Management of Isolated Tibial Plateau Defect in the Setting of Anterior Cruciate Ligament Reconstruction and Meniscus Repair: A Case Report and Review of the Literature

TL;DR

This case report describes using MACI to treat a tibial plateau defect alongside meniscus repair and ACL reconstruction, showing successful recovery.

Contribution

The paper presents a novel application of MACI for tibial plateau defects in combination with ACL and meniscus procedures.

Findings

The patient showed excellent recovery with pain resolution and return to sport within 10 months.

Outcome scores returned to preinjury levels by 8.5 months post-surgery.

The miniopen MACI technique is suggested to address anatomic challenges effectively.

Abstract

Purpose: Our work describes the use of matrix-induced autologous chondrocyte implantation (MACI) for a lateral tibial plateau osteochondral defect, in the setting of a concomitant meniscus repair and anterior cruciate ligament (ACL) reconstruction. To our knowledge, there is minimal research describing the application of MACI for cartilage defects of the tibial plateau, which brings about its own challenges.

Methods: A 26-year-old male presented with lateral right knee pain and instability following a soccer injury. A bucket-handle lateral meniscus tear, 2 cm by 2 cm osteochondral defect of the lateral tibial plateau, and complete ACL tear were identified on magnetic resonance imaging (MRI). Our case vignette describes a two-stage MACI procedure for an osteochondral defect of the lateral tibial plateau with concurrent all-inside meniscus repair and ACL reconstruction using bone-patellar tendon-bone (BTB) autograft.

Results: Follow up period was 20 months with excellent patient satisfaction and resolution of pain. Outcome measures (International Knee Documentation Committee (IKDC)) and Knee Injury and Osteoarthritis Outcome Score (KOOS) returned to preinjury levels at 8.5 months. Return to sport was achieved at 10 months postoperatively.

Conclusion: The miniopen MACI procedure provides a logistically reasonable technique mitigating the anatomic challenges of tibial plateau osteochondral defects and potentially providing improved long-term outcomes. It is our hope that this work will contribute to the current understanding of the treatment options for osteochondral defects of the tibial plateau.

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