title: Midterm Results of a Combined Biological and Mechanical Approach for the Treatment of a Complex Knee Lesion.
abstract: OBJECTIVE
  Complex fractures of the tibial plateau are difficult to treat and present a high complication rate. The goal of this report is to describe a combined biological and mechanical approach to restore all morphological and functional knee properties.
  
  
  METHODS
  We treated a 50-year-old woman, who was affected by a posttraumatic osteochondral lesion and depression of the lateral tibial plateau with knee valgus deviation. The mechanical axis was corrected with a lateral tibial plateau elevation osteotomy, the damaged joint surface was replaced by a recently developed biomimetic osteochondral scaffold, and a hinged dynamic external fixator was applied to protect the graft and at the same time to allow postoperative joint mobilization.
  
  
  RESULTS
  A marked clinical improvement was documented at 12 months and further improved up to 5 years, with pain-free full range of motion and return to previous activities. The MRI evaluation at 12 and 24 months showed that the implant remained in site with a hyaline-like signal and restoration of the articular surface.
  
  
  CONCLUSIONS
  This case report describes a combined surgical approach for complex knee lesions that could represent a treatment option to avoid or at least delay posttraumatic osteoarthritis and more invasive procedures.
authors.affiliation: III Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Filardo
authors.affiliation: III Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Di Martino
authors.affiliation: III Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Kon
authors.affiliation: III Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Delcogliano
authors.affiliation: III Clinic, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Marcacci
keywords: complex knee lesion; dynamic external fixator; osteochondral scaffold