التاريخ المرضي

The patient was diagnosed with medial grade V arthrosis وتآكل الغضروف الهلالي للركبة اليسرى. خضع لرأب المفصل الكاشط للغضروف والتثقيب الدقيق للعظم في الركبة اليسرى — تدخل تقليدي يهدف إلى تحفيز إعادة بناء الغضروف.

However, 10 weeks after surgery, تدهورت حالة المريض بشكل كبير. تطور تورم واضح في مفصل الركبة وألم شديد. فقد المريض القدرة على تحمل الوزن على الساق اليسرى واضطر لاستخدام العكازات. The knee joint became completely non-functional. Development of osteonecrosis of the medial femoral condyle was diagnosed — a complication threatening joint loss.

التشخيص

Status post surgery (abrasive arthroplasty + microperforation) on the left knee joint — with complications
Grade V arthrosis — terminal stage of cartilage degeneration, subchondral sclerosis
Bone marrow edema — sign of active inflammatory process and overload
Osteonecrosis of the medial femoral condyle — avascular necrosis with risk of articular surface collapse
Medial meniscus degeneration — multiple degenerative changes of the body and horns of the meniscus

التقرير الجراحي — طريقة MBRAR®

Procedure performed on 29.01.2016 at the MIBRAR clinic (Munich) under Prof. Dr. med. Arsen Babayan. Outpatient, under local anesthesia.

ntra-articular transplantation of autologous regenerative concentrates into the left knee joint cavity
ntraosseous transplantation — targeted injection of concentrates into the osteonecrosis area of the medial femoral condyle via microperforations
ntrameniscal transplantation — injection into the medial meniscus degeneration zone
CGF (Concentrated Growth Factors) — مركز من الدم الوريدي للمريض، غني بالصفيحات وعوامل النمو والعوامل المضادة للالتهاب
Lipogems® (microfragmented adipose tissue) — preparation with high concentration of mesenchymal stem cells and regenerative substances
njection sites: medial femoral condyle, medial meniscus, left knee joint space

MR Scans Before and 18 Months After MBRAR®

الصور 1، 3، 5، 7 من 12.01.2016 تتوافق مع الحالة قبل العملية. الصور 2، 4، 6، 8 من 02.06.2017 — الحالة بعد 18 شهراً من MIBRAR®. في صور المتابعة لا يُكتشف النخر العظمي ووذمة نخاع العظم. الغضروف الهلالي وطبقة الغضروف مستعادة بالكامل.

Knee MR: meniscus degeneration — before and 18 months after MBRAR®

mages 1–2: Medial meniscus degeneration before surgery. After 18 months — meniscus fully regenerated without resection.

Knee MR: cartilage wear — cartilage restoration after MBRAR®

mages 3–4: Medial compartment cartilage wear. After 18 months — new cartilage layer, joint space restored.

Knee MR: bone marrow edema — resolved after MBRAR®

mages 5–6: Fluid accumulation and bone marrow edema. After 18 months — complete normalization, edema absent.

Knee MR: sagittal slice — structural regeneration after MBRAR®

mages 7–8: Overall knee joint view — confirmation of full reconstruction of all damaged structures.

نتائج العلاج

After 4 weeks

Complaints completely ceased. The patient was able to walk independently — without crutches, without pain medication, without walking limitations.

After 8 weeks

The patient resumed full sports activities without any limitations. مفصل الركبة fully functional.

After 18 months

الرنين المتابعة (02.06.2017) confirmed: osteonecrosis and bone marrow edema not detectable. Meniscus fully regenerated, cartilage layer restored. Full reconstruction of all damaged joint structures.

على المدى الطويل

To this day, the patient has no complaints. يعيش حياة نشطة ويمارس الرياضة. استبدال المفصل، الحتمي مع تآكل درجة V والنخر العظمي، لم يكن مطلوباً.

أهمية الحالة

This case is particularly indicative as it demonstrates MBRAR® capabilities in a situation where conventional surgery had already been performed and led to complications. رأب المفصل الكاشط مع التثقيب الدقيق — طريقة معترف بها لتحفيز تجدد الغضروف — لم تفشل فحسب بل أثارت تطور النخر العظمي.

With grade V arthrosis and osteonecrosis, the standard indication is total knee joint replacement. MBRAR® not only avoided joint replacement but achieved full regeneration: at 18 months, MR confirmed osteonecrosis resolution, meniscus and cartilage restoration.

This case confirms that autologous regenerative concentrates CGF and Lipogems® can trigger regenerative processes even in terminal arthrosis stages with concurrent bone necrosis — a situation considered irreversible in classical orthopedics.