Direct comparison of different surgical approaches in a woman with bilateral osteochondrosis dissecans of her knees: a case report

Abstract

BackgroundOsteochondrosis dissecans is a disorder of the subchondral bone potentially affecting the adjacent articular cartilage. There remains disunity with regard to treatment methods.Case presentationWe present the case of a 21-year-old Swiss woman who presented with clinically symptomatic bilateral osteochondrosis dissecans lesions at both medial femoral condyles. She underwent sequential surgical intervention and was prospectively monitored using clinical scores and magnetic resonance imaging. Her left knee was treated with an open refixation of the osteochondrosis dissecans lesion with two 2.0 mm screws in combination with a cancellous bone graft and subchondral drilling since the cartilage of the osteochondrosis dissecans lesion was intact. On her right knee, she underwent open removal of the defective bone and cartilage, cancellous bone graft with subchondral drilling and coverage with a bilayered collagenous membrane (autologous matrix-induced chondrogenesis technique) since the cartilage of the osteochondrosis dissecans lesion was not intact. At final follow-up 12 months after surgery her Lysholm score had improved from 79 to 95 on her left side and from 74 to 78 on her right. Magnetic resonance imaging displayed good integration of the cancellous bone graft with a slight irregularity at the articular surface on her left side (magnetic resonance observation of cartilage repair tissue (MOCART) 75). The magnetic resonance imaging of her right knee depicted satisfying bony reconstitution with yet more irregularity at the joint surface (magnetic resonance observation of cartilage repair tissue 65) in comparison to her left femoral condyle.ConclusionsIn cases of failed conservative treatment of osteochondrosis dissecans lesions of the knee joint surgery should be taken into consideration. Considering this case, we believe that the focus should be the preservation of the cartilaginous layer whenever possible or at least replacement with high quality replacement tissue, such as autologous chondrocyte implantation.

Gel-Based Autologous Chondrocyte Implantation in a Patient with Noncontained Osteochondral Knee Defect at 9-Year Follow-Up

“…As reported, outcome after OD is dependent on the vascular situation and the cartilage surface. The more stable and physiological the cartilage layer, the better the outcome [ 21 ]. However, in this case, we operated a horizontal noncontained cartilage defect with sustained clinical improvement even after 9 years post-ACI.…”

Multiple Osteochondritis Dissecans in Multiple Joints

“…Bilateral knee OCDs might not be so rare, but a case of multiple OCDs occurring in multiple joints is a relatively rare condition. There were 21 cases of OCDs occurring in multiple joints previously reported in the literature, including bilateral knee cases [ 3 , 5 , 6 , 12 – 25 ]. Among them, there was only one case that was reported for the existence of left-right asymmetric OCDs in different joints of the contralateral side of the body.…”

“…Some cases with bilateral knee OCDs have been reported [ 5 , 6 ], but there are no previous cases reported for more than three OCDs occurring in multiple joints. We present a case of a patient who presented with clinically symptomatic multiple OCDs which occurred in multiple joints, including the elbow and knee joint.…”