Name: IntraOsseous BioPlasty® Procedure for a Patellar Bone Marrow Lesion
Uploaded: 2020-08-17T00:00:00Z
Channel: Arthrex
Description: Jack Farr, MD (Indianapolis, IN), presents a patient with a bone marrow lesion of the patella treated with the IntraOsseous BioPlasty ® procedure. Dr. Farr has used the IOBP ® technique extensively in his practice and relies on the surgical approach to treat symptomatic subchondral bone lesions resulting from several indications.

Jack Farr, MD (Indianapolis, IN), presents a patient with a bone marrow lesion of the patella treated with the IntraOsseous BioPlasty® procedure. Dr. Farr has used the IOBP® technique extensively in his practice and relies on the surgical approach to treat symptomatic subchondral bone lesions resulting from several indications.

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VID1-001196-en-US | A | IntraOsseous BioPlasty® Procedure for a Patellar Bone Marrow Lesion

Jack Farr

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Chirurg:innen präsentieren einen oder mehrere klinische Fälle

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IntraOsseous BioPlasty® Procedure for a Patellar Bone Marrow Lesion

Hi, I'm Jack Farr. I'm from Indianapolis, Indiana, and I'm going to present a case of intraosseous bioplastic of the patella. Over the past three years, I've performed approximately 70 knot at the patella. But patella, medial condyle, medial tibial plateau. And it has really added an essential component to my armamentarium on treating patients knee pain. I've shown before. If you want to look at the other cases, people that had more of a degenerative type of knee, and so that lesion was from overload of the degenerative process. This is a case of a young individual. She had chondrocytes of the patella that was treated elsewhere with a microfracture. She continued to have pain and then had an arthroscopic plasty one year later and now presented to me with retro patellar pain, mild effusion, and had to decrease her activity as a result. So on preoperative imaging, you can see on this T2 fat suppressed equivalent a rather intense bone marrow lesion focus at the median ridge, which is in the region of her articular cartilage damage. So what would you do? Well, I've been treating cartilage damage for many years. And my first thought would. Well, maybe I can do cell therapy. Well, I don't like a large bone marrow lesion if I'm going to do cell therapy. Type of cartilage restoration. Osteochondral allograft. And the median ridge is somewhat daunting, especially in a 17 year old. So I would like to treat this bone marrow lesion. So my plan was to actually perform an arthroscopy stage the cartilage lesion, measure it, grade it. And then at the same setting in addition to a biopsy I'd also like to treat the interosseous lesion with bioplastic. You can see I'm using a guide pin with triangulation using the sagittal and axial views of of the MRI. I'm able to place the pin right where the lesion corresponds. Then I'm over drilling it. In the case of the patella, I'm using a 3.5 drill. Some other people have used bioplastics with up to a seven millimeter drill. And I would discourage that at the patella. I think from a medial tibial plateau that's a different matter. But we're all concerned about patellar fractures, especially in light of what happens with some drilling after mpfl reconstruction. So there's the intraoperative photos. This is just a small video. This video will show my intraoperative technique for a patellar injection. The circle is the anterior superior iliac spine. I'm going five centimeters posterior to that. I'm tapping in my cannula. That's first with a sharp obturator. I'm going to aspirate very quickly trying to pull the first 2 to 3 mils out. And then I'll reinsert my blunt obturator. Tap it further. Re aspirate. So I'm trying to get that first 3 or 4 mils. Process it with a Angel system. Now I'm holding the patella and placing a guide pin. I'm over drilling. And then I have a 3.5. Now I'm inserting a cannula into that prepared 3.5 drill hole. And you can see I'm injecting Acting with some difficulty when adding DBM, it does make it thicker, so many times you'll inject a CC and then use the blunt obturator to further inject it. The rehab protocol I would use very much the same if they had any type of a stress fracture, so we're trying to keep them off of it. In the case of the patella lesion, it's not loaded in full weight bearing with full extension. So I place them in a brace there at the full extension. They're able to be off crutches when they're comfortable enough. I'd like for them to stay off stairs squats for at least three months, and then before they go back to high level activity, I'd like for at least six months to pass. This is 12 month follow up. And just to remind you, here's the pre-op that we showed you before and the post-op. So in this case, she was still waiting to undergo a cartilage restoration procedure as she was asymptomatic at that time. And I think with most of us, we don't treat asymptomatic patients.

IntraOsseous BioPlasty® Procedure for a Patellar Bone Marrow Lesion

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IntraOsseous BioPlasty® Procedure for a Patellar Bone Marrow Lesion

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Orthobiologics

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IntraOsseous BioPlasty^® (IOBP) Technique