Hasta Öyküsü

The patient was diagnosed with medial grade V arthrosis ve sol diz ekleminde menisküs aşınması. Sol diz ekleminde abraziv kıkırdak artroplastisi ve kemik mikroperforasyonu uygulandı — kıkırdak rekonstrüksiyonunu stimüle etmeyi amaçlayan konvansiyonel bir müdahale.

However, 10 weeks after surgery, hastanın durumu önemli ölçüde kötüleşti. Belirgin diz eklemi şişliği ve şiddetli ağrı gelişti. Hasta sol bacağına yük bindiremez hale geldi ve koltuk değneği kullanmak zorunda kaldı. The knee joint became completely non-functional. Development of osteonecrosis of the medial femoral condyle was diagnosed — a complication threatening joint loss.

Tanı

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

Ameliyat Raporu — MBRAR® Yöntemi

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) — hastanın venöz kanından elde edilen, trombositler, büyüme faktörleri ve antiinflamatuar faktörlerle zenginleştirilmiş konsantre
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®

12.01.2016 tarihli 1, 3, 5, 7 numaralı görüntüler preoperatif duruma karşılık gelir. 02.06.2017 tarihli 2, 4, 6, 8 numaralı görüntüler — MIBRAR® sonrası 18 ay. Kontrol taramalarında osteonekroz ve kemik iliği ödemi tespit edilemiyor. Menisküs ve kıkırdak tabakası tamamen restore edilmiş.

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.

Tedavi Sonuçları

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. Diz eklemi fully functional.

After 18 months

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

Uzun vadeli

To this day, the patient has no complaints. Aktif bir yaşam sürdürüyor, spor yapıyor. Evre V artroz ve osteonekrozda kaçınılmaz olan eklem protezi gerekmedi.

Vakanın Önemi

This case is particularly indicative as it demonstrates MBRAR® capabilities in a situation where conventional surgery had already been performed and led to complications. Mikroperforasyonlu abraziv artroplasti — kıkırdak rejenerasyonunu stimüle etmek için tanınmış bir yöntem — sadece sonuç vermekle kalmadı, osteonekroz gelişimini de provoke etti.

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.