Biointegrative fiber-reinforced implants for fixation of subchondral insufficiency with avascular necrosis: a case report

Abstract

Introduction: Treating avascular necrosis (AVN) of the knee can be challenging, particularly at later stages of progression. After subchondral collapse occurs, the only existing surgical treatment is arthroplasty. In earlier stages of collapse, joint sparing procedures for the treatment of AVN include core decompression, osteotomy with metallic implant fixation, and osteochondral grafting. However, there are no reported cases of using biointegrative nails to directly treat subchondral insufficiency of the femoral condyle due to AVN. Case presentation: In this case, the patient suffered from lateral-sided knee pain and swelling, which affected mobility and activities of daily living. At 6 months postoperatively, following subchondral cortex to cortex implantation of 2 biointegrative nails, the patient achieved full range of motion, and at 1 year, magnetic resonance imaging (MRI) showed improved resolution of edema and bone remodeling around the biointegrative nails. Conclusion: In this case report, we demonstrate a new surgical approach to the treatment of subchondral insufficiency due to AVN. Although the outcomes are positive, a larger sample size should be evaluated for the efficacy of treatment of AVN with biointegrative nails.

Keywords

• Avascular necrosis
• Biointegrative
• Bone marrow aspirate concentrate
• Case report
• Subchondral insufficiency