Elsevier

The Knee

Volume 9, Issue 1, February 2002, Pages 7-10
The Knee

Natural progression of osteo-chondral defect in the femoral condyle

https://doi.org/10.1016/S0968-0160(01)00133-8Get rights and content

Abstract

We have tried to establish the course of an isolated osteochondral defect in a femoral condyle would take if it were not treated surgically. We studied 15 knees in 12 patients where a diagnosis of the condition had been made in the past and no surgical treatment instituted for it. Each patient was examined clinically and had an MRI scan. The average period of follow-up was 109 months, the range being 54–282 months. Six patients (seven knees) were under the age of 18 at the onset of symptoms. Of these, MRI of six knees showed either no abnormality or a healed lesion. Where the onset was after skeletal maturity, six of the eight knees showed features osteoarthritis on the MRI scan. Symptomatically, there was also a difference between the two groups.

Introduction

Separation of isolated osteochondral fragment in a joint is a well-established condition. It occurs most commonly in the knee [1], but other joints are also known to be affected. Children and young adults are usually affected by it. It may be associated with trauma or with other causes of avascular necrosis of bone [2], but in the majority of cases, no clearly identifiable cause can be found.

As an osteochondral defect in a weight bearing joint can give rise to significant morbidity and adversely effect the life-style of an individual, it has generated a lot of interest in orthopaedic surgeons in the past, and continues to do so even now. Various methods of treating this condition have been tried in the past, and still newer methods are being tested [3], [4], [5], [6]. Going through the literature, one finds that very little study has been done to find out what would happen if such a lesion in the knee was left surgically untreated.

In this study, we have tried to establish what would be the natural course of events if such a lesion was left untreated surgically.

Section snippets

Patients and methods

Very strict criteria were laid down for the selection of patients for this study. Only those patients, who had a confirmed diagnosis of isolated osteochondral defect in the femoral condyle, were selected. Patients with such defects in the tibial plateau or in the patellae were excluded from this study. Patients with evidence of another associated injury, e.g. meniscal tear, cruciate ligament injury, etc. were similarly excluded from this study. Only those patients who did not have any surgical

Results

The summary of each case is given in Table 1. The total number of patients selected for our study was 12, and as three of these (25%) had bilateral affection with the same problem, the number of knees assessed was 15. Of the 12 patients, only one was female, showing a high preponderance for the male sex (Table 1).

Six of the 12 patients were under the age of 18 when their symptoms began and the diagnosis of isolated osteochondral defect was made (Table 1). In five instances, a definite history

Discussion

Isolated osteochondral defects in the knee is a well-known condition, which can cause significant morbidity. There have been suggestions that these lesions cause early onset of osteoarthritis, but the natural history of these lesions is not clear. Although Insall mentions that osteochondral defects in knees heal well in children [1], we did not come across any studies to authenticate this statement. In any case, we agree with this, as our findings suggest much the same. Insall also feels that a

Conclusion

An isolated osteochondral defect in the knee is a common condition, usually affecting young males. The prognosis appears to be good if it occurs in a person who has not achieved skeletal maturity. However, if it occurs later in life, the prognosis is less favourable as there is a high chance of the person developing degenerative features in the joint, and further research for treating this condition should be targeted at this group.

Acknowledgements

Dr R. Pethybridge, Statistician, Naval Institute of Medicine Gosport.

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