Revision of Failed Osteochondritis dissecans Surgical Treatment: Case Report.

Abstract

Osteochondritis dissecans (OD) is one of the most common cartilage lesions of the knee. Conservative treatment is recommended if the lesions are stable with no loose bodies or there are open physes. Surgical intervention is recommended as the primary treatment in symptomatic adults with unstable chondral lesions or with concomitant loose bodies. We describe a case of a patient suffering from OD with a bone lesion in the weight-bearing area of medial femoral condyle. Arthroscopy was performed and an osteochondral fragment from the medial femoral condyle was observed and two articular loose bodies were removed. After months, the patient returned with pain and a locked knee. magnetic resonance imaging (MRI) presented a new unstable chondral flap at the posterior border of the previous lesion. Surgery was performed again, and at open examination, the previous OD lesions were covered by regenerative tissue, with a lesion of 3cm2 at the inferior medial part of the chondral flap. The peripheral margins were cleaned, and a subchondral crater was curetted. The subchondral lesion was debrided, and the flap was fixed with pins and a central bioresorbable screws. Revision surgery with fixation of the chondral flap using bioresorbable pins and screws led to satisfactory results. Open revision surgery allowed us a more accurate assessment of the OD area to provide an effective fixation of the chondral flap and in this circumstance, this should have been done after seeing the first MRI.