2015 ISAKOS Biennial Congress ePoster #1509
Fixation of the Osteochondral Free Fragment in Osteochondritis Dissecans With Autologous Osteochondral Transplants
Radu Fleaca, MD, PhD, Sibiu, Sibiu ROMANIA
Mihai Roman, MD, Sibiu, Sibiu ROMANIA
Cosmin Mohor, MD, PhD, Sibiu ROMANIA
Univeristy Lucian Blaga of Sibiu, Emergency County Hospital Sibiu, Sibiu, Sibiu, ROMANIA
FDA Status Not Applicable
Summary: Autologous Osteochondral Transplantation can be an useful Technique to improve stabilisation of a refixed osteochondral fragment and in the same time to repair a focal cartilage defect and improve vascularisation of the osteocondritis dissecans area
Abstract:
Introduction
The presence of a large osteochondral fragment (more than 4 cm2) in osteochondritis dissecans is a real challenge for the reconstruction and coverage of the chondral defect. The transplanted osteochondral plugs can stabilize the fragment and cover residual chondral defects.
Material And Methods
This paper present 6 pacients with juvenile osteochondritis dissecans treated between 2008-2011. The pacients (4m and 2f) were between 18 and 25 yo, Tegner score preoperative 2 - 3, Lysholm score preoperative 32 (locked knee) - 52, IKDC D, 3 pacients with lesion at the medial and 3 at the external femoral condyle, chondral defect estimated between 4 and 8 cm2. In all cases the procedure was perform thru miniarthrotomy arthroscopically assisted. The osteochondral plugs were harvested from the lateral slope of the femoral trochlea and if needed from the medial slope. After the preparation of the osteochondral flap (remains only cartilage with attached bone, avivation) and of the receiving area, we have fixed the fragment and then cover the remaining defect with osteochondral plugs. The fragment was fixed only with osteochondral plugs (1 case) and with supplementary screws or k-wires for the rest. Postoperative 2 crouches no weight bearing for 4 weeks, without any immobilization, no limitation of ROM. Postoperative clinic reevaluation at 3, 6, 12 months, MRI at 6 month.
Results
and Discutions
For the refixation of the osteochondral fragment and the coverage of the residual defect we have used between 2 and 5 osteochondral plugs 8 mm diameter. IKDC score at 3 months was B in one case and C for the other 5 pacients (due to persistent hydrarthrosis and one leg hop test), at 6 months A for 4 pacients, B for one and C for one pacient. Tegner score was 5-7 at 6 months, Lysholm score 86-96 for 5 pacients and 78 for one pacient at 6 months. One of the pacients (with the lowest scores at 6 months) was reoperated arthroscopically at 4 months from the initial intervention for the removal of a free chondral fragment detached from a nonweightbearing area posterior and lateral from the initial defect. This pacient presented at one year Tegner score 9, IKDC A.
Conclusions
The results obtained suggests that the presented technique is useful for the refixation of the detached osteochondral fragment, allowing in the same time the coverage of the remaining chondral defect of the femoral condyle.