Symptomatic osteochondritis dissecans (OCD) and traumatic osteochondral fractures (OCF) are treated with fixation with either metal or bioabsorbable device. We performed a comparative review of patients with OCD and traumatic OCF stabilised with Bio-Compression screws which are headless absorbable compression screws. Our aim was to determine whether there was a difference in outcomes between presentations. Retrospective single-centre cohort study of all patients with OCD and OCF treated with Bio-Compression screw between July 2017 and September 2022. All patients followed up until discharge with satisfactory clinical outcome. Primary outcome was return to theatre for ongoing pain or mechanical symptoms. Secondary outcome was evidence of fixation failure on follow-up MRI scan.Abstract
Introduction
Methods
This study aimed to evaluate the clinical outcomes of paediatric patients who underwent a retrograde drilling treatment for their osteochondritis dissecans (OCD) of the talus. The secondary purpose was to identify factors that are predictive of a failure of the treatment. A retrospective study was done. All patients treated for talar OCD between 2014 and 2017 were reviewed to extract clinical and demographic information (age, sex, BMI, OCD size and stability, number of drilling, etc). Inclusion criteria were: (1) talar OCD treated with retrograde drilling, (2) less than 18 years, (3) at least one available follow up (4) stable lesion. Exclusion criteria was another type of treatment for a the talar OCD. Additionally, all pre-operative and post-operative medical imaging was reviewed. Outcome was classified based on the last follow-up appointment in two ways, first a score was attributed following the Berndt and Harty treatment outcome grading and second according to the necessity of a second surgery which was the failure group. Chi-square and Mann-Whitney tests were used to compared the success and failure group. Seventeen patients (16 girls and 1 boy, average age: 14.8±2.1 years) were included in our study group. The mean follow up duration was 11.5 (±12) months. Among this population, 4/17 (24%) had a failure of the treatment because they required a second surgery. The treatment result grading according to Berndt and Harty outcome scale identified good results in 8/17 (47%) patients, fair results in 4/17(24%) patients and poor results in 5/17 (29%) patients. The comparisons for various patient variables taken from the medical charts between patients who had a success of the treatment and those who failed did not find any significant differences. At a mean follow-up duration of 11.5 months, 76% of patients in this study had a successful outcome after talar OCD retrograde drilling. No statistically significant difference was identified between the success and failure group. Talar OCD in a paediatric population is uncommon, and this study reviewed the outcome of retrograde drilling with the largest sample size of the literature. Retrograde drilling achieved a successful outcome in 76% of the cases and represents a good option for the treatment of stable talar OCD.
1. One hundred patients with osteochondritis dissecans of the knee have been reviewed. Sixty-eight were male. Unilateral lesions were found in seventy-four. The average age at onset of symptoms was eighteen years. 2. The outstanding etiological feature was found to be direct injury to the joint surface (46 percent), repeated injuries sustained in first class athletics and field sports, and mechanical abnormalities of the knee. 3. Osteochondral fracture was found in seven cases. 4. The results of various types of treatment are described and a plan of management outlined.
1. This is a small series and patients have been treated in a variety of ways. Some impressions emerge, however, concerning the importance of initial trauma, the importance of the factor of heredity and the results of treatment. 2. More than 40 per cent of the patients in the series had an injury to the knee before symptoms began, which tends to support the traumatic theory. Twenty of the twenty-three patients who gave a past history of trauma had a lesion on the medial condyle, next to the intercondylar notch, and one patient of the three who had lesions on the lateral femoral condyle suffered from recurrent dislocation of the patella. 3. Although numerous examples have been reported in the literature of osteochondritis dissecans occurring in several members of a family, the family history of only one patient in this series suggested a familial tendency, and this was doubtful. It seems that patients showing a familial tendency are not commonly seen compared with the number of patients presenting with osteochondritis dissecans. 4. It is often stated that osteoarthritic changes will follow if part of the articular surface is lost, as in osteochondritis dissecans, and this belief has led to the school of thought which advocates restoration of the articular surface by reposition of the fragment. While there is no doubt that this method should be used if a large proportion of the weight-bearing surface of a femoral condyle is affected, the argument has less force if a small area is affected. It is interesting to find that of the five patients treated by replacement of a separated fragment four developed osteoarthritis, whereas in the first series only six patients out of the twenty-two developed such changes. Although these former had what appeared to be an accurate reposition of the fragment it is possible that a "step up" on the joint surface was produced, which gave rise to a more rapid deterioration of the articular cartilage. Accurate conclusions cannot be drawn from five patients, but it may be that attempts to reconstruct the articular surface of a femoral condyle can, over a long period of time, give worse results than simple removal of the lesion. 5. The group of patients treated conservatively gave encouraging results, and improved radiographic appearances were seen in most cases. There was also a notable absence of osteoarthritic changes and these results support the view that conservative treatment is indicated in adolescents and children.
