Infected Post-traumatic Bone Defect of the Knee using Bipolar Osteochondral Allograft and 3D Printing: A Case Report

Abstract

Introduction: Transplantation with fresh cadaveric osteochondral allograft (FOCA) is frequently used in defects of the femoral condyle and tibial plateau to preserve the knee joint. However, the use of FOCA in bipolar lesions remains controversial in cases with bipolar defects and a history of infection.

Case report: We present a 21-year-old male patient with a massive post-traumatic osteochondral defect of the lateral compartment of the knee and a history of infection, treated by a two-stage approach. In stage 1, infection was eradicated, and joint function recovered with aggressive debridement, polymethyl methacrylate beads, bone cement spacers, and Judet's quadricepsplasty. In stage 2, transplantation was performed with a bipolar FOCA. All treatments were planned using 3D-printed models.

Conclusion: The two-stage approach and 3D planning can increase the chances of transplant success by preparing the future allograft bed and obtaining an optimal match between the cadaveric allograft and the patient's defect in cases with potential contraindications, such as a bipolar lesion in the femoral condyle and tibial plateau and a history of infection. A combined approach may lead to a more beneficial outcome for the patient to preserve joint function and improve quality of life.

Keywords: 3D planning; Osteochondral allograft; bone defect.

Figure 1

(A) Unstable scar with split-thickness skin graft coverage. (B) Anteroposterior and lateral radiograph of the left femur and knee on admission to the institution.

Figure 2

(A) Computerized axial tomography scan showing the bony defect of the lateral compartment of the left knee. (B and C) Three-dimensional knee mirror reconstruction showing the size of the defect. (D) 3D printing models with cutting guides to regularize the femoral condyle and the external tibial plateau.

Figure 3

(A and B) Post-operative anteroposterior and lateral knee radiograph after the second phase of treatment with cement spacers and Judet’s quadricepsplasty.

Figure 4

(A and B) Panoramic radiographs of lower limbs at 15 months post-trauma before the fresh cadaveric osteochondral allograft transplantation.

Figure 5

Cutting sequence and reconstruction of the bony defect of the lateral compartment of the left knee with a fresh allograft. (A) Bone cement spacer of the femoral condyle and lateral tibial plate. (B) Cutting guide for regularization of the femoral condyle and external tibial plate. (C and D) Fresh articulated osteochondral allograft of the external femorotibial compartment plus osteosynthesis. (E and F) Anatomic reconstruction of posterolateral corner through bone tunnels and ligament reconstruction of lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon with quadriceps tendon autograft plus osteochondral allograft fixation.

Figure 6

Anteroposterior and lateral radiographs of the knee at discharge after reconstruction with fresh cadaveric osteochondral allograft.

Figure 7

Follow-up radiographs at 5 years after transplantation with fresh cadaveric osteochondral allograft.