OSTEOCHONDRITIS-DISSECANS OF AT THE KNEE- JOINT - A FOLLOW-UP-EXAMINATION

In a long-term follow-up examination (5-15 years postoperatively) clin ical and radiological results after surgical treatment of osteochondri tis dissecans of the knee of 97 patients with 109 osteochondritic lesi ons were controlled. The treatment consisted of retrograde removal of the subchondral osteonecrosis and -sclerosis with following autologous bone grafting in cases with intact hyaline cartilage. In cases of par tial or total loosening of the osteochondritic lesion this procedure w as done anterograde. For refixation different techniques such as fibri n glue or acylate glue were used. Using the classification of Arcq in 59.6% of the knee joints excellent and in 18.3% good results were obta ined. Regarding the development of osteoarthritis in 56% no signs of o steoarthritis were visible. Worst results were obtained in knee joints in which non-resorbable acrylate glue was used for refixation of diss ecates. In contrast to that patients in which loose dissecates were re fixated with fibrin glue reached a significant better postoperative lo ng-term result. In addition postoperative results were influenced by t he age in which first symptoms were complained, by the stage of cartil aginous lesion, the kind of intraoperative technique and by additional morphological disturbances at the knee such as varus- or valgus malla ignment. In general for the treatment of osteochondritis dissecans of the knee an early operation before occurence of cartilaginous lesions is recommended to avoid osteoarthritic changes. In cases of partial or complete loosening fibrin glue is recommended as the fixation techniq ue of first choice.