Both osteochondritis dissecans and coxa plana are diseases with identical pathological changes, namely avascular necrosis. Although the etiology is not known in either case, it seems likely that when the etiological factors are fully determined they will prove to be applicable to either condition. The relative importance of each etiological factor in the multiple pathogenesis of these two conditions is almost certainly different in each disease process, and probably in each individual case. Present day concepts suggest that there is an underlying constitutional disturbance, which is associated with other factors (of which trauma is almost universally accepted as being one; perhaps the only one), to predispose the individual to these conditions. It is hoped that further studies along these lines will not only help to provide a better understanding of the two conditions mentioned above, but will also be of value in the appreciation of the pathogenesis and etiology of a large number of disturbances including such varied conditions as dysplasia epiphysialis multiplex congenita, cretinoid dysgenesis of the capital femoral epiphysis, adolescent coxa vara, transient synovitis of the hip, and the recently discussed (Merle d'Aubigné 1964) idiopathic avascular necrosis of the femoral head in adults. That there is an etiological relationship between osteochondritis dissecans and coxa plana seems clear, but much more work is required before we will have at hand the patho-physiological evidence that will permit an accurate correlation of these two conditions.
Osteochondritis dissecans occurring bilaterally in either the knees or the elbows is recorded in four members of one family. The suggestion is supported that the underlying pathology may be developmental, resulting in a form of localised osteochondrodystrophy.
1. The pathological anatomy of osteochondritis dissecans of the hip is described, and its causation is discussed. 2. Eight new cases are reported. 3. The problems of treatment are considered.
1. The record is presented of an attempt to treat osteochondritis dissecans on idealistic lines. 2. The operative technique to be adopted in the various circumstances likely to be encountered in the knee joint is described. Two cases affecting the talus are recorded. 3. The radiological appearance has become virtually normal in twenty-seven cases (the remaining four are recent); healing has been observed directly in seven cases in which a second operation to remove the means of internal fixation was necessary; and the patients' complaints have been eliminated, but the long term results of treatment are unknown. 4. Suggestions are made for possible developments in the technique of operation.
1. A family, in which ten members of the second and third generations had osteochondritis dissecans, is described. 2. It is probable that the disease also occurred in the first and fourth generations.
Nine cases of osteochondritis dissecans of the elbow and knee in three generations of the same family are described. There was clear evidence of a dominant inherited factor.
1. Three patients suffering from osteochondritis dissecans in several joints, and all below average height, are described. 2. There was evidence of a constitutional upset in each case. 3. It is suggested that there was an underlying endocrine imbalance at puberty.
Autologous chondrocyte transplantation has become a possible solution for the treatment of chondral knee lesions. Recently an autologous tissue engineered cartilage (Hyalograft C), using biodegradable scaffolds for cell proliferation, was successfully developed. In osteochondritis dissecans (OCD) the lesion also involves subchondral bone. For this reason we began to use a two-step technique: arthroscopic autologous bone grafting followed by autologouos condrocyte Hyalograft C transplantation after 4–6 months. We treated five patients affected by OCD. All the patients were clinically evaluated and analysed according to the International Repair Cartilage Society score at 12 and 24 months. The ICRS score showed highly satisfactory clinical results in all treated patients at 12 and 24 months; CT and MRI evaluation had demonstrated a good articular surface reconstruction with complete bone defect restoration at a short 12-month follow-up period. The autologous chondrocyte transplantation provides highly satisfactory clinical results. This second-generation autologous tissue-engineered cartilage transplantation avoids the use of periosteal flap, simplifies the surgical procedure and permits use of an arthroscopic approach. In association with autologous bone grafting, bone loss can also be restored in order to recreate a perfect articular surface. The preliminary clinical and histological results are encouraging but longer follow-up is required to better evaluate this technique.
