Case Report : Concomitant Osteochondral Autograft Transplantation and Fixation of Osteochondral Fragment for Treatment of a Massive Osteochondritis Dissecans: A Report of 8-Year Follow-up Results

( Byung Ill Lee ),( Byoung Min Kim ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.4

Numerous procedures exist to treat osteochondritis dissecans (OCD); however, it remains a topic of debate which procedure is most ideal. When restoringa massive osteochondral defect, the use of only one procedure may not always allow complete filling of the defect. This case report presents a massive OCD with displaced osteochondral fragment and loose body in the knee joint that occupied almost all of the weight bearing area of the medial femoral condyle and was treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. To our knowledge, this is a rare report on OCD treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. At 8 years after surgery, the clinical outcome was excellent, and radiographs revealed congruence of the medial femoral condyle. The patient returned to sports activities. In massive and complex OCD lesions, individual techniques have limitations. Two or more techniques are needed to increase the rate of success.

Clinical Article : 소아 청소년기 운동선수에서 발생한 슬관절 박리성 골연골염의 수술적 치료 결과

국우종 ( Woo Jong Kuk ),장형원 ( Hyoung Won Jang ),김재영 ( Jae Young Kim ),하정구 ( Jeong Ku Ha ),김진구 ( Jin Goo Kim ) 대한스포츠의학회 2013 대한스포츠의학회지 Vol.31 No.2

The purpose of this study was to investigate clinical and radiological outcomes of multiple drilling in case of failed conservative treatment of juvenile osteochondritis dissecans in athletes. We treated 37 lesions from 30 athletic patients who failed conservative treatment for juvenile osteochondritis dissecans. Multiple drillings were done for 32 lesions and multiple drilling and bioabsorbable pin fixations were done for 5 lesions. Lysholm score, Hughston clinical scale were used for clinical evaluation before and last follow up of treatment. For radiologic evaluation we used magnetic resonance imaging at 3 months and 12 months after operation. Of all 37 lesions, 11 lesions were located on medial femoral condyle, 2 lesions on lateral femoral condyle and 24 lesions on trochlear groove. There were clinical and radiological improvement from Hughston scale after operative treatment. Twenty-five patients among 30 returned to the sports activity. There were no specific complications after operation. Multiple drilling and bio-absorbable pin fixation of juvenile athletic osteochondritis dissecans patients after failure of conservative treatment showed good clinical and radiologic results. So it would be helpful for juvenile athletic patients to return to sports activities.

『傷寒論』 甘草附子湯으로 호전된 거골 박리성 골연골염 증례 1례

최재영,이성준,이숭인 대한상한금궤의학회 2023 대한상한금궤의학회지 Vol.15 No.1

Objective: This is the result of a study on patients with osteochondritis dissecans (OCD) of the talus whose pain was improved by Gamchobuja-tang (GBT). Methods: The patient took GBT for 46 days. We observed the progress of symptoms, patient compliances and side effects. Quality of life related to pain was quantified through the SF-36 and AQoL-6D questionnaires. The degree of pain in the talus and ankle areas was quantified using VAS and observed through the symptoms and frequency complained of by the patient. Results: According to the DPIDS, the patient was diagnosed with the 175 provision in Taeyangbing chestbind (大陽病 結胸). As a result, SF-36 score increased from 36 points to 74 points, and the AQoL-6D score increased from 74 points to 104 points. The visual analogue scale (VAS) of ankle pain lowered from 9 to 2. The number of days with VAS levels 1 also increased. Conclusions: Gamchobuja-tang is effective in reducing pain in the talus area caused by osteochondritis dissecans..

