Fixation with autogenous osteochondral grafts for the treatment of osteochondritis dissecans (stages III and IV)

Abstract

This paper presents a clinical and functional assessment of the cases of osteochondritis dissecans (OCD) treated with small mosaicplasty type osteochondral grafts. Between 1999 and 2004, we operated on 12 knees with OCD stages III and IV. They were assessed using the International Cartilage Research Society (ICRS) scale, the Visual Analogue Scale (VAS) scale, X-ray and magnetic resonance imaging (MRI). The study was carried out using a clinical series, was retrospective and had a level of evidence of 4. Before surgery, all patients were in classes III and IV on the ICRS scale (four in class III and eight in class IV). At the time of surgery, the patient age was 27.5 +/- 7.9 years, with male predominance (75%). Eleven of the cases were assessed as classes I and II on the ICRS scale (seven in class I and four in class II), with one patient in class IV. X-ray assessment was less favourable, revealing alterations in the articular space in 75% of cases. The results show that this technique enables the biological fixation of fragments and, functionally, the clinical results obtained were very good. The osteochondral grafts avoid the implantation of foreign material and make use of bone fragments of the same rigidity as the OCD fragment. We conclude that the technique described is an excellent alternative to the techniques normally used for the fixation of stage III and IV OCD.

Arthroscopic Bioabsorbable Screw Fixation of Unstable Osteochondritis Dissecans in Adolescents: Clinical Results, Magnetic Resonance Imaging, and Second-Look Arthroscopic Findings

“…Also in a study of autologous osteochondral grafting and fixation, 70% to 95% of the patients were improved clinically and radiologically. 20 21 22) Gudas et al 23) reported that clinical and radiological improvement was obtained in 92% of the patients with autologous chondrocyte implantation.…”

Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

“…Nowadays, however, this is no longer done owing to poor results, with up to 71% rate of osteoarthritic (OA) changes. 2,6,47,55,58,63,83,87,91,[104][105][106][107][108][109][110][111][112][113][114][115] For these reasons, fragment refixation of partially or completely loose bodiesas far as is possible-is recommended (see example in Fig. 4).…”

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

“…This technique may offer both biologic and mechanical stability. Several authors have reported healing on MRI followup studies with approximately 66% to 95% having good to excellent clinical outcomes using either the Hughston rating or the International Cartilage Repair Society (ICRS) [20,38,57]. Miniaci and TytherleighStrong [55] used multiple 4.5-mm osteochondral autograft plugs.…”