Abstract
One of the most important factors influencing therapeutical decisions in orthopaedic surgery are long-term results. Although, osteochondritis dissecans (o.c.d.) of the femoral condyles is the most often occurring location little is known about long-term results. Furthermore, it is of interest to see the time course of such patients regarding the development of secondary osteoarthritis. Thus, it was the aim of our study to re-analyse patients suffering from o.c.d. of the femoral condyle which had been operated have been followed up after a medium time-intervall.
Material & methods: 97 of 147 with o.c.d. of the femoral condyles which were operated using different surgical techniques depending on the stage were followed-up clinically (Lysholm-Score) & radiologically (Arcq- classification/Tapper- & Hoover-score for OA). Results were analysed depending on the age, stage and surgical technique. In 2nd follow-up ten years after the first follow-up patients were reexamined with the same clinical and radiological scores.
Results: At 1st follow-up we found a median Lysholm-Score of 83.7 (21–100, SD 19.6) pts.. Regarding the OA-changes in 56.3% no changes, in 21.9 % 1°-changes, in 3.1% 3°-changes, in 6.3 % 3°-changes & in 12.5 % 4° changes. The mean stage postop. was 0.97 SD 1.4. Ten years later similar results were found: in 56.3% no osteoarthritic changes were seen. 1°-changes were found in 21.9%, 2°-changes in 3.1% and 3°-changes in 6.3% and severe OA 4°-changes were found in 12.5%. In comparison to the 1st follow-up at the 2nd follow-up no individual changes could be detected in 73 %, a slight impairment in 11.5 % & a slight improvement in 15.4%. In most of the patients osteoarthritic changes were slight & did not show a severe impairment after a mean of 20.3 years.
Depending on the age (the stage of the growth plate open vs. closed) adolescents exhibited no or slight oa-changes in 83.3% & moderate changes in 16.7%. Severe oa-changes were not detectable. Adults exhibited a distinct higher incidence of oa (no o.-a.: 37.5%/1°: 25%/2°: 12.5% 3°:/12.5%/4°:12.5%). Regarding the surgical technique retrograde technique leaving the cartilage layer intact resulted in distinct better results than those perforating the cartilage layer.
Conclusion: Best long-term results with a low incidence of OA are to obtain in cases with o.c.d. with intact cartilage layer not necessitating cartilage damage. Worst results are seen in adult patients with 4°-lesions.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
