Keyhani Sohrab, Soleymanha Mehran, Verdonk René, Abbasian Mohammadreza
Orthopedic Department Chair, Akhtar Orthopedic Training and Research Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Orthopaedic Research center, Department of Orthopaedic, Poursina Hospital and School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Arch Bone Jt Surg. 2020 May;8(3):426-431. doi: 10.22038/abjs.2019.39026.2038.
Although some surgical techniques have been described for the operative treatment of unstable Osteochondritis dissecans (OCD) of the knee, outcomes are variable and are not satisfying totally. The aim of the present study is to evaluate the outcomes of autogenous osteochondral grafting for OCD of the knee.
In a case series study, from June 2014 to July 2015, 16 patients with stage II-IV OCD (International Cartilage Repair Society (ICRS)) of the femoral condyle were investigated. Surgical intervention considered in cases of stage III (4 cases) and IV (2 cases) and in stage II (10 cases) ones that were nonresponsive to conservative treatment. At the initial and final visits, the IKDC, Lysholm score and Tegner activity scale were evaluated.
The mean preoperative IKDC score (53.4) increased significantly following surgery (84.3) (). Based on the IKDC grading system, before the operation, the knee status was graded as nearly normal, abnormal, and severely abnormal in 4, 10, and 2 patients, respectively. At final post-surgical follow up, 15 normal and 1 abnormal knee were documented (). The mean Lysholm score increased from 44.3 per operatively to 86.3 ().Tegner activity score improved from 2.8±1 pre operatively to 5.6±2 ().
Surgical treatment of unstable OCD using autogenous osteochondral graft shows successful outcomes. In addition to reliable fixation, it can enhance healing and convert an uncontained lesion to contained one appropriate for autogenous osteochondral grafting with healthy cartilage.
尽管已经描述了一些用于膝关节不稳定剥脱性骨软骨炎（OCD）手术治疗的外科技术，但结果各不相同，且总体上并不令人满意。本研究的目的是评估自体骨软骨移植治疗膝关节OCD的效果。
在一项病例系列研究中，对2014年6月至2015年7月期间16例股骨髁II-IV期OCD（国际软骨修复协会（ICRS））患者进行了调查。对III期（4例）和IV期（2例）以及对保守治疗无反应的II期（10例）患者进行手术干预。在初次和末次随访时，评估IKDC、Lysholm评分和Tegner活动量表。
术前IKDC平均评分（53.4）术后显著提高（84.3）（）。根据IKDC分级系统，术前膝关节状态分级为接近正常、异常和严重异常的患者分别为4例、10例和2例。术后最终随访时，记录到15例膝关节正常，1例异常（）。Lysholm平均评分从术前的44.3提高到86.3（）。Tegner活动评分从术前的2.8±1提高到5.6±2（）。
使用自体骨软骨移植治疗不稳定OCD手术效果良好。除了可靠的固定外，它还可以促进愈合，并将非包容性病变转变为适合自体健康软骨骨软骨移植的包容性病变。
