Arthroscopic surgical management of osteochondritis dissecans of the knee.

Surgical management of osteochondritis dissecans of the knee is indicated when the ununited fragment remains persistently ununited and the knee becomes symptomatic and does not respond to conservative measures of rest and immobilization. Traditionally, arthrotomy was done and either bone peg grafts, with or without fixation, or excision of the fragment and drilling of the base of the crater were performed. This paper presents a series of 29 patients who were treated surgically for symptomatic osteochondritis dissecans using arthroscopic techniques. In this series of patients, excision of fragment and drilling or abrasion of the crater were done. In the instances when the fragment had become a loose body, the loose body was simply excised and the crater was then either drilled or left alone. The plan of this study is to follow up these patients for a long time to determine the ultimate result. To our knowledge, this paper is the first report of the early results of this form of surgery in the treatment of this difficult lesion of the knee. The early follow-up indicates a 72% satisfactory result rate when both subjective and objective means of measuring the results are considered. An interesting finding during the study was the high incidence of significant intra-articular pathology (51%) other than the osteochondritis discovered when arthroscopic techniques are used. There were no complications from the arthroscopic surgery.