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Fixation of Unstable Osteochondritis Dissecans Lesions of the Knee Using Arthroscopic Autogenous Osteochondral Grafting (Mosaicplasty)

      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.

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      References

        • Brittberg M.
        • Winalski C.S.
        Evaluation of cartilage injuries and repair.
        J Bone Joint Surg Am. 2003; 85: 58-69
        • Berlet G.C.
        • Mascia A.
        • Miniaci A.
        Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty).
        Arthroscopy. 1999; 15: 312-316
        • Kobyashi T.
        • Fujikawa K.
        • Oohashi M.
        Surgical fixation of massive osteochondritis dissecans lesion using cylindrical osteochondral plugs.
        Arthroscopy. 2004; 20: 981-986
        • Hefti F.
        • Muller W.
        Current state of evaluation of knee ligament injuries.
        Orthopade. 1993; 22: 351-362
        • Dipaola J.D.
        • Nelson D.W.
        • Colville M.R.
        Characterising osteochondral lesions by magnetic resonance imaging.
        Arthroscopy. 1991; 7: 101-104
        • O’Connor M.A.
        • Palaniappan M.
        • Kahn N.
        • Bruce C.E.
        Osteochondritis dissecans of the knee in children.
        J Bone Joint Surg Br. 2002; 84: 258-262
        • Jurgensen I.
        • Buchomour G.
        • Schleicher I.
        • Haas H.
        Arthroscopic versus conservative treatment of OCD lesions of the knee: Value of MRI in therapy planning and follow-up.
        Arthroscopy. 2002; 18: 375-386
        • Smillie I.S.
        Treatment of osteochondritis dissecans.
        J Bone Joint Surg Br. 1957; 39: 248-260
        • Linden B.
        Osteochondritis dissecans of the knee.
        J Bone Joint Surg Br. 1971; 53: 448-456
        • Thomson N.L.
        Osteochondritis dissecans and osteochondral fragments managed by Herbert compression screw fixation.
        Clin Orthop Relat Res. 1987; 224: 71-78
        • Johnson L.L.
        • Uitvlugt G.
        • Austin M.
        • Detrisac D.A.
        • Johnson C.
        Osteochondritis dissecans of the knee: Arthroscopic compression screw fixation.
        Arthroscopy. 1990; 6: 179-189
        • Slough J.A.
        • Noto A.M.
        • Schmidt T.L.
        Tibial cortical bone peg fixation in osteochondritis dissecans.
        Clin Orthop Relat Res. 1991; 267: 122-127
        • Ziran B.H.
        • Marcus R.E.
        Biologic fixation of osteochondritis dissecans of the knee.
        Orthopaedics. 1994; 2: 527-532
        • Victorff B.N.
        • Marcus R.E.
        • Deutsch A.
        Arthroscopic bone peg fixation in the treatment of osteochondritis dissecans of the knee.
        Arthroscopy. 1996; 12: 506-509
        • Tuompo P.
        • Arvela V.
        • Partio E.K.
        • Rokkanen P.
        Osteochondritis dissecans of the knee fixed with biodegradable self-reinforced polyglycolide and polylactide rods in 24 patients.
        Int Orthop. 1997; 21: 355-360
        • Dervin G.F.
        • Keene G.C.
        • Chissell H.R.
        Biodegradable rods in adult osteochondritis dissecans of the knee.
        Clin Orthop Relat Res. 1998; 356: 213-221
        • Friden T.
        • Rydholm U.
        Severe aseptic synovitis of the knee after biodegradable internal fixation.
        Acta Orthop Scand. 1992; 63: 94-97
        • Friedrichs M.G.
        • Greis P.E.
        • Burks R.T.
        Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws.
        Arthroscopy. 2001; 17: 542-545
        • Scioscia T.N.
        • Giffin J.R.
        • Allen C.R.
        • Harner C.D.
        Potential complications of bioabsorbable screw fixation for osteochondritis dissecans of the knee.
        Arthroscopy. 2001; 17: E7
        • Tytherleigh-Strong G.
        • Hurtig M.
        • Miniaci A.
        intra-articular Hyaluronan following autogenous osteochondral grafting of the knee.
        Arthroscopy. 2005; 21: 999-1005
        • Gudas R.
        • Kalesinskas R.J.
        • Kimtys V.
        • et al.
        A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of young athletes.
        Arthroscopy. 2005; 21: 1066-1075
        • Evans P.J.
        • Miniaci A.
        • Hurtig M.B.
        Manual punch versus power harvesting of osteochondral grafts.
        Arthroscopy. 2004; 20: 306-310