1 . Two cases of osteochondritis dissecans after Legg-Calvé-Perthes' disease observed for thirty years are described. 2. Osteochondritis dissecans of the hip can remain in an apparently unchanged state for many years and in these two patients is associated with excellent function, not requiring surgery.
A case of osteochondritis dissecans complicating Legg-Calvé-Perthes' disease is reported. Despite four years of conservative treatment in an ischial-bearing caliper a part of the fragmented femoral head failed to unite with the rest of the epiphysis and has persisted as an intra-articular loose body. Freehafer (1960) listed the indications for surgical removal of this fragment in such cases: 1) persisting symptoms; 2) dislocation of the loose fragment into the joint with secondary arthritic changes inevitable; 3) a mechanical block to movement of the hip. Since our patient had a relatively symptomless hip with a full range of movement, surgical removal of the loose body was not advised. The prognosis for this hip is nevertheless guarded, and surgery can be reserved for the above indications or for reconstructive procedures should they be required in the future.
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.
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.
1. A case of osteochondritis dissecans of the hip in a young girl who at the age of one and a half years underwent open reduction of congenital dislocation of the hip, is reported. 2. The possible relationship between this condition and the osteochondritic changes which followed the reduction is discussed.
1. In sixty mature rabbits osteochondral fractures of various types were made in the medial femoral condyle. 2. The fractures or fragments which remained stable united but those in which movement occurred progressed to non-union. 3. An ununited osteochondral fragment resembled osteochondritis dissecans in the human both radiologically and histologically. 4. Experiments in the cadaveric knee show that the patella articulates with the classical site on the intercondylar aspect of the medial femoral condyle in full flexion of the joint and here an osteochondral fracture could be sustained. 5. It is concluded that the fragment in osteochondritis dissecans follows an osteochondral fracture which remains ununited.
1. A case of flake fracture of the talus progressing to osteochondritis dissecans is reported. 2. The relationship between direct injury and the onset of the lesion is noted. 3. The sequence of events was observed radiographically and clinically for two years from the date of the original injury.
Three cases of osteochondritis dissecans of the knee in two brothers and a sister are described. In the brothers both knees were involved. None of the other joints of the skeleton was affected in any of the patients.
Surgical treatment is standard for advanced osteochondritis dissecans (OCD) of the humeral capitellum. When cartilage is seen to be separated or completely detached, this fragment fixation is not usually applied. There have been reports of cases in which advanced OCD of the humeral capitellum progressed to osteoarthritis (Fig), particularly in cases which involved the lateral wall. In these cases, every attempt should be made to reconstruct the lateral wall to avoid osteoarthritis. In this study, we followed up cases with rib osteochondral autograft transplantation technique. Subjects were 20 cases who were followed up until after they started pitching. The mean age was 13.8 years old and the mean observation period was 2 years and 6 months (from 7 months to 6 year 3 months). Kocher's approach was used to give a good access to the aspect of the radiohumeral joint. The majority of cases suffered from extensive OCD of the elbow. Detached fragment was removed (Fig. 2a) and graft from 5th or 6th rib with screw fixation was performed on 12 patients and 8 received fixation with no material (Fig. 2b). Follow-up assessment included the range of motion, start time of playing catch and throwing a ball with full power, sports activity, evaluation of radiography, a subjective (including Pain, Swelling, Locking/Catching and Sport activity) and objective (Flexion contracture, Pronation/Supination and sagittal arc of motion) modified elbow rating system by Timmeman et al. We also investigated the details of the arthroscopy observations and the 2nd arthroscopy findings for 4 cases.Objectives
Methods
Afterwards arthroscopy with transplantation of autologous osteochondral grafts was performed. An osteomy of the medial malleolus was necessary by 4 patients. Non weight bearing and continuous passive motion for 6 weeks was advised.
Osteochondritis dissecans (OCD) is a localised disorder of subchondral bone and the overlying articular cartilage. The most commonly used classification systems involve arthroscopy and MRI.
To investigate the correlation between arthroscopic and MR findings in patients with OCD of the talus.
