Knee large osteochondral defects (OCD) in young adults are associated with functional impairment and reduced quality of life, most common etiologies include osteochondritis dissecans (OCD) or recent trauma. Currently there is an ongoing debate on the best treatment, where patient age, physical activity and etiology should be considered for the appropriate treatment. Here we present a case of a 39-year-old man who experienced severe left knee pain with significant limitation in mobility and was unable to bear weight. Importantly the clinical presentation started after an arthroscopic anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstruction. A knee MRI revealed a structural osteochondral lesion of the medial femoral condyle of 25 mm length × 15 mm wide × 10 mm deep that affected over 50% of the loading zone of the medial femoral condyle with a reabsorption of the graft from the previous ACL reconstruction. The osteochondral defect in the medial condyle perfectly aligned with the anterior cruciate ligament femoral tunnel. This young man was diagnosed with an iatrogenic structural osteochondral defect in the medial condyle, and he was treated with matrix-induced autologous chondrocyte implantation (MACI) and autologous bone grafting using the segmental sandwich technique. Recovery was evaluated via magnetic resonance imaging (MRI) and the Modified Cincinnati Knee Rating System (mCKRS). The case: • Severe left knee pain with limited mobility in a young man after an arthroscopic procedure • Large iatrogenic structural osteochondral defect in the medial condyle • Two stage surgery with matrix-induced autologous chondrocyte implantation with autologous bone grafting in a segmental sandwich technique. Lessons learned: • Iatrogenic osteochondral lesions are still frequent, cautions should be taken when undergoing arthroscopy while the drill is under power. • A thorough and systematic evaluation of the knee, including the cartilage and subchondral bone are essential for proper diagnosis, considering previous medical information. • A definitive two stage surgery with matrix-induced autologous chondrocyte implantation and autologous bone grafting might be an effective and definite repair technique, as it can offer a rapid recovery specially in young patients with higher demands. Level of evidence: V.
Osorno-Aimar et al. (Sun,) studied this question.