tailieunhanh - Chondral Disease of the Knee - part 8

Bệnh nhân là một người đàn ông 36 tuổi người duy trì một chấn thương condyle đùi trung gian của đầu gối trái của mình khi bị ngã xuống từ một Á hậu sóng trực tiếp ấn tượng đầu gối. Ông đã phát triển một tràn dịch lớn, | PATHOLOGY Focal chondral defect medial femoral condyle and varus alignment TREATMENT High tibial osteotomy and autologous chondrocyte implantation SUBMITTED BY Tom Minas MD and Tim Bryant RN Cartilage Repair Center Brigham and Women s Hospital Chestnut Hill Massachusetts USA CHIEF COMPLAINT AND HISTORY OF PRESENT ILLNESS The patient is a 36-year-oId man who sustained an injury to the medial femoral condyle of his left knee when he fell from a wave runner directly striking his knee. He developed a large effusion medial joint pain difficulty walking and had catching and giving-way type symptoms. Arthroscopy was performed that demonstrated a large grade IV chondral defect of his medial femoral condyle which was debrided arthroscopically Figure . A second arthroscopic abrasion arthroplasty followed by a period of nonweight bearing also failed to improve his symptoms. Biopsy for future autologous chondrocyte implantation ACI was then performed. Physical therapy and antiinflammatory medications were also utilized leading to no improvement in his symptoms. PHYSICAL EXAMINATION Height 6 ft 1 in. weight 210 lb. At presentation the patient ambulated with a significant antalgic gait using a cane. Clinical evaluation demonstrated mild varus alignment quadriceps atrophy and a small joint effusion. Range of motion was symmetric and full. His medial femoral condyle was tender to palpation as was his joint line. Meniscal compression testing was unremarkable. His ligament examination was within normal limits. RADIOGRAPHIC EVALUATION Plain radiographs demonstrate early medial joint space narrowing compared to the contralateral knee. Long-leg alignment radiographs demonstrated early peripheral medial osteophyte formation minimal joint space narrowing and mechanical axis falling into the center of the medial compartment Figure . SURGICAL INTERVENTION ACI of the medial femoral condyle was performed for a grade IV defect measuring 45 mm long by 8mm wide Figure . A .