Tibial cortical bone peg fixation in osteochondritis dissecans of the knee

Ten knees in nine patients with large, symptomatic osteochondritis dissecans lesions of the knee were treated by cortical bone peg fixation. The follow-up time averaged 2.9 years (range, 0.9-6.6 years). The average age was 19.5 years (range, 15-33 years). The knees were evaluated and rated clinically and roentgenographically. Magnetic resonance (MR) imaging of nine knees was obtained at the follow-up examination to evaluate lesion and bone peg incorporation, evidence of lesion loosening, and the articular cartilage. Eight good to excellent, one fair, and one poor result were obtained clinically. MR imaging showed 33% of knees had poor lesion cartilage and 44% had partial or poor lesion incorporation possibly consistent with loosening. Complications included four partial defect healings, one tibial donor graft-site fracture, and one bone peg loosening. Four symptomatic knees had follow-up arthroscopy at an average of 1.8 years postsurgery and findings included four loose bodies, one loose peg, one meniscal tear, and one symptomatic hypertrophic synovium. MR imaging was a useful tool in evaluating lesion stability, articular cartilage quality, lesion and bone peg incorporation, the menisci, and cruciate ligaments. Bone peg fixation of large osteochondritis dissecans defects of the knee offers a physiologic approach to treatment of this lesion in nearly skeletally mature or skeletally mature patients.