too aggressive microfracture, small holes of 1 mm in diameter are made at the bottom of the lesion, so that bone marrow progenitor cells are oriented in the defect. They then differenciate into collagen-like cells and promote the synthesis of a fibrocartilaginous tissue within the previously placed scaffold. In this case of a 15-year-old patient with a OCD of the medial femoral condyle, a mesh of hyaluronic acid (HYALOFAST) was used.
This is the case of a 32-year-old patient who had had 6 previous meniscal surgeries including a meniscal transplantation 13 years earlier. She presented with invalidating pain, and she was unable to perform activities of daily living. She use to need strong pain killers as well as crutches, since she had had a motorcycle accident 1 year before. In this video, the injured medial aspect of her right knee join is seen. It was performed, using FRESH osteochondral allograft, transplantation of the medial tibial plateau including its meniscus, a cylinder in the medial femoral condyle and a valgus osteotomy to unload the transplanted tissue and recover its physiological valgus alignment.
On Saturday May 16, 2020, the webinar organized by the Colombian ACCART took place. In it, doctors Brian Cole, Ramón Cugat and Pablo Gelber spoke about the different treatment options for knee joint cartilage. In this video you can see the talks given by Dr Cole (in English) and Dr Gelber (in Spanish).
This Thursday, March 19, during the strict confinement due to the pandemic that affects worldwide due to the coronavirus, at the online medical teaching platform Aware Doctor, Doctor Gelber offered his enormous experience in fresh osteochondral allograft transplantations of the knee. This topic, in which he is a world reference, is the most appropriate treatment for serious injuries of the articular cartilage, in order to avoid prostheses in young patients. The 60 minutes-online seminar consisted of a 30-minute presentation. Then, Dr. Gelber answered all the questions and doubts from hundreds of orthopedists from around the world, who followed his explanations with great attention. You can watch the entire webinar in the following window.