Deliwala Ujjval, Sethia Sumit Jain
Deliwala Arthroscopy & Sports Injury Center, Bhavnagar, Gujarat, India.
Department of Orthopedics, Civil Hospital, Bhavnagar, Gujarat, India.
Case Rep Orthop. 2022 May 16;2022:6946860. doi: 10.1155/2022/6946860. eCollection 2022.
Osteochondritis dissecans (OCD) is a disorder of the subchondral bone affecting the adjacent articular cartilage that may lead to cartilage and bone fragment detachment. It commonly occurs in the knee joint, elbow, wrist, and ankle. Although several surgical concepts have been described to treat OCD (fragment fixation, microfracture, autologous chondrocyte implantation (ACI), and mosaicplasty), no gold standard treatment has been accepted for managing OCD. Multiple factors like age, stability of defect, and defect size should be considered while selecting a specific treatment for OCD. Here, we discuss the case of an 18-year-old patient with horizontal and noncontained OCD. The MRI and CT scan evaluations of condylar notch view showed a defect (23 mm × 19 mm × 8 mm) with ICRS grade IV lateral femoral condyle OCD that was successfully managed by gel-based ACI. After 9 years of ACI, the patient was asymptomatic with full range of motions at the knees. Improvement in visual analog scale score, International Knee Documentation Committee score, and Magnetic Resonance Observation of Cartilage Repair Tissue score was also seen at 9 years post-ACI. No further surgical interventions were needed post-ACI.
剥脱性骨软骨炎（OCD）是一种影响相邻关节软骨的软骨下骨疾病，可能导致软骨和骨碎片脱落。它常见于膝关节、肘关节、腕关节和踝关节。尽管已经描述了几种治疗OCD的手术概念（碎片固定、微骨折、自体软骨细胞植入（ACI）和镶嵌植骨术），但对于OCD的治疗尚未接受金标准治疗方法。在为OCD选择特定治疗方法时，应考虑年龄、缺损稳定性和缺损大小等多种因素。在此，我们讨论一名18岁患有水平型和非包容性OCD患者的病例。髁间切迹视图的MRI和CT扫描评估显示存在一个缺损（23毫米×19毫米×8毫米），外侧股骨髁OCD为国际软骨修复协会（ICRS）IV级，通过基于凝胶的ACI成功治疗。ACI术后9年，患者无症状，膝关节活动范围正常。在ACI术后9年，视觉模拟量表评分、国际膝关节文献委员会评分和磁共振软骨修复组织观察评分也有所改善。ACI术后无需进一步手术干预。
