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How to treat osteochondritis dissecans of the knee: surgical techniques and new trends

28/05/2012

AAOS exhibit selection

Kon E, Vannini F, Buda R, Filardo G, Cavallo M, Ruffilli A, Nanni M, Di Martino A, Marcacci M, Giannini S.

Abstract

BACKGROUND:
Osteochondritis dissecans is a relatively common cause of knee pain. The aim of this study was to describe the outcomes of five different surgical techniques in a series of sixty patients with osteochondritis dissecans.

METHODS:
Sixty patients (age 22.4 ± 7.4 years, sixty-two knees) with osteochondritis dissecans of a femoral condyle (forty-five medial and seventeen lateral) were treated with osteochondral autologous transplantation, autologous chondrocyte implantation with bone graft, biomimetic nanostructured osteochondral scaffold (MaioRegen) implantation, bone-cartilage paste graft, or a "one-step" bone-marrow-derived cell transplantation technique. Preoperative and follow-up evaluation included the International Knee Documentation Committee (IKDC) score, the EuroQol visual analog scale (EQ-VAS) score, radiographs, and magnetic resonance imaging.

RESULTS:
The global mean IKDC score improved from 40.1 ± 14.3 preoperatively to 77.2 ± 21.3 (p &lt; 0.0005) at 5.3 ± 4.7 years of follow-up, and the EQ-VAS improved from 51.7 ± 17.0 to 83.5 ± 18.3 (p &lt; 0.0005). No influence of age, lesion size, duration of follow-up, or previous surgical procedures on the result was found. The only difference among the results of the surgical procedures was a trend toward better results following autologous chondrocyte implantation (p = 0.06).

CONCLUSIONS:
All of the techniques were effective in achieving good clinical and radiographic results in patients with osteochondritis dissecans, and the effectiveness of autologous chondrocyte implantation was confirmed at a mean follow-up of five years. Newer techniques such as MaioRegen implantation and the "one-step" transplantation technique are based on different rationales; the first relies on the characteristics of the scaffold and the second on the regenerative potential of mesenchymal cells. Both of these newer procedures have the advantage of being minimally invasive and requiring a single operation.

J Bone Joint Surg Am. 2012 Jan 4;94(1):e1(1-8).

Traducción al español

Conclusiones

Todas las técnicas fueron eficaces en el logro de buenos resultados clínicos y radiográficos en pacientes con osteocondritis disecante, y la eficacia de la implantación de condrocitos autólogos se confirmó en un seguimiento medio de cinco años. Las técnicas más nuevas, como la implantación MaioRegen y la técnica de trasplante de "una etapa" se basan en fundamentos diferentes; la primera se basa en las características del andamio y el segundo en el potencial regenerativo de las células mesenquimales. Ambos de estos procedimientos nuevos tienen la ventaja de ser mínimamente invasiva y requiere una sola operación.




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