Focal inlay resurfacing for full-thickness chondral defects of the femoral medial condyle may delay the progression to varus deformity

Abstract

Introduction

Full-thickness chondral defects at the knee joint predispose to the beginning of a degenerative process which final consequence is the compartment collapse and finally the deviation to varus, because the cartilage of the medial femoral condyle is the most frequently affected area. Likewise, people with these chondral defects are more likely to develop tricompartmental osteoarthritis, reason why early surgical management should be the treatment of choice.

The aim of this study was to compare the pre- and post-operative lower limb alignment (mechanical axis), in cases of full-thickness chondral defects of the femoral medial condyle that have been managed by means of a prosthetic focal inlay resurfacing, at a minimum follow-up of five years.

Methods

A retrospective study of patients treated for chondral defects in the medial femoral condyle was performed. The inclusion criteria were patients who had undergone a focal inlay resurfacing and minimum follow-up of 5 years. Patients that required a concomitant valguizing tibial osteotomy were finally excluded. The follow-up analysis was performed by means of radiological examinations performed prior to surgery and at the last follow-up visit. The mean limb mechanical axis of the operated knees was calculated both pre- and post-operatively, and comparisons between these two settings were performed.

Results

Ten patients were included: eight men and two women. The mean age at the time of surgery was 55 (40–65) years. The mean follow-up was 9 years (range 5–15). The mean limb mechanical axis was 1.33 ± 4.16 in the pre-operative setting and 2.40 ± 5.50 in the post-operative setting (p = 0.441).

Conclusion

In the setting of small to moderate size, unique femoral medial condyle full-thickness chondral lesions, filling the defect with an inlay prosthetic resurfacing may protect against the progression to varus deformity.

Level of evidence

Therapeutic case series, Level IV.

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Acknowledgements

Authors would like to thank the Epidemiology Department of Hospital General de Granollers for their collaboration in the statistical calculations done in this study.

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Correspondence to Luis Natera.

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Cases, E., Natera, L., Antón, C. et al. Focal inlay resurfacing for full-thickness chondral defects of the femoral medial condyle may delay the progression to varus deformity. Eur J Orthop Surg Traumatol 31, 57–63 (2021). https://doi.org/10.1007/s00590-020-02746-8

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Keywords

  • Chondral defects
  • Full-thickness
  • Medial condyle
  • Focal inlay resurfacing
  • Knee osteoarthritis
  • Varus deformity