Bone graft substitute plug failure with giant cell reaction in the treatment of osteochondral lesions of the distal femur: a report of 2 cases with operative revision.

Although the treatment of symptomatic osteochondral lesions remains the focus of many orthopaedic clinicians, controversy remains regarding treatment choices and indications. Recently, the use of synthetic bone graft substitute composite plugs has been described to treat bone void lesions. We report 2 cases in which bone graft substitute plugs were used to graft bone defects in the knee and subsequently failed, requiring revision surgery. At revision arthroscopy, failure of incorporation was noted with foreign-body giant cells on histologic evaluation. Our technique for site debridement, revision bone grafting, and osteochondral resurfacing is presented.