Case Report: Three-dimensional planning for autologous osteoperiosteal transplantation in the treatment of a massive osteochondral defect of the medial femoral condyle.

Background: Extensive osteochondral defects of the knee, which often cause pain, functional impairment, and potential osteoarthritis, are commonly treated with established strategies such as osteochondral autograft and allograft transplantation. Autologous osteoperiosteal transplantation has emerged as a promising alternative. However, a notable evidence gap exists regarding its application for large osteochondral defects in the knee. Case presentation: Here, we present a case study of a 21-year-old male farmer with a significant osteochondral defect located on the medial femoral condyle. To achieve a precise match with the anatomical surface geometry of the medial femoral condyle, three-dimensional printing technology was employed to create an autologous osteoperiosteal graft harvested from the ipsilateral iliac crest. This graft was subsequently utilized to repair the large osteochondral lesion. At 22 months postoperatively, the patient exhibited substantial clinical improvement, as evidenced by a Lysholm Knee Score of 90. Follow-up imaging revealed complete integration of the graft with the surrounding bone and restoration of articular congruency. The patient successfully returned to normal activities without experiencing pain or swelling. Conclusion: This case report demonstrates the successful application of three-dimensional planning for autologous osteoperiosteal transplantation to achieve precise restoration of a massive osteochondral defect in the medial femoral condyle. Favorable postoperative function outcome and good integration of the graft were observed. Therefore, this case provides an alternative therapeutic option for such complex osteochondral defects. Nevertheless, larger studies with long-term follow-up are needed to evaluate the effectiveness and potential complications of this novel technique.