Surgical Technique and Postoperative Management

After the preoperative planning, the SCP procedure was performed with the patient in supine position under spinal anesthesia.

According to preoperative planning, the entry point of the cannula was marked on the skin with the aid of fluoroscopy on both frontal and lateral view. A skin incision was then performed and the cannula introduced until the bone. A second check with the aid of the fluoroscopy was done to identify the proper entry point. The cannula was then introduced and drilling was continued until it reached the lesion. A fluoroscopic check was done to control the exact position of the cannula and to assess that all the three holes of the side-delivery cannula were deep to the cortex and oriented in the desired direction.

The AccuFill Bone Substitute Material (ETEX Corporation, Cambridge, Massachusetts, United States) was then prepared until the proper viscosity was reached and introduced into the injured area, checking its distribution with the aid of fluoroscopy ( Fig. 2 ).

Intraoperative fluoroscopic anteroposterior (AP) image showing the placement of the cannula and the diffusion of the calcium phosphate (CaP) in the medial femoral condyle.

After the SCP procedure, arthroscopy was performed to check the intra-articular leakage of the bone substitute and to evaluate and address intra-articular pathology such as chondral flaps, loose bodies, and degenerative meniscal tears.

The postoperative management consisted of partial weight-bearing with the aid of crutches for 1 week and then full weight-bearing was allowed without any restrictions in terms of range of motion. Return to daily-life activities was encouraged as soon as tolerated.