Objective: To evaluate the feasibility and effectiveness of allograft osteochondral transplantation with arthroscopic assistance for osteochondritis dissecans (OCD) associated with large osteochondral defects.
Methods: From January 2004 to May 2007, 13 patients with OCD with large osteochondral defects were treated. There were 7 males and 6 females, aged 18-59 years with an average of 35.8 years. The locations were left side in 8 cases and right side in 5 cases. The disease course was 7 days to 20 years with the median duration of 42 months. Four cases had obvious sprained history. The involved locations were lateral portion of the medial femur condyle (MFC) in 5 cases, trochlea area of MFC in 2 cases and lateral femur condyle in 6 cases. The range of motion was (95.0 +/- 13.5) degrees and the Lysholm score was 62.23 +/- 7.79. According to International Cartilage Repair Society classification system and the Guhl classification of OCD under arthroscopy, all the patients were type IV. Defect areas were 3-7 cm2 with an average of 4.32 cm2. The depths of defects were 0.8-2.0 cm with an average of 1.55 cm. Allograft osteochondral transplantation combining with adsorbable screw was applied for the lesions. The patients were closely instructed to do exercise through following up.
Results: The wounds all healed by first intention. Thirteen cases were followed up for 2.2 years (14 months to 4 years) after operation. Three months after operation, 2 cases had pain after continuous exercise for 1 hour, they were directed in the methods of functional exercise and to strengthen their quadriceps femoris. Medicine was given in 2 patients who had sign of friction feeling of joint 6 months after operation. The range of motion at the last follow-up was (137.0 +/- 9.8) degrees, showing statistically significant difference when compared with that before operation (P < 0.05). The X-rays and EMRI examinations at following-up indicated that bone healed well and articular facet was integrity. The Lysholm score was 92.08 +/- 7.64 one year after operation, showing statistically significant difference when compared with that before operation (P < 0.05).
Conclusion: Allograft osteochondral transplantation with arthroscopic assistance is a useful method in treatment of OCD with large osteochondral defects of the knees.