CHOICE OF OPERATIVE METHODS FOR OSTEOCHONDRITIS DISSECANS OF THE FEMORAL CONDYLES

Abstract

The outcomes of various operative methods for osteochondritis dissecans of the femoral condyles were reviewed, and choice of these operative methods were discussed.

Twenty-four cases (19 males and 5 females) which underwent operative treatments were reviewed. The operative methods included drilling, repositioning and fixation of the osteochodral fragment, and bone graft or osteochondral graft. The minimum follow-up period was two years. The medial femoral condyle was involved in 17 cases, and the lateral, in seven. Lateral discoid meniscus or meniscal injury was combined in all the 7 cases in the lateral. The operative methods were decided from the condition of the cartilage. Drilling was performed in cases with no or minimal cartilage damages (10 cases). Repositioning (if required) and fixation of the fragment using absorbable pins was carried out in cases with a partial or total fragmentation (7 cases). Bone graft or osteochondral graft was performed when the original site was already degenerated (7 cases). Partial meniscectomy was added when the meniscal injury was combined.

In patients who received drilling, the lesion healed radiographically in all the cases and they complained of no or minimal symptoms. In patients who received the fragment fixation, re-union of the fragment was observed in 71% and the clinical outcomes were satisfactory in most of the cases. In patients who received bone graft or osteochondral graft, although union of the graft was observed in all the cases radiographically, 71% of the patients complained of residual pain.

From the results, drilling is sufficient if the cartilage surface is not damaged. When the fragmentation occurred already, the fragment should be repositioned and fixed to the original site before degenerated, as its clinical symptoms were much better than those with bone graft or osteochondral graft.