Osteochondritis dissecans of the femoral condyles.

Abstract

Because the results of treatment of osteochondritis dissecans of the femoral condyles are not consistently satisfactory, cases were reviewed in 83 patients (95 knees) with osteochondritis dissecans who were followed for 2-31 yr to identify factors that may influence treatment and long-term prognosis. Of the 83 patients, 16 had only non-surgical treatment, 65 had only surgical treatment and 2 had non-surgical treatment of 1 knee and surgical treatment of the other. Of the 22 knees (18 patients) that were treated non-surgically, 15 were treated before and 7 were treated after distal femoral epiphyseal closure. Of the 73 knees (in 67 patients) that were treated surgically because of persisting symptoms, 23 were treated before epipiphyseal closure and 50, after closure. At follow-up, each knee was given a rating of excellent, good, fair, poor or failure and a corresponding point score. Seventy-seven percent of the knees in the surgical group and 82% of those in the conservatively treated group were rated either excellent or good. The average scores in both groups were higher in knees in which the osteochondritic defect was small and treated before epiphyseal closure and in knees in which the fragment healed as compared with the ones from which the fragment was removed. Knees with osteochondritis dissecans of the femoral condyles that had no other abnormal physical findings or functional disability responded well to conservative treatment before epiphyseal closure. Those with objective evidence of looseness of the necrotic fragment or functional disability were best treated surgically. The meniscus provides a weight-bearing surface and should be saved whenever possible. The knees that were treated successfully by either conservative means or surgical means showed little evidence of progressive long-term degeneration after follow-up of as long as 31 yrs.