Fijación artroscópica de la osteocondritis Dissecans de rodilla.(Inglés)

Arturo Makino, MD, D. Luis Muscolo, MD, Miguel Puigdevall, MD, Matias Costa-Paz, MD* and Miguel Ayerza, MD From the Italian Hospital of Buenos Aires, Buenos Aires, Argentina

Background: Optimal treatment of osteochondritis dissecans of the knee is still controversial.

Purpose: To review a group of patients with osteochondritis dissecans of the knee who were treated with arthroscopic compressive screw fixation and who were evaluated with magnetic resonance imaging studies and a second-look arthroscopic procedure at follow-up.

Study Design: Case series; level of evidence, 4.

Methods: A total of 14 patients (15 knees) with osteochondritis dissecans of the knee were treated with arthroscopic titanium Herbert screw fixation of the osteochondral fragment. A second-look arthroscopic procedure was performed to remove hardware and to evaluate fragment stability. At final follow-up, magnetic resonance imaging studies were used to evaluate potential healing of the subchondral bone. Outcomes were clinically evaluated at a mean follow-up of 50 months (range, 25–104 months) by the Lysholm score and by the International Knee Documentation Committee score.

Results: At second-look arthroscopy, 14 of 15 knees showed evidence of a stable fragment with an intact smooth surface. According to magnetic resonance imaging parameters, 14 knees showed evidence of a healing process of the osteochondral fragment. The average Lysholm score improved 18 points from a mean of 79 preoperatively to 97 postoperatively, and according to the International Knee Documentation Committee score, 13 of 15 knees showed a normal result.

Conclusion: This study suggests that magnetic resonance imaging parameters of a healed osteochondral fragment and patients with satisfactory functional results correspond with arthroscopic evidence of fragment stability. According to this study, arthroscopic fixation with compressive screws is an effective method of repair for osteochondritis dissecans of the knee.

The American Journal of Sports Medicine 33:1499-1504 (2005).