Anamnesi del paziente

The patient was diagnosed with medial grade V arthrosis e usura meniscale del ginocchio sinistro. Si è sottoposto ad artroplastica abrasiva della cartilagine e microperforazione ossea del ginocchio sinistro — un intervento convenzionale mirato a stimolare la ricostruzione cartilaginea.

However, 10 weeks after surgery, le condizioni del paziente sono peggiorate significativamente. Si sono sviluppati gonfiore pronunciato del ginocchio e dolore severo. l paziente ha perso la capacità di caricare la gamba sinistra ed è stato costretto a usare le stampelle. The knee joint became completely non-functional. Development of osteonecrosis of the medial femoral condyle was diagnosed — a complication threatening joint loss.

Diagnosi

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

Rapporto operatorio — Metodo 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) — concentrato dal sangue venoso del paziente, arricchito con piastrine, fattori di crescita e fattori antinfiammatori
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®

Immagini 1, 3, 5, 7 del 12.01.2016 corrispondono alla condizione preoperatoria. Immagini 2, 4, 6, 8 del 02.06.2017 — condizione 18 mesi dopo MIBRAR®. Alle scansioni di controllo, osteonecrosi ed edema midollare non rilevabili. Menisco e strato cartilagineo completamente ripristinati.

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.

Risultati del trattamento

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. Articolazione del ginocchio fully functional.

After 18 months

RMN di controllo (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 lungo termine

To this day, the patient has no complaints. Conduce uno stile di vita attivo, pratica sport. La sostituzione articolare, inevitabile con artrosi grado V e osteonecrosi, non è stata necessaria.

mportanza 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. L'artroplastica abrasiva con microperforazione — un metodo riconosciuto per stimolare la rigenerazione cartilaginea — non solo non ha prodotto risultati ma ha provocato lo sviluppo dell'osteonecrosi.

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.