当院における膝離断性骨軟骨炎の治療方針および成績

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Objective: The treatment strategy for osteochondritis dissecans of the knee depends on various factors such as patient activity, open or closed growth plates, radiographically determined arthroscopic stage, and location, size, and stability of osteochondral lesions. In our hospital, we adopt conservative therapy for patients with stable osteochondral lesions and surgical therapy for patients with unstable lesions or lesions that do not heal after conservative therapy. The surgical procedure is selected depending on the following factors: open or closed growth plates, arthroscopic stage, location, size, and amount of bony osteochondral lesions. Methods: We examined the clinical outcome in 39 patients (43 knees) with osteochondritis dissecans of the knee treated at our hospital from 2003 to 2012. Thirteen patients (17 knees) were treated using conservative therapy and 26 (26 knees) using surgical therapy, respectively. Of the 26 surgical patients, 5 were treated using the arthroscopic microfracture method, 14 using internal fixation with bioabsorbable pins or bone strips from the tibia, 1 using mosaicplasty, and 6 using autologous chondrocyte implantation with platelet-rich plasma gel. The clinical outcomes in all patients were evaluated according to the Hughston criteria and Lysholm score. Result: The clinical outcomes were satisfactory in all patients (good in 20 patients and excellent in 18 patients) according to the Hughston criteria, and the average Lysholm score was high (97.2 points). Conclusion: The selection of the surgical procedure in patients with osteochondritis dissecans of the knee, which was based on the presence of open or closed growth plates and the stability of osteochondral lesions, had excellent clinical results.
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当院における膝離断性骨軟骨炎の治療方針および成績

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