안정성과 불안정성 박리성 골연골염의 감별에서 자기공명 양상소견 : 자기공명영상 기준의 재평가

최득린 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.1

Objective: To assess the radiographic and MR features of osteochondritis dissecans(OCD) in the knee, ankle and elbow and reappraise the criteria for differentiating stable and unstable OCD by using MRI. Materials and Method: The author retrospectively reviewed 16 cases of OCD who had correlative arthroscopy or arthrotomy. There were 15 patients with an average age of 18 years(12-41 years). The author analysed age, location, shape, signal intensity, articular cartilage, subchondral bone, abnormal fluid collection and displacement of OCD if any. Results: 12 cases in femoral condyle(7 in MFC and 5 in LFC), 2 cases in medial talar dome and 2 cases in capitulum. Stable OCD were present in 4(25%) and ubstable OCD in 12(75%)of 16 cases. Radiography showed poor correlation with arthrography and 7 cases were understaged. MRI proved accurate in discriminating stable(4 of 4 cases) versus unstab1e(12 of 12 cases) OCD. Conclusion: The author conclude that high signal intensity line between OCD and underlying bone, defect of articular cartilage and subchondral bone cyst, displacement of fragment(if any) on T2WI of MRI are strongly suggestive findings of unstable OCD. MRI is very sensitive method of detecting instability of OCD and can predict arthroscopic findings accurately.

박리성 골연골염환자 1예에 대한 증례보고

이옥진 ( Yu Chen Lee ),김빛나라 ( Bin Nara Kim ),이정민 ( Jung Min Lee ) 대전대학교 한의학연구소 2013 한의학연구소 논문집 Vol.22 No.1

Objective : The objective of this study is to observe the effect of anti-inflammatory herbal acupuncture, acupuncture, physical theraphy, external treatment, therapeutic exercise on the osteochondritis dissecans. Methods : Anti-inflammatory herbal acupuncture and acupuncture were used to treat knee pain and gait disturbance. We evaluated the patient through VAS(visual analogue scale) daily and symptoms. Results & Conclusions : After 31 days of treatment, right knee pain was decreased from VAS 10 to VAS 4, redness, burning sensation, edemaright of right knee were decreased. And the patient could walk. Oriental medicine treatment is proved to be helpful to imporve the symptoms of the osteochondritis dissecans.

Case Report : Bilateral Osteochondritis Dissecans of the Femoral Condyles in Both Knees; A Report of Two Sibling Cases

( Jae Hoon Jeong ),( Randy Mascarenhas ),( Hang Seob Yoon ) 대한슬관절학회 2013 대한슬관절학회지 Vol.25 No.2

Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful.

골수흡인물 농축액 및 기질유래연골형성 수술 이후 관찰된 거골의 골연골병변의 골유합: 증례 보고

송태훈,서진수,최준영 대한족부족관절학회 2023 대한족부족관절학회지 Vol.27 No.4

Traditionally, arthroscopic microfracture and autologous osteochondral autograft transplantation have been the primary surgical treat- ments for osteochondral lesions of the talus. On the other hand, recent advancements have introduced alternative approaches, such as autologous chondrocyte transplantation, matrix-derived autologous chondrocyte transplantation, intra-articular injection of concen- trated bone marrow aspirate concentrate, and the use of fibrin glue to address chondral defects. Furthermore, some studies have ex- plored a combination of bone marrow aspirate and matrix-derived chondrogenesis. In light of these developments, this report presents a case study of a young male patient in his early twenties with a relatively large osteochondral lesion exceeding 1.5 cm2 on the medial talar dome. Instead of removing the osteochondral lesion, a surgical approach was employed to retain the lesion while addressing the unstable cartilage in the affected area. This approach involved a combination of bone marrow aspirate concentrate and matrix-derived chondro- genesis. The treatment yielded favorable clinical outcomes and ultimately successfully induced the bony union of osteochondral lesions. This paper reports the author’s experience with this innovative approach with a review of the relevant literature

자가 골연골 플러그를 이용한 슬관절 불안정 박리성 골연골염의 치료

서승석(Seung-Suk Seo),서진혁(Jin-Hyeok Seo),이정우(Jeong-Woo Yi),정동욱(Dong-Wook Jung),김도훈(Do-Hun Kim) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.1

