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How to Treat Osteochondritis Dissecans of the Knee: Surgical Techniques and New Trends AAOS Exhibit Selection

III Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna 20136, Italy.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 01/2012; 94(1):e1(1-8). DOI: 10.2106/JBJS.K.00748
Source: PubMed

ABSTRACT

Osteochondritis dissecans is a relatively common cause of knee pain. The aim of this study was to describe the outcomes of five different surgical techniques in a series of sixty patients with osteochondritis dissecans.
Sixty patients (age 22.4 ± 7.4 years, sixty-two knees) with osteochondritis dissecans of a femoral condyle (forty-five medial and seventeen lateral) were treated with osteochondral autologous transplantation, autologous chondrocyte implantation with bone graft, biomimetic nanostructured osteochondral scaffold (MaioRegen) implantation, bone-cartilage paste graft, or a "one-step" bone-marrow-derived cell transplantation technique. Preoperative and follow-up evaluation included the International Knee Documentation Committee (IKDC) score, the EuroQol visual analog scale (EQ-VAS) score, radiographs, and magnetic resonance imaging.
The global mean IKDC score improved from 40.1 ± 14.3 preoperatively to 77.2 ± 21.3 (p < 0.0005) at 5.3 ± 4.7 years of follow-up, and the EQ-VAS improved from 51.7 ± 17.0 to 83.5 ± 18.3 (p < 0.0005). No influence of age, lesion size, duration of follow-up, or previous surgical procedures on the result was found. The only difference among the results of the surgical procedures was a trend toward better results following autologous chondrocyte implantation (p = 0.06).
All of the techniques were effective in achieving good clinical and radiographic results in patients with osteochondritis dissecans, and the effectiveness of autologous chondrocyte implantation was confirmed at a mean follow-up of five years. Newer techniques such as MaioRegen implantation and the "one-step" transplantation technique are based on different rationales; the first relies on the characteristics of the scaffold and the second on the regenerative potential of mesenchymal cells. Both of these newer procedures have the advantage of being minimally invasive and requiring a single operation.

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    • "Considering the hyaline cartilage's very limited ability to heal, finding treatment options that can achieve optimal results is of paramount importance. Many recent studies have emphasized the role of the subchondral bone in the proper functioning of articular cartilage, highlighting the need for simultaneous treatment of both components – bone and cartilage – in cases of chondral and osteochondral lesions of the knee [1] [2] [3] [4] [5] [6] [7]. From the many available bone graft substitutes [8], ceramic-based grafts, and particularly bioactive glasses, stand out as substances with special properties and important clinical implications [9]. "
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