患者病史

The patient was diagnosed with medial grade V arthrosis 和左膝半月板磨损。他接受了左膝关节磨蚀性软骨成形术和骨微穿孔术——一种旨在刺激软骨重建的常规干预。

However, 10 weeks after surgery，患者状况显著恶化。出现明显膝关节肿胀和剧烈疼痛。患者失去了左腿承重能力，被迫使用拐杖。 The knee joint became completely non-functional. Development of osteonecrosis of the medial femoral condyle was diagnosed — a complication threatening joint loss.

诊断

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

手术报告 — MBRAR®方法

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疗法F (Concentrated Growth Factors) — 来自患者静脉血的浓缩物，富含血小板、生长因子和抗炎因子
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®

图片1、3、5、7（2016.01.12）对应术前状态。图片2、4、6、8（2017.06.02）——MIBRAR®后18个月状态。复查影像中骨坏死和骨髓水肿不可检出。半月板和软骨层完全恢复。

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.

治疗结果

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. 膝关节 fully functional.

After 18 months

复查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.

长期

To this day, the patient has no complaints. 过着积极的生活方式，参与体育运动。在V级关节退变和骨坏死情况下不可避免的关节置换术不再需要。

病例意义

This case is particularly indicative as it demonstrates MBRAR® capabilities in a situation where conventional surgery had already been performed and led to complications. 微穿孔磨蚀性成形术——一种公认的刺激软骨再生的方法——不仅未能产生效果，反而引发了骨坏死的发展。

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疗法F and Lipogems® can trigger regenerative processes even in terminal arthrosis stages with concurrent bone necrosis — a situation considered irreversible in classical orthopedics.