Arthroscopic Bone Graft and Screw Fixation

 

MRI

 

Knee OCD Case MRI 1Knee OCD Case MRI 2

 

Plan

 

Probably unstable

- need to mobilise

- debride base

- bone graft

- fix securely in situe

 

Arthroscopy

 

Knee OCD Case 1Knee OCD Case 2Knee OCD Case 3

 

Arthroscope in lateral portal

- instrument through medial portal

- ensure can visualise entire fragment

 

Mobilisation of fragment

 

Knee OCD Case 4Knee OCD Case 6Knee OCD Case 7

 

Lesion carefully mobilised with scaple and probe

- left to lever open inferiorly

- want it to stay partially attached

- need to release some fibres of PCL medially

- insert spinal needle from medial knee to hold fragment open

 

Debride base of lesion

 

Knee OCD Case 8Knee OCD Case 9Knee OCD Case 11

 

Fibrous tissue removed meticulously from femur with curette and shaver

 

Take bone graft from medial tibia

- depends on amount of bony defect

- turn into paste / add blood

- put in small syringe that will fit through AM portal

- cut tip off

 

Use K wire to microfracture

- insert bone graft

- immediately reduce fragment

- secure with K wires for cannulated screws

 

Knee OCD Case 12Knee OCD Case 13Knee OCD Case 14

 

ORIF

 

Knee OCD Case 16Knee OCD Case 18

 

In this case, 2 x Arthrex bioabsorble screws used

- drill and tap over wire

- remove wire

- insert screw and bury head

 

MRI Follow Up

 

Healed OCD MRI Post ORIF