Focal Resurfacing Implant to Address Symptomatic Chondral Lesion From Osteonecrosis

Background: Osteonecrosis of the knee is an uncommon but potentially debilitating condition.Surgical treatment is often dictated by lesion size and disease stage, with joint-preserving procedures favored in younger patients.The OvertureTi Knee Resurfacing System (Overture Orthopaedics), a focal resurfacing implant composed of a 3-dimensional-printed titanium nitride femoral component, is designed to address symptomatic osteochondral defects while preserving native joint anatomy.Case Report: A 27-year-old female developed left knee pain during treatment of chronic right knee osteonecrosis.Imaging showed reduced vascularity of the left lateral femoral condyle, consistent with an osteochondral defect with underlying osteonecrosis.Given her age, activity level, and desire to maintain joint function, the patient underwent resurfacing of the lesion with a 17-mm OvertureTi implant.The patient was immediately weight-bearing after surgery, with physical therapy beginning on postoperative day 2. At 15-month follow-up, radiographs demonstrated stable implant position without complications.Clinically, the patient's pain severity decreased by 29%, while her Knee injury and Osteoarthritis Outcome Score (KOOS) pain score improved from 75.0 to 91.67.Improvements were also noted in International Knee Documentation Committee, KOOS sport, and KOOS quality of life scores, with gains maintained through final follow-up.Conclusion: This case demonstrates focal resurfacing with the OvertureTi Knee Resurfacing System as a viable joint-preserving option for symptomatic osteonecrosis of the knee in a young, active patient.Early and intermediate outcomes were improved pain, function, and quality of life scores with preservation of native joint structures.Synthetic resurfacing may serve as an intermediary treatment between biologic joint-preservation procedures and arthroplasty in appropriately selected patients.