HIGH TIBIAL OSTEOTOMY IN THE TREATMENT OF ADULT OSTEOCHONDRITIS-DISSECANS

This study reports one surgeon's experience using valgus high tibial o steotomy in the treatment of osteochondritis dissecans of the medial f emoral condyle in adult patients. Seven knees in six patients with ost eochondritis dissecans were reviewed as the basis of the study. Five p atients (five knees) were men, and one patient (two knees) was a woman . The average age at surgery was 32 years. Patients reported medial kn ee pain, recurrent effusions, and disability, An average of three proc edures per knee had been performed previously. Four knees had achieved union of the osteochondral fragments but with overlying articular car tilage degeneration observed at arthroscopy. Three knees had failed at tempts at fixation with eventual excision of the fragmented osteochond ral lesions. None of the knees showed diffuse medial compartment gonar throsis by radiographic or arthroscopic examinations, Involved knees h ad relative varus malalignment with an average femoral and tibial angl e of 0 degrees compared with the uninvolved knees average of 5 degrees valgus, Preoperative technetium scintigraphy showed isolated uptake i n the medial femoral condyle of all involved knees. Preoperative Lysho lm scores averaged 39 points. Patients were observed for an average of 30 months after surgery. The average Lysholm score at latest followup was 89 points. Femoral and tibial angles averaged 9 degrees valgus. O n subjective questioning, all patients reported marked improvement, sa tisfaction with the surgery, and said they had no need for additional operative intervention.