16 ankles in 14 patients with radiographically proven OCD were reviewed. Nine were male and five female. Mean age was 35yrs (range 18–64yrs). The lesions were staged independently using the Guhl
Arthroscopically there were eight stable and eight unstable lesions. Of the eight stable lesions, MRI staged five as stable and three as unstable. Of the eight unstable lesions, MRI staged six as unstable and two as stable. This gives a sensitivity of diagnosing unstable lesions as 0.75, with a specificity of 0.63.
This small study demonstrates that MR scans may have some limitations in classifying OCD lesions of the talus. Possible explanations are discussed. We propose that MRI findings, of OCD of the talus, should not be taken in isolation, but correlated with the patients symptoms and signs to avoid unnecessary arthroscopy.
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.
The purpose of this study was to describe a clinical evaluation of the etiological factors in osteochondritis dissecans (OCD) of the knee from radiographic and arthroscopic findings. Twenty-two knees of 20 patients (16 male and 4 female, 16.1 years old in average at surgery) with symptomatic OCD of the femoral condyle were studied. The medial femoral condyles were affected in 16 knees of 14 patients (medial group) and the lateral femoral condyle in 6 knees of 6 patients (lateral group). These two groups were compared using radiological location and arthroscopic findings. In radiography, the location of OCD was classified in accordance with Cahill et al. (1989). On the anteroposterior view, five zones were numbered 1 to 5 from medial to lateral. On the lateral view, three zones were labeled A,B and C from anterior to posterior. In the medial group, the locations of OCD were 23BC(12), 2BC(1), 23ABC(1) and 23C(2); 14(88%) of 16 knees involved in non-meniscal area. In the lateral group, the locations of OCD were 45C(4), 5C(1) and 4BC(1); 5(83%) of 6 knees involved in meniscal area. In arthroscopy the medial group did not have medial meniscal tear, while the lateral group had 5 lateral meniscal lesions of 6 knees; 3 discoid meniscus (2 with tear and 1 without tear), 2 bucket-handle type tear and one no meniscal lesion. Lateral meniscal lesions (with or without discoid) might cause OCD of the lateral femoral condyle. In the medial femoral condyle, we thought that OCD did not relate to meniscal lesions.
1. Two cases of osteochondritis dissecans affecting several joints are described. 2. There is no evidence that injury, congenital anomaly or constitutional disturbance played any part in the etiology of either case.
Although described by Gattelier and Chastang in 1924, the transfibular approach to the ankle has been slow to emerge as a conventional orthopaedic technique. To date, applications have been confined to the treatment of tibiotalar arthrodesis, ankle joint incongruity and exposure of the fractured talus, where the distal fibula is also fractured. While seemingly undocumented, it is also proving effective in mosaic-plasty of the talus. This paper outlines an innovative technique of segmental distal fibula osteotomy and its role in the treatment of osteochondritis dissecans of the postero-lateral talar dome.
The purpose of this study is to describe a surgical procedure for unstable osteochondritis dissecans (OCD) of the capitellum and its results. Between 1992 and 1997, 11 elbows of 11 patients with OCD of the capitellum were treated in our institution. The average age at surgery was 14.7 years and the ages ranged from 12 to 16 years. All patients were male baseball players affected in the throwing side. The follow-up period was from 31 to 95 months (average: 57 months). All patients underwent internal fixation using the pull out wiring method and bone graft (this procedure was established by Kondo in 1989). All lesions of OCD were not only softening or cracked but also unstable with early separation or partially detached fragment. After surgery, a long arm cast was applied for 3 weeks. After confirming bony union of OCD by X-ray, the wires were removed ranged from 15 to 21 weeks (average 17 weeks) postoperatively. Throwing activity was allowed 6 months after surgery. At the follow-up, all patients were relieved pain and all except one returned to previous throwing levels. Radiographs showed good healing of OCD and minimum degenerative changes were found in only a few joints. We concluded that this surgical procedure was an effective treatment for adolescent baseball players with unstable OCD of the capitellum.
