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1例成人外侧盘状半月板行半月板修复及碟形化术后外侧股骨髁剥脱性骨软骨炎自发愈合的病例报告

An adult case of spontaneous healing of concurrent osteochondritis dissecans of the lateral femoral condyle after saucerization with meniscal repair for discoid lateral meniscus: A case report.

作者信息

Nishino Kazuya, Hashimoto Yusuke, Nishida Yohei, Yamasaki Shinya, Nakamura Hiroaki

机构信息

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.

Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.

出版信息

Int J Surg Case Rep. 2021 Oct;87:106427. doi: 10.1016/j.ijscr.2021.106427. Epub 2021 Sep 23.

Abstract

BACKGROUND

The treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear.

CASE PRESENTATION

A 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points.

CONCLUSIONS

We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.

摘要

背景

成人盘状外侧半月板(DLM)合并剥脱性骨软骨炎(OCD)的治疗策略仍不明确。

病例报告

一名22岁男性在膝关节扭伤后出现左膝疼痛。体格检查发现外侧关节线压痛,麦氏试验阳性。影像学检查显示股骨外侧髁OCD,根据Brückl分类为3期。磁共振成像显示根据Ahn分类为完全性DLM伴前中央移位,根据Nelson分类为11mm×8mm、2级OCD。在计算机断层扫描(CT)上,病变处可见一个界限清晰的碎片。基于这些发现,对不稳定的DLM进行了半月板修复的碟形化手术。OCD病变表现为软化,无任何裂隙,诊断为1级。未进行额外的手术操作。术后1年,X线片和CT证实碎片愈合。术后5年最后一次随访时,Lysholm评分从58分提高到100分。

结论

我们遇到一例成人稳定型OCD合并DLM的病例,该病例在对DLM进行重塑手术以模拟正常半月板形态后实现了自发愈合,而未对稳定的OCD病变进行额外治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6330/8476636/ce6fcef0e479/gr1.jpg

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