Kocher Mininder S, Tucker Rachael, Ganley Theodore J, Flynn John M
Children's Hospital Boston, Harvard Medical School, MA 02115, USA.
Am J Sports Med. 2006 Jul;34(7):1181-91. doi: 10.1177/0363546506290127.
Osteochondritis dissecans of the knee is being seen with increased frequency in pediatric and young adult athletes and is thought to be, in part, owing to earlier and increasingly competitive sports participation. Despite much speculation, the cause of both juvenile and adult osteochondritis dissecans remains unclear. Early recognition is essential. Whereas adult osteochondritis dissecans lesions have a greater propensity to instability, juvenile osteochondritis dissecans lesions are typically stable, and those with an intact articular surface have a potential to heal with nonoperative treatment through cessation of repetitive impact loading. The value of adjunctive immobilization, protected weightbearing, and unloader bracing has not been established. Skeletally immature patients with stable lesions that have not healed with nonoperative treatment should have consideration given to arthroscopic drilling to promote healing before the lesion progresses and requires more involved treatment with a less optimistic prognosis. Magnetic resonance imaging may allow early prediction of lesion healing potential. The majority of adult osteochondritis dissecans cases as well as those skeletally immature patients with unstable lesions and secondary loose bodies require fixation and possible bone grafting. Many unstable lesions will heal after stabilization, but long-term prognosis is not clear. Chronic loose fragments can be difficult to fix and have poor healing potential. Results of excision of large lesions from weightbearing zones are poor. Chondral resurfacing techniques have limited long-term data for cases of osteochondritis dissecans in skeletally immature patients.
膝关节剥脱性骨软骨炎在儿科和年轻成年运动员中越来越常见，部分原因被认为是更早且越来越多地参与竞技性运动。尽管有很多推测，但青少年和成人剥脱性骨软骨炎的病因仍不清楚。早期识别至关重要。成人剥脱性骨软骨炎病变更易出现不稳定，而青少年剥脱性骨软骨炎病变通常是稳定的，那些关节面完整的病变有可能通过停止重复性冲击负荷的非手术治疗而愈合。辅助固定、保护性负重和卸载支具的价值尚未确定。骨骼未成熟且病变稳定但非手术治疗未愈合的患者，应考虑在病变进展并需要更复杂治疗且预后不太乐观之前，进行关节镜钻孔以促进愈合。磁共振成像可能有助于早期预测病变的愈合潜力。大多数成人剥脱性骨软骨炎病例以及骨骼未成熟且病变不稳定和有继发性游离体的患者需要固定并可能需要植骨。许多不稳定病变在稳定后会愈合，但长期预后尚不清楚。慢性游离碎片可能难以固定且愈合潜力差。从负重区切除大病变的结果不佳。对于骨骼未成熟患者的剥脱性骨软骨炎病例，软骨修复技术的长期数据有限。
