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CC BY 4.0 · Surg J (N Y) 2021; 07(04): e289-e296
DOI: 10.1055/s-0041-1735602
Case Report

Osteochondral Allograft Reconstruction of the Tibia Plateau for Posttraumatic Defects—A Novel Computer-Assisted Method Using 3D Preoperative Planning and Patient-Specific Instrumentation

Martin Zaleski
1   Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
,
Sandro Hodel
1   Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
,
Philipp Fürnstahl
2   Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
,
Lazaros Vlachopoulos
1   Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
,
Sandro F. Fucentese
1   Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
› Author Affiliations Funding None.
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Abstract

Background Surgical treatment of posttraumatic defects of the knee joint is challenging. Osteochondral allograft reconstruction (OCAR) is an accepted procedure to restore the joint congruity and for pain relief, particularly in the younger population. Preoperative three-dimensional (3D) planning and patient-specific instrumentation (PSI) are well accepted for the treatment of posttraumatic deformities for several pathologies. The aim of this case report was to provide a guideline and detailed description of the preoperative 3D planning and the intraoperative navigation using PSI in OCAR for posttraumatic defects of the tibia plateau. We present the clinical radiographic results of a patient who was operated with this new technique with a 3.5-year follow-up.

Materials and Methods 3D-triangular surface models are created based on preoperative computer tomography (CT) of the injured side and the contralateral side. We describe the preoperative 3D-analysis and planning for the reconstruction with an osteochondral allograft (OCA) of the tibia plateau. We describe the PSI as well as cutting and reduction techniques to show the intraoperative possibilities in posttraumatic knee reconstructions with OCA.

Results Our clinical results indicate that 3D-assisted osteotomy and OCAR for posttraumatic defects of the knee may be beneficial and feasible. We illustrate the planning and execution of the osteotomy for the tibia and the allograft using PSI, allowing an accurate anatomical restoration of the joint congruency.

Discussion With 3D-planning and PSI the OCAR might be more precise compared with conventional methods. It could improve the reproducibility and might allow less experienced surgeons to perform the precise and technically challenging osteotomy cuts of the tibia and the allograft. Further, this technique might shorten operating time because time consuming intraoperative steps such as defining the osteotomy cuts of the tibia and the allograft during surgery are not necessary.

Conclusion OCAR of the tibia plateau for posttraumatic defects with 3D preoperative planning and PSI might allow for the accurate restoration of anatomical joint congruency, improve the reproducibility of surgical technique, and shorten the surgery time.

Keywords

knee - tibia plateau - trauma - patient-specific instrumentation - allograft reconstruction


Publication History

Received: 17 May 2020

Accepted: 23 July 2021

Article published online:
22 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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