Midterm results of surgical treatment for adult osteochondritis dissecans of the knee.
BACKGROUND
Determination of appropriate treatment options for adult osteochondritis dissecans is difficult, as most published papers on surgical osteochondritis dissecans treatment report outcomes in a population consisting of both adult and juvenile patients.


OBJECTIVE
This study examines the outcomes of surgical procedures in patients with adult osteochondritis dissecans.


METHODS
Case series; Level of evidence, 4.


METHODS
The cohort included 46 adult patients (48 knees) with adult osteochondritis dissecans of the knee who had undergone surgical treatment (debridement, drilling, loose-body removal, arthroscopic reduction and internal fixation, microfracture, osteochondral allograft, or autologous chondrocyte implantation). The average patient age was 34 +/- 9.5 years (range, 20-49) and patients were followed for 4.0 +/- 1.8 years. The mean defect size was 4.5 +/- 2.7 cm(2). Outcomes were assessed via clinical assessment and established outcome scales, including the Lysholm, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner, Cincinnati, and Short Form-12.


RESULTS
Statistically significant improvement (P < .05) was noted in all outcome scales, including Noyes, Tegner, Lysholm, IKDC, KOOS (subdivided into 5 categories including Pain, Symptoms, Activities of Daily Living, Sport, and Quality of Life), Short Form-12 Physical, and Short Form-12 Mental. Seven knees (14%) had clinical failure of the initial treatment and underwent a revision procedure at a mean follow-up of 14 months. Patients treated with arthroscopic reduction and internal fixation and loose-body removal demonstrated a statistically higher postoperative percentage score increase for the KOOS Sport (P = .008) and KOOS Quality of Life (P = .03) categories than those treated with an osteochondral allograft.


CONCLUSIONS
Patients with adult osteochondritis dissecans of the knee, treated with surgical cartilage procedures, show durable function and symptomatic improvement at a mean 4.0 years of follow-up. Patients treated with arthroscopic reduction and internal fixation and loose-body removal demonstrated a greater improvement in outcome scores than those treated with osteochondral allograft.
Rush University Medical Center, 1725 West Harrison Street, Chicago, IL 60612, USA. bcole@rushortho.com
Cecilia
C
Pascual-Garrido
Nicole A
NA
Friel
Spencer S
SS
Kirk
Allison G
AG
McNickle
Bernard R
BR
Bach
Charles A
CA
Bush-Joseph
Nikhil N
NN
Verma
Brian J
BJ
Cole
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010008:Osteochondritis Dissecans / Q000175:diagnosis / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000379:methods; D055815:Young Adult