Arthroscopic Autologous Minced Cartilage Implantation for Subchondral Insufficiency Fracture of the Knee.

Abstract

Subchondral insufficiency fracture of the knee, previously known as spontaneous osteonecrosis of the knee, commonly affects the medial femoral condyle and may progress to subchondral collapse and eventually osteoarthritis. Joint-preserving options for focal medial femoral condyle lesions remain limited, particularly in middle-aged patients with concomitant meniscal pathology. We describe an all-arthroscopic technique using autologous minced cartilage implantation to treat a focal chondral defect overlying a medial femoral condyle subchondral insufficiency fracture of the knee. After diagnostic arthroscopy and meniscal repair, unstable cartilage is debrided to stable margins; the debrided cartilage is harvested and mixed with platelet-rich plasma to form a composite. The defect is filled with the composite, which is then stabilized using fibrin sealant. The procedure provides a cost-effective, minimally invasive solution with no donor site morbidity to treat subchondral insufficiency fracture of the knee with the aim of joint preservation.