How to treat osteocondritis dissecans of the knee: surgical techniques and new trends

Objectives: Osteocondritis dissecans (OCD) is a relatively common cause of knee pain. Ideal treatment is still controversial. Aim of this exhibit is to describe the outcomes of 5 different surgical techniques in a series of 63 patients. Methods: 63 patients (age 22.5 ± 7.4 years) affected by OCD of the femoral condyle (45 medial and 17 lateral) were treated by either osteochondral autologous transplantation, autologous chondrocyte implantation with bone graft, biomimetic nanostructured osteochondral scaffold (Maioregen) implantation, bone-cartilage paste graft or bone marrow derived cells transplantation ‘‘one-step’’ technique. Patient evaluation included IKDC score, eq-vas score, X-Rays and MRI preoperatively and at follow-up. Results: Global mean IKDC improved from pre-operative 40.1 ± 14.6 to 77.2 ± 21.3 (p\0.0005) at mean 5.3 ± 4.7 years follow-up, while eq-vas improved from 51.7 ± 17.0 to 83.5 ± 18.3 (p\0.0005). No influence of age, size of the lesion, length of followup and associated surgeries on the result was found. No differences were found between the results obtained with different surgeries except a slight tendency of better improvement in the result following autologous chondrocyte implantation (p\0.01). Control MRI evidenced a satisfactory repair of cartilaginous layer and subchondral bone. Conclusions: The techniques described were effective in providing good clinical and radiographic results in the treatment of OCD and confirmed the validity of autologous chondrocyte implantation over time. Newer techniques such as Maioregen implantation and ‘‘onestep’’ base on different rationales, the first relying on the characteristics of the scaffold and the second on the regenerative potential of mesenchymal cells. Both of them have the advantages to be minimally invasive surgeries and to require a single operation