Historial del paciente

The patient was diagnosed with medial grade V arthrosis y desgaste del menisco de la rodilla izquierda. Se sometió a artroplastia abrasiva del cartílago y microperforación ósea de la rodilla izquierda — una intervención convencional dirigida a estimular la reconstrucción del cartílago.

However, 10 weeks after surgery, el estado del paciente empeoró significativamente. Se desarrolló hinchazón pronunciada de la rodilla y dolor severo. El paciente perdió la capacidad de apoyar la pierna izquierda y se vio obligado a usar muletas. The knee joint became completely non-functional. Development of osteonecrosis of the medial femoral condyle was diagnosed — a complication threatening joint loss.

Diagnóstico

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

nforme quirúrgico — Método 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) — concentrado de la sangre venosa del paciente, enriquecido con plaquetas, factores de crecimiento y factores antiinflamatorios
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®

Imágenes 1, 3, 5, 7 del 12.01.2016 corresponden al estado preoperatorio. Imágenes 2, 4, 6, 8 del 02.06.2017 — estado 18 meses después de MIBRAR®. En los controles, la osteonecrosis y el edema de médula ósea no son detectables. Menisco y capa cartilaginosa completamente restaurados.

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.

Resultados del tratamiento

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. Articulación de rodilla fully functional.

After 18 months

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

A largo plazo

To this day, the patient has no complaints. Lleva un estilo de vida activo, participa en deportes. El reemplazo articular, inevitable con artrosis grado V y osteonecrosis, no fue necesario.

mportancia del caso

This case is particularly indicative as it demonstrates MBRAR® capabilities in a situation where conventional surgery had already been performed and led to complications. La artroplastia abrasiva con microperforación — un método reconocido para estimular la regeneración del cartílago — no solo no produjo resultados sino que provocó el desarrollo de osteonecrosis.

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.