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.
Résumé
Les auteurs présentent une évaluation clinique et fonctionnelle des malades avec ostéochondrite disséquante du genou (OCD) traitées avec des greffons osteochondrales (mosaicplasty-lie).Entre 1999 et 2004, nous avons opéré 12 genoux avec ostéochondrite disséquante (étage 3 et 4). Ils ont été évaluées en utilisant l’échelle d'ICRS, VAS, les radiographies et la résonance magnétique. Série clinique, rétrospectif, niveau de évidence 4.Avant la chirurgie, tous les malades étaient dans les groupes III et IV de l'échelle ICRS (4 á l’étage III ; 8 à IV). Au moment de la chirurgie, l'âge moyen était de ± 27.5 7.9 ans et prédominance masculine (75%). Au moment de la révision 11 des malades étaient dans les groupes I et II d'ICRS (7 I et 4 II), 1 malade dans le groupe IV. L'évaluation radiographique montrait altérations arthrosiques avec pincement d’interligne articulaire en 75% des cas.Cette technique permet la fixation biologique des fragments. Fonctionnellement, les résultats cliniques obtenus étaient très bons. Elle peut dispenser l'implantation d’autre matériel (un corp étranger) en même que les greffes de fixation présentent la même rigidité du fragment osteochondral.La technique décrite est une excellente alternative aux techniques normalement utilisées pour la fixation des Osteochondritis disséquantes dégrée III et IV.
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Notes
The cartilage standard evaluation form/knee. ICRS Newsletter, Spring 1998.
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Acknowledgement
The authors would like to thank Francisco Balacó for the interpretation and critical review of the statistical analysis.
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Fonseca, F., Balacó, I. Fixation with autogenous osteochondral grafts for the treatment of osteochondritis dissecans (stages III and IV). International Orthopaedics (SICO 33, 139–144 (2009). https://doi.org/10.1007/s00264-007-0454-2
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DOI: https://doi.org/10.1007/s00264-007-0454-2