title: Donor-site giant cell reaction following backfill with synthetic bone material during osteochondral plug transfer.
abstract: Osteochondral defects are common in younger, active patients. Multiple strategies have been used to treat these lesions, including microfracture and osteochondral plug transfer. We describe a patient experiencing chronic knee pain and a full-thickness cartilage defect on the lateral femoral condyle. After failing conservative management and microfracture surgery, the patient underwent osteochondral autograft plug transfer, with backfilling of the donor sites using synthetic bone graft substitute. Initial recovery was uncomplicated until the patient experienced pain following a twist of the knee. Magnetic resonance imaging for the subsequent knee injury revealed poor healing at the donor sites. The donor sites were debrided, and specimens revealed a foreign body giant cell reaction. Donor-site morbidity is of primary concern during osteochondral plug transfer; however, insufficient data exist to support the use of synthetic bone graft material. Our results indicate that off-label use of synthetic bone graft substitute during a primary procedure requires further investigation.
authors.affiliation: Sports Medicine Division, Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908-0159, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fowler
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Hart
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hart
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
mesh_terms: D000328:Adult; D001182:Arthroscopy; D018786:Bone Substitutes / Q000009:adverse effects*; D016025:Bone Transplantation / Q000379:methods* / Q000473:pathology; D019902:Chondrocytes / Q000637:transplantation*; D003646:Debridement; D005260:Female; D015745:Granuloma, Foreign-Body / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D056687:Off-Label Use
chemical_list: D018786:Bone Substitutes