목적: 박리성 골연골염의 불안정성 골연골편을 자가 골연골 플러그를 이용하여 고정을 한 치료 방법의 임상적 결과를 평가하자고 한다. 대상 및 방법: 2004년 1월부터 2012년 1월까지 International Cartilage Repair Society 2, 3, 4단계에 해당되는 불안정성의 박리성골연골염을 가진 환자 중 자가 골연골 플러그로 골편 고정이 가능하였고 2년 이상 추시가 가능하였던 19명의 환자를 대상으로, 술 전 및 최종 추시 시의 Lysholm 점수와 International Knee Documentation Committee (IKDC) 주관적 점수를 비교하여 임상적 평가를 하였다. 결과: 환자는 모두 남자였으며, 평균나이는 19.1세였고, 병변은 대퇴내과 외측면이 16예, 대퇴외과 관절면이 2예, 대퇴골 활차부위가 1예였다. 병변의 평균 크기는 5.68 ㎟, 사용된 골연골 플러그의 개수는 평균 4.3개, 평균 추시 기간은 38개월이었다. 수술 전 Lysholm 점수와 IKDC 주관적 점수는 수술 후 유의하게 호전되었다. 결론: 자가 골연골 플러그를 이용한 박리성 골연골염의 불안정성 골편의 고정은 남아 있는 조직을 이용하고 보존할 수 있어 장점이 있는 수술 방법으로 생각된다. Purpose: The purpose of this study was to evaluate the clinical results of fixation of the unstable osteochondral dissecans (OCD) lesion with autologous osteochondral plugs. Materials and Methods: This study was conducted in 19 patients who were relevant to the International Cartilage Repair Society 2, 3, or 4 who were treated with autologous osteochondral plugs and followed-up for more than 2 years from January 2004 to January 2012. Clinical evaluation was performed by comparing the preoperative and last follow-up scores of Lysholm score and subjective International Knee Documentation Committee (IKDC) score. Results: All patients were male and the average age was 19.1 years. Of the 19 cases, there were 16 cases of medial femoral condyle lateral side lesion, 2 cases of lateral femoral condyle articular surface, and 1 case of femoral intercondylar notch lesions. The average size of the lesion was 5.68 ㎟, and average use of osteochodral plugs were 4.3. Average follow-up period was 38 months. Preoperative Lysholm score, IKDC subjective score showed significant improvement. Conclusion: Fixation with autologous osteochondral plugs for unstable OCD uses the remnant tissues therefore conserving it, which is thought to be the positive aspect of this type of operation.

박리성 골연골염의 방사선학적 소견

김재승 대한영상의학회 1993 대한영상의학회지 Vol.29 No.3

To evaluate the radiographic characteristics of osteochondritis dissecans (OCD) and useful parameter for predicting mechanical stability, we retrospectively analysed 26 plain radiographic examinations and seven MR imagings in 28cases of OCD in 24 patients. Typical radiologic findings were osteochondral defect with sclerotic rim of variable thickeness and osteochondral fragment. Sites of osteochondral defect were medial (35.9%) or lateral (32%) femoral chondyle and medial (7.1%) or lateral (25%) side of talar dome. Sclerotic rim was seen in 24 cases (85%) and osteochondral fragments including nine loose bodies were seen in 21 cases (75%) The size of osteochondral defect wtith unstable fragment (average 2.05cm) and loose body (2.04cm) in the knee joint were similar to, but statistically larger than that with stable fragment (1.35cm) All osteochondral defects were well visualized on MR images. Abonrmalities of articular cartilage and effusion in the interface betwen the parent bone and fragment werw seen in five cases of which there were confirmed three unstable cases arthroscopically. We conclude that size of defect may be a good parameter for predicting mechanical stability and MRI may be useful in the diagnosis of OCD and determining the methods of treatment

Multiple Osteochondritis Dissecans of Knee Joint in a Patient with Wilson Disease, Focusing on Magnetic Resonance Findings

박노혁,김형수,이상엽,민병조 대한슬관절학회 2013 대한슬관절학회지 Vol.25 No.4

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.