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7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Knee dissecans ostheocondritis with intra articular loose bodies. Fixation or Excision? About, top-level athletes, 4 cases report where Platelet Rich Plasma (PRP) was associated to the surgical treatment

Meeting Abstract

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  • corresponding author presenting/speaker Henrique Jones - Orthopedic Surgery and Sports Medicine Clinic Montijo / Portuguese Football Association, Montijo - Lisbon, Portugal
  • Manuel Virgolino - Orthopedic Surgery and Sports Medicine Clinic Montijo / Portuguese Football Association, Montijo - Lisbon, Portugal

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm022

DOI: 10.3205/11esm022, URN: urn:nbn:de:0183-11esm0227

Published: October 24, 2011

© 2011 Jones et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: The Dissecans Ostheocondritis (OD) of the knee is a defect, in the subchondral region, with partial or complete separation of bone fragment. Most often seen on the postero-lateral aspect of the medial femoral condyle (about 80% of cases), and less often seen in posterior aspect of lateral condyle, is usually unilateral (74%), twice as common in males and classically occurring below the age of 18 (range: 6 to 53 years). Although the etiology of the injury differs from the traumatic osteocondral fractures the clinical presentation could be identical. The repetitive overloading causes fragmentation and separation of bony fragment (loose bodies in 50% of the cases) and the etiology of this multifactorial injury various, according with several theories, from trauma, vascular isquemia, alterations of ossification nuclei, genetic predisposition or combination of referred factors. The treatment of OD of the knee, with detachable fragment, or intra articular loose body already present, (grade III and IV of Ewing and Voto classification) became a surgeon problem regarding the correct surgical attitude. The controversy is rule when presentation is under the form of free body, with respect to the technique to use (reinsertion or excision), in the perspective of cartilage regeneration or integration of those loose bodies after its reinsertion. Milgram, demonstrated that deterioration of the chondral covering of free bodies can occur after its insertion in the original place, in proportion to the time of osteochondral detachment to the joint. Recently, Touten et al. concluded that, even so, the reduction and reinsertion of OD loose fragments must be intended, as soon as possible, and that even in late cases this technique must be attempted because it seems possible late cartilage reintegration, and regeneration. This perspective stimulates the authors to revue 4 clinical cases, involving young top athletes, where excision and micro fractures (MF) were made in two cases (Figure1 [Fig. 1]) and fragment reinsertion, with absorbable pins (Figure 2 [Fig. 2]), was made in the other 2 cases.

Material/Methods: Four cases follow up and two different surgical methodologies, for the same pathology, in different stages and time delay as loose intra articular bodies. Different decisions but the same objectives regarding return to competition. In the 4 cases the authors associated the application of Platelet-Rich Plasma (PRP) either in MF site or in the fragment fixation site. The 4 cases were evaluated at 6 and 12 months utilizing IKDC scale and imagiologic study objectives.

Results: In accordance with the related criteria, 3 results have been considered excellent, and 1 result considered good, with return to competition between 9 and 13 months, the same anterior level. The criteria for both attitudes are mentioned as well as the importance of PRP resource in this pathology treatment.

Conclusion: The surgical decision in symptomatic and dysfunctional knee dissecans ostheocondritis, with detached fragment or loose bodies in the joint, mostly in young top level athletes, must allawys attempt the possibility of reduction and reinsertation when this surgical attitude seems possible in adequate articular congruence.In cases where this decision seems impossible,the fragments excision associated with in situ Micro fractures seems to be a good alternative choise of treatment.The Platelet Rich Plasma (PRP) association to MF site or reinsertation site seems to improve the healing process and acts like a complementary attitude to be considered in this pathology treatment.


References

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2.
Adachi N, Motoyama M, Deie M, Ishikawa M, Arihiro K, Ochi M. Histological evaluation of internally-fixed osteochondral lesions of the knee. J Bone Joint Surg Br. 2009;91(6):823-9.
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Pascual-Garrido C, Tanoira I, Muscolo DL, Ayerza MA, Makino, A. Viability of loose body fragments in osteochondritis dissecans of the knee. A series of cases. Int Orthop. 2010;34(6):827-31.