Long term prognosis of osteochondritis dissecans of the knee

Excerpt

Although osteochondritis dissecans (OCD) of the knee has been known for a long time, we still do not fully understand why it develops. We have also known for a long time that the prognosis is better if it develops before the epiphyseal plates are closed. In the 1970s the Swedish researcher Bjarne Linden used the fact that Sweden’s third largest city, Malmö, had only one hospital and that the population around Malmö was very stable and did not move, in order to make a 33 year follow-up of OCD cases. He found that the juvenile cases had much better long term prognosis than the adult cases. In a recent study Bruns and colleagues from Hamburg, Germany, found similar results. Bruns et al. also found that retrograde drilling in cases with intact cartilage layer gives better long term results than antegrade drilling. Their worst results were found in cases where an acrylic glue had been used to attach loose bodies. They have also restudied their cases. Their first follow-up was after 10 years and now they have studied them after 20 years. As expected some results deteriorated with time but 49% of their studied patients had improved. The age of the patients and the stage of the epiphyseal plate were the most important prognostic factors. Although their material is small, it seems from their study and those of others as if it is better to try to reattach the loose fragment than to remove it. Some surgeons still operate the juvenile OCD cases although there seems to be a good chance that they heal without surgery. Unfortunately there are no randomized prospective studies on the treatment of OCD like in so many other areas of orthopaedic surgery. We need more research on as well the etiology as on the treatment of this disease. …