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Case Reports
. 2023 Feb 15:2023:7612206.
doi: 10.1155/2023/7612206. eCollection 2023.

MACI "Sandwich" Technique for a Large Osteochondritis Dissecans Lesion: A Case Report

Bhumit Desai  1 , Graylin Jacobs  2 , Deryk Jones  2
Affiliations
Case Reports

MACI "Sandwich" Technique for a Large Osteochondritis Dissecans Lesion: A Case Report

Bhumit Desai et al. Case Rep Orthop. .

Abstract

There is widespread use of matrix-induced autologous chondrocyte implantation. Initial use of autologous bone grafting in combination with the matrix-induced autologous chondrocyte implantation procedure has shown efficacy in small- to medium-sized osteochondral lesions. This case report demonstrates use of the "Sandwich" technique in a large, deep osteochondritis dissecans lesion of the medial femoral condyle. Technical considerations that are key to containment of the lesion and outcomes are reported.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Bone graft is placed up to the subchondral plate level. Base drilled with 1.5 mm drill bit.
Figure 2
Figure 2
Preoperative radiographs. (a) Posterior-anterior weight-bearing view. (b) Anterior-posterior weight-bearing view. (c) Lateral view.
Figure 3
Figure 3
(a) Hip-to-ankle views. (b) Merchant's patellofemoral view.
Figure 4
Figure 4
Arthroscopy. (a) Loose body removal. (b) Lateral compartment view.
Figure 5
Figure 5
Arthroscopy. (a) Fragmentation medial OCD. (b) Irreparable fragment. (c) Medial posterior OCD. (d) Bone defect/medial wear.
Figure 6
Figure 6
Cartilage biopsy. (a) Lateral intercondylar notch. (b) Needle biopsy. (c) Initial biopsy site. (d) Completed biopsy.
Figure 7
Figure 7
High tibial osteotomy X-rays. (a) Intra-operative mechanical axis. (b) Alignment HTO guide. (c) HTO fixation anterior view. (d) HTO fixation lateral view.
Figure 8
Figure 8
HTO, lesion characteristics. (a) High tibial osteotomy. (b) OCD poorly contained lesion. (c) Prepared lesion site. (d) Bleeding created base lesion.
Figure 9
Figure 9
Bone grafting and first MACI stabilization. (a) Bone graft defect. (b) Fibrin glue base lesion. (c) MACI graft # 1 cell layer up. (d) MACI graft # 1 suture stabilization.
Figure 10
Figure 10
Second MACI stabilization. (a) MACI graft # 2 cell layer down. (b) MACI graft # 2 suture stabilization. (c) MACI graft # 2 sewn. (d) MACI grafts sewn with fibrin glue.
Figure 11
Figure 11
(a) 3-month post-operative posterior-anterior (PA) weight-bearing (WB) view. (b) 3-month post-operative lateral view.
Figure 12
Figure 12
(a) 6-month post-operative PA WB view. (b) 6-month hip-to-ankle WB view.
Figure 13
Figure 13
(a) Right knee IKDC and Lysholm. (b) Right knee KOOS.
Figure 14
Figure 14
Right knee pain VAS.
Figure 15
Figure 15
(a) Left knee IKDC and Lysholm. (b) Left knee KOOS.
Figure 16
Figure 16
Patient short form and multisource feedback.
See this image and copyright information in PMC

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References

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