Blanke Fabian, Feitenhansl Andreas, Haenle Maximilian, Vogt Stephan
Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany.
Clinic and Policlinic for Orthopaedic Surgery, University Rostock, Rostock, Germany.
Cartilage. 2020 Oct;11(4):441-446. doi: 10.1177/1947603518800541. Epub 2018 Sep 15.
The etiology of osteochondritis dissecans (OCD) is still uncertain. Recently, it has been hypothesized that instability of the anterior horn of the meniscus is an important cause for the development of a nontraumatic OCD in adolescents with good results after surgical stabilization. This case series aims to evaluate the treatment results after meniscus stabilization in adults with nontraumatic OCD.
Ten patients with magnetic resonance imaging (MRI)-confirmed OCD of the knee joint, meniscal instability, and closed epiphyseal plates were enrolled in this study. The instable meniscus was stabilized by direct suturing of the anterior horn of the meniscus. MRI examinations were performed preoperative and 6 and 12 months postoperative. The OCD was classified arthroscopically according to Guhl and according to Hughes in the MRI. The overall knee function was evaluated by the Lysholm score before treatment and 12 months postoperative.
Four women and 6 men with a mean age of 20.6 ± 1.9 years were included in this study. Preoperatively 60% of the patients showed a grade II or III lesion arthroscopically and 70% a grade III or IVa lesion in the MRI examination. After arthroscopic meniscus stabilization the Lysholm score increased in average from 48.1 ± 14.12 before treatment to 97.5 ± 3.1 postoperative. At final follow-up after 12 months, an improvement of the OCD in the MRI could be demonstrated in all patients (100%). In 80% of the patients a complete healing of the OCD could be noted.
The clinical concept of an instable anterior horn of the meniscus as a cause for the development of a nontraumatic OCD seems to be transferable to adults and arthroscopic stabilization can lead to a sufficient healing of this knee pathology.
剥脱性骨软骨炎（OCD）的病因仍不明确。最近有假说认为，半月板前角不稳定是青少年非创伤性OCD发生的重要原因，手术稳定后效果良好。本病例系列旨在评估成人非创伤性OCD患者半月板稳定术后的治疗效果。
本研究纳入了10例经磁共振成像（MRI）确诊为膝关节OCD、半月板不稳定且骨骺板闭合的患者。通过直接缝合半月板前角来稳定不稳定的半月板。术前以及术后6个月和12个月进行MRI检查。根据Guhl分类法在关节镜下对OCD进行分类，并在MRI上根据Hughes分类法进行分类。治疗前和术后12个月通过Lysholm评分评估膝关节整体功能。
本研究纳入了4名女性和6名男性，平均年龄为20.6±1.9岁。术前，60%的患者在关节镜检查中显示为II级或III级病变，70%的患者在MRI检查中显示为III级或IVa级病变。关节镜下半月板稳定术后，Lysholm评分平均从治疗前的48.1±14.12提高到术后的97.5±3.1。在12个月的最终随访中，所有患者（100%）的MRI显示OCD有所改善。80%的患者OCD完全愈合。
半月板前角不稳定作为非创伤性OCD发生原因的临床概念似乎可应用于成人，关节镜下稳定术可使这种膝关节病变充分愈合。
