Authors: Ivan Alejandro Perez Kalejman , Mariano Garcia Bistolfi , Juan Pablo Zícaro , Carlos Yacuzzi , Matías Costa-Paz

Abstract

Background: Avascular osteonecrosis (AVN) is an idiopathic condition characterised by subchondral ischemia leading to subsequent articular collapse. It can manifest as primary, secondary, or post-surgical. Bone marrow aspirate and concentrate (BMAC) represents a composite of mesenchymal stem cells with robust self-renewal and differentiation capabilities, employed as a surgical adjunct to enhance the healing process.
Case Presentation: Presented herein is a case of a 16-year-old male with a history of acute lymphocytic leukemia and extended corticosteroid therapy, developing AVN in the lateral femoral condyle and concurrent articular cartilage delamination. Arthroscopic repositioning of the chondral fragment was undertaken, complemented by the application of BMAC. Rehabilitation efforts focused on reinstating joint mobility and fostering knee proprioception. At the 1-year postoperative follow-up, the patient reported a pain level of 2/10 on the visual analog scale, an International Knee Documentation Committee score of 88 points, and radiographic evidence indicating consolidation.
Conclusion: The integration of BMAC in knee AVN, coupled with subchondral decompression and chondral fragment repositioning, emerges as a viable treatment option, yielding promising short-term clinical outcomes.

Keywords: BMAC, case report, avascular necrosis, leukemia, osteochondral fragment reposition, bone marrow aspiration