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.
Patellofemoral instability might br a challenge sometimes. Here we present the case of a 31 year old patients who had been operated twice in the previous year. One year ago, he underwent on a tibial tubercle (TT) medialization and medial patellofemoral ligament (MPFL) reconstruction. After failure, his surgeons decided to advance the vastus medialis 6 months later. The patient showed up to my office with a chronically dislocated right patella, unable to flex more than 40º and with an absolute invalidating condition. I then performed this complex surgery, where his trochlear dysplasia was corrected with a trochleoplasty, the failed MPFL with a new reconstruction and also a large medialization of the TT.
A 29-year-old patient with multiple predisposing factors of patellar instability is presented. In this complex case, multiple surgical techniques were performed concomitantly to restore the knee to a state as anatomical and physiological as possible. The patient used to complain of continuous recurrent dislocation, recurrent effusion, and moderate pain.
In this patient, three treatments were performed in the same surgery. The patient had a chronic tear of the anterior cruciate ligament and a symptomatic genu valgus with a lesion of the cartilage in the medial femoral condyle. Therefore, a reconstruction of the ACL with semitendinous tendon, a valgus tibial osteotomy and a combination of nanofractures -to promote the filling of the chondral defect with progenitor cells of the bone marrow-, and the application of a chitosan gel in the surface of the defect -to stabilize the stem cells coming from the bone marrow- were performed.