Osteochondral lesion of lateral tibial plateau with extrusion of lateral meniscus treated with retrograde osteochondral autograft transplantation and arthroscopic centralisation

Abstract

Background: Extrusion of the meniscus has been reported to be correlated with progression of osteoarthritis. In cases with osteochondral lesions after extrusion of the meniscus, meniscal transplantation was the only surgical intervention. Recently, a novel procedure called arthroscopic centralisation has been developed to restore the meniscus function by centralising the midbody of the extruded meniscus onto the rim of the tibial plateau using suture anchors.

Case report: A combination of novel techniques-retrograde osteochondral autograft transplantation to retain hyaline articular cartilage and arthroscopic centralisation to restore residual meniscal function-was used to repair an osteochondral lesion of the lateral tibial plateau possibly caused by extrusion of the lateral meniscus. Good clinical and radiographic outcomes were achieved at the 2-year follow-up.

Conclusion: A combination of retrograde osteochondral autograft transplantation and arthroscopic centralisation can be a good option to treat the osteochondral lesion of the tibial plateau caused by extrusion of the meniscus.

Keywords: arthroscopic centralisation; extrusion; lateral meniscus; osteochondral transplantation; tibial plateau.

Figure 1

(A) Preoperative X-ray, (B) coronal, and (C) sagittal views of preoperative computed tomography showed the osteochondral lesion with bone cysts and a free body on the lateral tibial plateau.

Figure 2

(A) Coronal and (B) sagittal views of preoperative MRI showed the osteochondral lesion on the lateral tibial plateau (blue arrows) and 4-mm extrusion of the lateral meniscus with degenerative change in the anterior part (orange arrows). MRI = magnetic resonance imaging.

Figure 3

Arthroscopic findings. (A)The osteochondral lesion, 10 mm × 10 mm in size, on the lateral tibial plateau was covered with fibrous tissues (arrow), and the free body was also included in the fibrous tissues. (B) The anterior to middle part of the lateral meniscus was degenerated and elongated. (C) Displacement of the lateral meniscus was confirmed by pushing the midbody of the meniscus out of the rim of the lateral tibial plateau using a probe.(D) The osteochondral plug, the chondral surface of which was oriented 45° obliquely, was inserted into the tibial tunnel in a retrograde fashion, and its cartilage surface was matched to the surrounding cartilage of the lateral tibial plateau (arrow). (E) The midbody of the lateral meniscus was sutured at the margin between the meniscus and the capsule to the lateral edge of the lateral tibial plateau using two JuggerKnot Soft Anchors (Biomet) (arrowheads). (F) Extruded meniscus was centralised after stabilisation of the midbody of the lateral meniscus. LFC = lateral femoral chondyle; LM = lateral meniscus.

Figure 4

Postoperative findings at 3 months after surgery. (A) Computed tomography showed good adaptation and union of the graft (white arrow). (B) Coronal and (C) sagittal views of magnetic resonance imaging showed congruent chondral resurfacing of the lateral tibial plateau although the bone plug and low signal intensity in T2 images (blue arrows). The midbody of the lateral meniscus (orange arrow) was well positioned without extrusion.

Figure 5

Postoperative findings at 2 years after surgery. (A) Computed tomography showed complete union of the graft and remodelling of the subchondral bone to be congruent (white arrow). (B) Coronal and (C) sagittal views of magnetic resonance imaging showed healing of the implanted plug (same intensity as surrounding bone, blue arrows), and position of the lateral meniscus was maintained (orange arrow).