Medulloscopy-Assisted Surgery for Osteonecrosis of the Knee Following Treatment for Adolescent Leukemia: Mid-term Results.

Abstract

This study aimed to introduce the medulloscopy-assisted autologous bone graft for osteonecrosis of the knee following adolescent leukemia treatment and to report the mid-term clinical and radiological results. We retrospectively reviewed records of eight consecutive knees in six patients with extensive osteonecrosis of the distal femoral condyles, from 2013 to 2015. All patients were treated with autologous bone grafts using medulloscopy. We evaluated functional and objective Knee Society Score (KSS) pre- and postoperatively. Clinical and radiological outcomes were evaluated at the last follow-up. The mean age of the patients at the time of surgery was 21.5 years. The mean follow-up period was 45 months. No additional surgery was required during the follow-up period. The mean objective KSS significantly increased from 60.6 points (range 55-65) to 90.0 points (range 70-95), postoperatively (<i>p</i> < 0.001). The mean functional KSS significantly improved from 48.8 points (range 45-55) to 90.0 points (range 80-100) postoperatively (<i>p</i> < 0.001). No patients had progression of collapse of the femoral condyles at the final follow-up. At the final follow-up, the onset of minimal osteoarthritis was seen in two knees, with a Kellgren-Lawrence grade 1. Medulloscopy-assisted bone grafting can be an effective treatment option for early symptomatic osteonecrosis of knee following treatment for adolescent leukemia.