To determine if there are osteochondritis dissecans (OCD) lesions of the knee that are so unstable on MRI that they are incapable of healing without operative intervention. A secondary objective was to determine the ability of orthopaedic residents to accurately grade OCD lesions according to the Kijowski criteria of stable and unstable. A retrospective review was performed of patients who had femoral condyle OCD lesions from 2009-present. Only patients with open growth plates and serial MRIs were included. Each MRI was classified according to the Kijowski classification by a junior orthopaedic surgery resident as well as an MSK trained radiologist. A weighted kappa value was used to assess the inter-rater agreement. The final analysis included 16 patients (17 knees) with 49 MRI's. The weighted kappa agreement between reviewers for overall lesion stability was moderate (0.570 [95% CI 0.237–0.757]). The initial MRI lesion was graded as stable in 59% (10/17) of the knees. Two of these 10 knees became unstable during the study period, however, both stabilised again on subsequent MRIs, one with surgery and the other without surgery. The initial MRI was graded as unstable in 41% (7/17) of the knees. Two of the seven knees (29%) later demonstrated MRI evidence of lesion stability without surgical intervention. The most important finding in this study was the ability of unstable OCD lesions on MRI to heal without operative intervention. The ability of an orthopaedic surgery resident to grade these lesions on MRI was moderate.
Familial osteochondritis dissecans (FOCD) is an inherited defect of cartilage and bone characterized by development of large cartilage lesions in multiple joints, short stature and early onset osteoarthritis. We have studied a family from Northern Sweden with FOCD over five generations. All affected family members have a heterozygous missense mutation on exon 17 of the aggrecan gene, resulting in a Val-Met amino acid replacement in the G3 aggrecan C-type lectin domain (CLD). Aggrecan, a major proteoglycan of articular cartilage produced by chondrocytes, has a large protein core richly substituted with sulfated glycosaminoglycan chains. The unique structure, its high concentration within the cartilage extracellular matrix and its ability to form a supermolecular complex with hyaluronan and bind to other matrix proteins all profoundly influence the biomechanical properties of the tissue. Deletion of CLD in a chick aggrecan construct was found to influence its secretion from chondrocytes and human aggrecan constructs carrying the V2303M mutation showed diminished interactions with the ECM proteins tenascin-R, fibulin-1 and fibulin-2. To investigate the pathogenesis of FOCD, we studied chondrogenic differentiation of patient bone marrow mesenchymal stem cells and induced pluripotent stem cells. We demonstrated that the mutation results in accumulation of unfolded or misfolded aggrecan within the lumen of the chondrocyte endoplasmic reticulum. Associated with this is the failure to assemble a normal extracellular matrix. This explains the susceptibility of these patients to cartilage injury and the degenerative changes that lead to early onset osteoarthritis.
We treated a patient with extensive osteochondritis dissecans of the elbow by an osteochondral graft from a rib. It had consolidated seven months after operation. When seen at follow-up, after seven years and eight months, the elbow was free from pain with an improvement in the range of movement of 24°.
To assess the use of autogenous osteochondral graft fixation (mosaicplasty) in unstable osteochondritis dissecans (OCD) lesions (Clanton type 2 and 3) of the knee. Eleven patients with x-ray and N4R1 confirmed OCD lesion in their femoral condyle, that had remained symptomatic despite adequate conservative treatment, underwent arthroscopic mosaicplasty plug fixation of the lesion. The OCD lesions were all loose at operation and were all fixed rigidly in situ. using a number of autogenous 4. 5min osteochondral plugs harvested from the edge of the trochlear groove. The patients were prospectively assessed both clinically and by MRI scan at 3, 6 and 12 months and then six monthly. Average follow up was 2. 7 years (2 – 4. 1). Prior to operation all patients had joint effusions and were experiencing pain limiting their activities. By 6 months post-operation the IKDC score had returned to normal in all cases and none of the patients had joint effusions or pain. Serial NHU scans documented healing of the osteochondral plugs and a continuous articular cartilage surface layer in all cases by 9 months. Using mosaicplasty plug fixation we were able to obtain healing in all 1 1 unstable OCD lesions. The benefits of this technique are the ability to obtain rigid stabilization of the fragment using multiple plugs, stimulation of the subchondral blood supply and autogenous cancellous bone grafting. We conclude that mosaic-plasty plug fixation of unstable OCD lesions in the knee is a good technique and recommend its use. Eleven patients with an unstable osteochondritis dissecans lesion (OCD) in their femoral condyle underwent in situ arthroscopic osteochondral graft fixation (mosaicplasty) of the lesion using a number of 4. 5min plugs harvested from the trochlear groove. By 6 months follow-up all of the patients were pain free with no joint effusion and by 9 months all had NW evidence of plug healing and continuous articular cartilage coverage. The benefits of this technique are the ability to obtain rigid stabilization, stimulation of the subchondral blood supply and cancellous bone grafting. We conclude that mosaic-plasty fixation of OCD lesions is a useful technique.
