[Osteochondritis dissecans of the knee joint. Results of follow-up]

In a long-term follow-up examination (5-15 years postoperatively) clinical and radiological results after surgical treatment of osteochondritis dissecans of the knee of 97 patients with 109 osteochondritic lesions were controlled. The treatment consisted of retrograde removal of the subchondral osteonecrosis and -sclerosis with following autologous bone grafting in cases with intact hyaline cartilage. In cases of partial or total loosening of the osteochondritic lesion this procedure was done anterograde. For refixation different techniques such as fibrin glue or acylate glue were used. Using the classification of Arcq in 59.6% of the knee joints excellent and in 18.3% good results were obtained. Regarding the development of osteoarthritis in 56% no signs of osteoarthritis were visible. Worst results were obtained in knee joints in which non-resorbable acrylate glue was used for refixation of dissecates. In contrast to that patients in which loose dissecates were refixated with fibrin glue reached a significant better postoperative long-term result. In addition postoperative results were influenced by the age in which first symptoms were complained, by the stage of cartilaginous lesion, the kind of intraoperative technique and by additional morphological disturbances at the knee such as varus- or valgus mallaignment. In general for the treatment of osteochondritis dissecans of the knee an early operation before occurrence of cartilaginous lesions is recommended to avoid osteoarthritic changes. In cases of partial or complete loosening fibrin glue is recommended as the fixation technique of first choice.