Spontaneous osteonecrosis of the knee. Treatment and evolution

We performed a retrospective study on 21 patients affected by unilateral spontaneous osteonecrosis of the femoral condyle. Fifteen were women and 6 men. Their average age was 66.9 years. In ten cases the onset of pain was sudden, with a clear previous history of trauma in two of them. Gait pain, effusion, and joint locking were the most frequent clinical symptoms. At the time of diagnosis, 7 patients presented with grade I necrosis, 8 grade II, 1 grade III, and 5 grade IV, following Koshino's classification [11]. The average percentage of osteonecrosis was 36.8%. Six patients underwent conservative treatment with physical exercises and nonsteroidal anti-inflammatory drugs. We performed arthroscopy alone in 4 patients, arthroscopy and drilling in 8, valgus high tibial osteotomy in 2, and total knee arthroplasty in 1. The overall results after an average follow-up 41 months were excellent and good in 76.2% of the cases, fair in 14.3%, and poor in 9.5%. An associated medial meniscus tear was found in half of the patients who underwent surgery. In patients diagnosed with grade III and IV osteonecrosis, no increase in the percentage of necrosis was observed.