Chondral Delamination of the Knee in Soccer Players

Abstract

This study reports on the diagnosis and treatment of chondral delamination in the knees of soccer players. The authors attempted to provide a clinical standard for comparison with emerging cartilage repair techniques. Twenty-three consecutive chondral fractures in a ho mogeneous population of athletes were evaluated us ing physical examination, magnetic resonance imag ing, and arthroscopic examination. All knees were treated with debridement to a stable border and re moval of the calcified cartilage base. Results were graded using the scoring system advocated by propo nents of chondral transplant. All patients reported pain that limited soccer activities. Effusions occurred in 48%, joint line tenderness in 33%, and crepitus in 19% of the knees. Results from magnetic resonance imag ing correlated with arthroscopic examination in 21 % of the knees. Arthroscopic examinations revealed lesions on the medial femoral condyle in eight patients, the patella in six, the lateral femoral condyle in six, and the trochlea in three. Athletes returned to play at an aver age of 10.8 weeks. Repeat arthroscopic procedures in eight cases revealed fibrocartilage at the initial site. There were 6 excellent, 9 good, 0 fair, and 0 poor results at their 1-year followup examinations (15 knees). The definitive diagnosis of chondral delamina tion 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 recom mended when treating articular cartilage injuries be cause no long-term data exists on whether any treat ment modality can prevent the development of degenerative joint disease.