Full thickness cartilage defect and varus alignment


It's not every day that you operate on an internationally renowned sports knee surgeon but I met Ziyad El Qirem, who's one of the leading soft tissue sports knee and shoulder surgeons in the middle east at the trauma and innovation forum in Florida where I was speaking in January 2017.

Ziyad is a very fit and active gentleman who really enjoys his sport, particularly wake boarding and when he is not working he is busy enjoying himself in Jordan doing very physical activities. He tore his ACL in 2009 and had it reconstructed in 2011 and things looked good. He went on to make an excellent recovery but towards the end of last year he experienced a sudden onset of medial knee pain.

He came up to me - he was one of the delegates - and introduced himself and showed me his MRI scan which showed a very nasty full thickness cartilage defect affecting the medial femoral condyle of his right knee.

He obviously thought about his options and had heard good things about the osteotomy surgery I had carried out, so when we met in Florida in January he asked if I could take a look at him.

full thickness cartilage defect

His MRI is quite impressive, with this full thickness lesion on the medial femoral condyle, which was 20mm by 10mm.

cartilage defect post acl

Varus with full-thickness cartilage lesion

His ACL was beautifully stable but his alignment is varus and unfavourable on this side, whereas he is neutral on the normal side, so he has fallen into varus as a result of his cartilage lesion. He did and does tick all the boxes for osteotomy combined with cartilage surgery.

Surgery - HTO plus collagen patch

So we organised things and he came over from Jordan on the weekend and yesterday I took him to theatre and carried out a combined high tibial osteotomy using my minimally invasive technique with a precision bone wedge and opened the knee having looked first arthroscopically and carried out a cartilage procedure using the latest in cartilage technology with a ChondroGide porcine collagen patch which I sewed into the defect after first having made some very tiny holes using a 'nano-fracture device' which is microfracture using a very small fine tool.

Then having cleaned the cartilage defect which as I say was 20x9 mm and quite rectangular in shape, I did the nanofracture and sewed in the patch and then filled it with PRP which I injected underneath the patch and into the knee in the osteotomy site.

However, I've just been to see him - it is always a little nerve-wracking when you go and see someone who is high profile like this - but he is delighted and I am delighted. It is just day one following this surgery.

He has virtually no pain - he rates it at 2 out of 10 at the most - he has already been walking around, he has no swelling, he can flex his knee to 120 degrees and has an excellent straight leg raise. I think the GameReady has worked very well - he is impressed with that, as am I, and so far so good so he is very happy to do a blog with us about it.

At 2 months...

And this is Ziyad at 2 months post HTO and Chondro-Gide cartilage procedure!

At 4 months...

At 4 months the MRI scan looks fantastic. His area of damage has filled in very nicely and is no longer visible on the scan - that's where I did a microfracture and ChondroGide collagen patch.

pre-osteotomy post acl

Adrian Wilson

It's great to start the day when you go in and see a patient with such an amazing result with what are very large surgical procedures. I'm very proud of the technique that we have developed and it does seem in a significant number of patients to allow them to get through this surgical procedure with no pain.

Varus with cartilage defect

Pre-osteotomy long leg films
(poor photograph)

osteotomy wedge

Showing the extent of the opening wedge during surgery

high tibial osteotomy - old_ACL

Showing the osteotomy plate in situ

Leave a Comment: