case_images: PMC10800164_01
case_images: Preoperative radiograph of the right knee. The arrows indicate bone and cartilage defects. The dashed line is the Mikulicz line.
case_images: cureus-0016-00000052568-i01.jpg
case_images: PMC10800164_01_cureus-0016-00000052568-i01.jpg
case_images: FIG1
case_images: Imaging findings on simple X-rays (anterior and lateral views) showed a translucent bone image suggesting bone defects with partial osteosclerosis at the medial femoral condyle and concavity of the joint surface (Figure 1).
case_images: Preoperative CT scan
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case_images: PMC10800164_01_cureus-0016-00000052568-i02.jpg
case_images: FIG2
case_images: Standing full-length leg anterior view revealed a hip-knee-ankle (HKA) angle of 12.5  varus (left 6.3  varus), a femorotibial angle (FTA) of 186  (left 180 ), and a percentage of mechanical axis (%MA) of 15% (left 30%), indicating a varus deformity in the right knee (Figure 2).
case_images: Preoperative MRI. The arrows indicate bone and cartilage defects with bone marrow edema.
case_images: cureus-0016-00000052568-i03.jpg
case_images: PMC10800164_01_cureus-0016-00000052568-i03.jpg
case_images: FIG3
case_images: CT scans showed a bone defect at the joint surface of the medial femoral condyle measuring 36 mm in length and 16 mm in width and with a maximum depth of 15 mm (Figure 3).
case_images: Initial arthroscopic findings
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case_images: PMC10800164_01_cureus-0016-00000052568-i04.jpg
case_images: FIG4
case_images: MRI proton density images showed uniform high signals at the bone defect, suggesting bone marrow edema at the medial femoral condyle (Figure 4).
case_images: (A-H) Surgical findings of autologous chondrocyte implantation using the knotless suture bridge technique
case_images: cureus-0016-00000052568-i05.jpg
case_images: PMC10800164_01_cureus-0016-00000052568-i05.jpg
case_images: FIG5
case_images: The cartilage at the medial femoral condyle was detached, with some parts being loose (Figure 5). The detached cartilage at the medial femoral condyle was excised, and the bone defect was thoroughly curetted and freshened until the cancellous bone was exposed (Figure 5A, Figure 5B). Autologous Transplantation (OATS(R)), and bone grafting was performed in the bone defect (Figure 5C), and cancellous bone was packed into the defect (Figure 5D). After bone grafting, a collagen membrane larger than the cartilage defect was shaped and fixed by inserting and securing it along with Arthrex's BioComposite  (BC) PushLock(R) 2.9 mm anchor (Arthrex, Naples, Florida, United States) and 1.3 mm suture tape drilled into the normal cartilage at the center of the lower edge of the cartilage defect. Suture tape was loaded into BC PushLock(R) after drilling on the inner and outer edges below the cartilage defect to create a suture bridge (Figure 5E). After creating the suture bridge up to the central inner and outer edges of the cartilage defect, JACC(R) was transplanted into the bag-shaped defect formed by the collagen membrane (Figure 5F). A suture bridge was created up to the upper inner and outer edges of the cartilage defect, further transplanting JACC(R), and finally, the suture tape from the inner and outer sides was passed through the BC PushLock(R) at the upper central edge of the cartilage defect to fix the collagen membrane, completing the ACI (Figure 5G, Figure 5H).
case_images: Postoperative radiograph of the right knee
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case_images: PMC10800164_01_cureus-0016-00000052568-i06.jpg
case_images: FIG6
case_images: Lastly, alignment correction was performed with a hybrid closed-wedge high tibial osteotomy (HCWHTO) (Figure 6).
case_images: MRI at one year postoperatively. The arrows indicate lesions with autologous chondrocyte implantation.
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case_images: PMC10800164_01_cureus-0016-00000052568-i07.jpg
case_images: FIG7
case_images: Outerbridge Cartilage Repair Assessment (MOCART) score was 80 points (Figure 7). One year after the cartilage surgery, the range of motion improved to -5  extension and 135  flexion.
case_images: Radiograph of the right knee at one year postoperatively. The arrows indicate bone and cartilage defects. The dashed line is the Mikulicz line.
case_images: cureus-0016-00000052568-i08.jpg
case_images: PMC10800164_01_cureus-0016-00000052568-i08.jpg
case_images: FIG8
case_images: Simple X-ray results showed an FTA of 173 , an HKA angle of 0 , and a %MA of 58%, indicating a favorable outcome (Figure 8).