Case 15 yo male just diagnosed with MED

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Presentation transcript:

Case 15 yo male just diagnosed with MED Initially presented 6 months ago with diffuse R knee pain MRI showed medial and lateral distal femur lesions that were stable. Treated non-op with activity modification and did well for awhile…

Just represented with… After trying to play tennis he had immediate pain and swelling. Repeat MRI is shown on the next slide. LFC posterior lesion is now unstable.

Questions? Does anybody have experience with OCD lesions in patients with MED? I am leaning towards fixing possibly arthroscopically. If I need to open, I may bone graft with proximal tibia bone graft. I am concerned about how posterior this lesion is that it may be difficult to access either open or arthroscopically. Any thoughts? With a lesion this posterior (it looks to engage around 45 degrees of flexion) would anybody just debride? Would anybody go straight to an osteochondral allograft given his MED? He is in slight valgus 3 degrees. Is it worth considering a DFO for this small angular deformity?