Results of arthroscopic excision of the fragment in the treatment of osteochondritis dissecans of the knee

Purpose: To evaluate clinical and radiological results of arthroscopic excision of the fragment and debridement of the crater in the treatment of osteochondritis dissecans of the knee (OCD). Type of Study: Case series. Methods: We investigated 20 patients with partial or complete detachment of the OCD fragment. The average age at surgery was 21 years (range, 12 to 32 years). All the patients were treated by the same surgeon. They were evaluated at an average follow-up of 9 years (range, 6 to 17 years). Results: The combined subjective and objective evaluation showed excellent and good results for 85% of the patients. Radiographic studies showed 2 grades of worsening (from no degenerative signs preoperatively to narrowing of the joint line up to 50% at follow-up) in 1 patient (5%). One grade of worsening (Fairbank's changes without joint space narrowing) was found in 45% of weight-bearing anteroposterior radiographic views and in 35% of weight-bearing bent knee posteroanterior views. Statistical correlations were significant between radiographic degenerative changes and the size of the osteochondral lesion at surgery, with larger lesions resulting in greater degenerative changes. Conclusions: The arthroscopic removal of an osteochondral fragment and debridement of the crater is a viable option in the treatment of grade III and IV OCD lesions. Results are better in lesions less than 2 cm(2).