Patient History

The patient was diagnosed with medial grade IV arthrosis and meniscus wear of the left knee joint. He underwent abrasive cartilage arthroplasty and bone microperforation of the left knee joint — a conventional intervention aimed at stimulating cartilage reconstruction.

However, 10 weeks after surgery, the patient's condition significantly worsened. Pronounced knee joint swelling and severe pain developed. The patient lost the ability to bear weight on the left leg and was forced to use crutches. The knee joint became completely non-functional. Development of osteonecrosis of the medial femoral condyle was diagnosed — a complication threatening joint loss.

Diagnosis

Status post surgery (abrasive arthroplasty + microperforation) on the left knee joint — with complications
Grade IV 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

Surgical Report — MIBRAR® Method

Procedure performed on 29.01.2016 at the MIBRAR clinic (Munich) under Prof. Dr. med. Arsen Babayan. Outpatient, under local anesthesia.

Intra-articular transplantation of autologous regenerative concentrates into the left knee joint cavity
Intraosseous transplantation — targeted injection of concentrates into the osteonecrosis area of the medial femoral condyle via microperforations
Intrameniscal transplantation — injection into the medial meniscus degeneration zone
CGF (Concentrated Growth Factors) — concentrate from the patient's venous blood, enriched with platelets, growth factors, and anti-inflammatory factors
Lipogems® (microfragmented adipose tissue) — preparation with high concentration of mesenchymal stem cells and regenerative substances
Injection sites: medial femoral condyle, medial meniscus, left knee joint space

MRI Scans Before and 18 Months After MIBRAR®

Images 1, 3, 5, 7 from 12.01.2016 correspond to the pre-operative condition. Images 2, 4, 6, 8 from 02.06.2017 — condition 18 months after MIBRAR®. On follow-up scans, osteonecrosis and bone marrow edema are not detectable. Meniscus and cartilage layer fully restored.

Knee MRI: meniscus degeneration — before and 18 months after MIBRAR®

Images 1–2: Medial meniscus degeneration before surgery. After 18 months — meniscus fully regenerated without resection.

Knee MRI: cartilage wear — cartilage restoration after MIBRAR®

Images 3–4: Medial compartment cartilage wear. After 18 months — new cartilage layer, joint space restored.

Knee MRI: bone marrow edema — resolved after MIBRAR®

Images 5–6: Fluid accumulation and bone marrow edema. After 18 months — complete normalization, edema absent.

Knee MRI: sagittal slice — structural regeneration after MIBRAR®

Images 7–8: Overall knee joint view — confirmation of full reconstruction of all damaged structures.

Treatment Results

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. Knee joint fully functional.

After 18 months

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

Long-term

To this day, the patient has no complaints. Leads an active lifestyle, participates in sports. Joint replacement, inevitable with grade IV arthrosis and osteonecrosis, was not required.

Case Significance

This case is particularly indicative as it demonstrates MIBRAR® capabilities in a situation where conventional surgery had already been performed and led to complications. Abrasive arthroplasty with microperforation — a recognized method for stimulating cartilage regeneration — not only failed to produce results but provoked osteonecrosis development.

With grade IV arthrosis and osteonecrosis, the standard indication is total knee joint replacement. MIBRAR® not only avoided joint replacement but achieved full regeneration: at 18 months, MRI 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.