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The Journal of Bone and Joint Surgery, Vol 66, Issue 9 1340-1348, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Osteochondritis dissecans of the femoral condyles
JC Hughston, PT Hergenroeder and BG Courtenay
Because the results of treatment of osteochondritis dissecans of the
femoral condyles are still not consistently satisfactory, we reviewed the
cases of eighty-three patients (ninety-five knees) with osteochondritis
dissecans who were followed for two to thirty-one years to identify factors
that may influence treatment and long-term prognosis. Of the eighty-three
patients, sixteen had only non-surgical treatment, sixty-five had only
surgical treatment, and two had non-surgical treatment of one knee and
surgical treatment of the other. Of the twenty-two knees (eighteen
patients) that were treated non-surgically, fifteen were treated before and
seven were treated after distal femoral epiphyseal closure. Of the
seventy-three knees (in sixty-seven patients) that were treated surgically
because of persisting symptoms, twenty-three were treated before epiphyseal
closure and fifty, 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 per cent of the knees in the surgical group and
82 per cent 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 was treated before
epiphyseal closure, and in knees in which the fragment healed as compared
with the ones from which the fragment was removed. We found that 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.(ABSTRACT TRUNCATED AT 250
WORDS)
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