CHONDRAL DELAMINATION OF THE KNEE IN SOCCER PLAYERS

This study reports on the diagnosis and treatment of chondral delamina tion in the knees of soccer players. The authors attempted to provide a clinical standard for comparison with emerging cartilage repair tech niques. Twenty-three consecutive chondral fractures in a homogeneous p opulation of athletes were evaluated using physical examination, magne tic resonance imaging, and arthroscopic examination. All knees were tr eated with debridement to a stable border and removal of the calcified cartilage base. Results were graded using the scoring system advocate d by proponents of chondral transplant. All patients reported pain tha t limited soccer activities. Effusions occurred in 48%, joint line ten derness in 33%, and crepitus in 19% of the knees. Results from magneti c resonance imaging correlated with arthroscopic examination in 21% of the knees. Arthroscopic examinations revealed lesions on the medial f emoral condyle in eight patients, the patella in six, the lateral femo ral condyle in six, and the trochlea in three. Athletes returned to pl ay at an average of 10.8 weeks. Repeat arthroscopic procedures in eigh t cases revealed fibrocartilage at the initial site. There were 6 exce llent, 9 good, 0 fair, and 0 poor results at their I-year followup exa minations (15 knees). The definitive diagnosis of chondral delaminatio n relies on a thorough arthroscopic probing of the articular surface. The early functional results of this treatment compare favorably with the autologous transplantation technique. Caution, however, is recomme nded when treating articular cartilage injuries because no long-term d ata exists on whether any treatment modality can prevent the developme nt of degenerative joint disease.