Purpose: A number of surgical techniques have been described for the operative fixation of
an unstable osteochondritis dissecans (OCD) lesion in the knee that has failed appropriate
nonoperative management. However, no one technique has been universally successful.
We report the results of a new fixation technique for unstable OCD lesions using arthroscopic
autogenous osteochondral grafting (mosaicplasty). Methods: Twenty patients with OCD lesions (16 International Cartilage Repair Society [ICRS]
OCD type II, 3 ICRS OCD type III, and 1 ICRS OCD type IV) who had failed an appropriate
course of nonoperative management underwent autogenous osteochondral grafting. The
OCD lesions were assessed arthroscopically and then fixed in situ by using multiple
4.5-mm osteochondral dowel grafts harvested from the edges of the femoral trochlea.
The lesion was initially fixed with an osteochondral graft passing through the center
of the fragment and then stabilized by using further grafts inserted around its periphery.
Results: Preoperative International Knee Documentation Committee scores assessed 5 patients
as nearly normal, 8 as abnormal, and 7 as severely abnormal. At the 18-month follow-up,
all of the knees were scored as normal. The average preoperative visual analog pain
score out of 10 was 8.3, which was reduced to 0.8 at 6 months and to 0 at 1 year after
surgery. Serial magnetic resonance imaging scans showed healing of the bony part of
the lesion in all of the knees 6 months after surgery and continuous articular cartilage
healing at 9 months. Conclusions: Autogenous osteochondral grafting of unstable OCD lesions in the knee is a reliable
and minimally invasive technique that provides a stable biologic fixation using autogenous
bone graft and has few complications. Level of Evidence: Level IV, therapeutic case series.
Key Words
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Article Info
Footnotes
The authors report no conflict of interest.
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Copyright
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