Introduction: (OCD) is characterized by bone necrosis and softening of the overlying cartilage, which may separate and displace. It is thought to be secondary to trauma, ischaemia or abnormal epiphyseal ossification. Management remains controversial during the early stages of the disease. Surgery for advanced chondral lesions with loose bodies however remains a challenge. Options that include periosteal graft and autologous chondrocyte transplantation have been used with variable degrees of success. This study investigates the efficacy of these techniques and the use of mesenchymal stem cells to treat advanced chondral lesions found in OCD in animal models. Materials and Methods: A full thickness articular cartilage defect (6mm long, 3mm wide and 1mm deep) was created in the weight-bearing surface of medial femoral condyle in 22-week old NZW rabbits. A total of 90 knees were randomly divided into 3 groups as follows: 1) Transfer of cultured chondrocytes 2) Transfer of cultured periosteum-derived MSCs and 3) Repair by periosteal graft with their contralateral knees as control. The rabbits were allowed to move freely in their cages. The rabbits were sacrificed at 2, 6, 12, 24 and 36 weeks post-operatively. The healing of the defects was assessed by gross examination and histological grading and subjected biomechanical testing. Results: Gross and histological examination at 36 weeks post operation (Wakitani et al grading), the mean score for Group 1 is 2.5, Group 2 is 2.3 and Group 3 is 4.5 with control group of 8.9 in terms of cell morphology, matrix staining, surface regularity, thickness of repaired cartilage and integration of cartilage to adjacent host. Biomechanically by indentation test, Group1 had value of 0.22 MPa, Group 2 0.20 MPa, Group 3 0.16 MPa and Control group of 0.12 MPa. Conclusion: The findings suggested that cultured chondrocytes and mesenchymal stem cells had comparable enhancing effect of the repair of chondral defect in advanced OCD
Introduction
We attempted to characterise the biological quality
and regenerative potential of chondrocytes in osteochondritis dissecans
(OCD). Dissected fragments from ten patients with OCD of the knee
(mean age 27.8 years (16 to 49)) were harvested at arthroscopy.
A sample of cartilage from the intercondylar notch was taken from
the same joint and from the notch of ten patients with a traumatic
cartilage defect (mean age 31.6 years (19 to 52)). Chondrocytes
were extracted and subsequently cultured. Collagen types 1, 2, and
10 mRNA were quantified by polymerase chain reaction. Compared with
the notch chondrocytes, cells from the dissecate expressed similar
levels of collagen types 1 and 2 mRNA. The level of collagen type
10 message was 50 times lower after cell culture, indicating a loss
of hypertrophic cells or genes. The high viability, retained capacity
to differentiate and metabolic activity of the extracted cells suggests
preservation of the intrinsic repair capability of these dissecates.
Molecular analysis indicated a phenotypic modulation of the expanded
dissecate chondrocytes towards a normal phenotype. Our findings
suggest that cartilage taken from the dissecate can be reasonably
used as a cell source for chondrocyte implantation procedures.
Purpose: An Osteochondral defect in the knees of young active patients represents a challenge to the orthopedic surgeon. Early studies on allogenic cartilage transplantation showed this tissue to be immunologically privileged, showed fresh grafts to have hyaline cartilage, and surviving chondrocytes present several years after implantation. Method: Since January 1978 until October 1995 we enrolled 72 patients in a prospective non-randomized study of fresh osteochondral allografts in our institute. Ten international patients which were lost to follow-up were excluded. The major indications for the procedure were: patients younger than 60 years of age having post-traumatic unipolar defects larger than three cm in diameter and one cm in depth. Results: Sixty two patients, ages 11–57 (mean 28) were followed for 15–31 years (mean 20.4 years). The etiology for the osteochondral defect was traumatic injury to the knee in 41 patients (66%),