2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress ePoster

 

New Treatment Algorithm for Unstable, Unsalvageable Osteochondritis Dissecans of Knee

Kukuh Dwiputra Hernugrahanto, MD, Surabaya, East Java INDONESIA
Jifaldi Afrian Maharaja Dinda Sedar, MD, Surabaya, East Java INDONESIA
Dwikora Novembri Utomo, MD, PhD, Surabaya, East Java INDONESIA
Nicolaas C. Budhiparama, MD, PhD (LUMC, NL), PhD (UGM, ID), FICS, Prof., Jakarta, DKI Jakarta INDONESIA

Universitas Airlangga, Dr Soetomo General Academic Hospital, Surabaya, East Java, INDONESIA

FDA Status Cleared

Summary

This study offers a new treatment algorithm for unstable, unsalvageable lesions, taking into account size, accessibility, and congruity, and explores the use of a novel xenogeneic cartilage scaffold.

ePosters will be available shortly before Congress

Abstract

Introduction

Osteochondritis dissecans (OCD) is a condition affecting the osteochondral unit, leading to the separation of subchondral bone, sometimes accompanied by articular cartilage involvement and instability. The current treatment approach is based on factors like skeletal maturity, lesion stability, and potential for salvage. Due to the relatively infrequent occurrence of OCD in the knee, there is no universally accepted treatment method. Existing literature does not factor in lesion size, accessibility (location), or congruity when considering treatment options. This study offers a new treatment algorithm for unstable, unsalvageable lesions, taking into account size, accessibility, and congruity, and explores the use of a novel xenogeneic cartilage scaffold.

Methods

This study presents a case series of 12 patients with unstable, unsalvageable osteochondritis dissecans (OCD) lesions, selected from a total of 16 OCD patients treated between 2019 and 2024. All 12 patients presented with delayed symptoms of pain and impingement after unsuccessful conservative treatment. Treatment approaches were tailored based on lesion characteristics. Marrow stimulation (microfracture) was performed in three patients with open physes. Autologous chondral transfer was performed in four patients with closed physes, lesions smaller than 2 centimeters, and good accessibility and congruity. Xenogeneic bovine cartilage scaffold implantation was performed in the remaining five skeletally matured patients with lesions larger than 2 centimeters, difficult access, and poor congruity. Functional outcomes were evaluated using the Lysholm score. Magnetic Resonance Imaging (MRI) was performed to assess the healing of the lesion and the MOCART score. Post-treatment complications were also monitored and evaluated.

Results

A significant improvement was observed in the average Lysholm score, increasing from 54 to 90. Additionally, there was a significant reduction in the average lesion size and a notable improvement in the mean radiographic score. Radiographic evidence of healing was seen in all patients within an average of 5.2 months after the drilling procedure (ranging from 3 to 10 months). No complications were apparent during the follow-up period.

Conclusion

Treatment algorithms for unsalvageable OCD should include not only skeletal maturity but also lesion size, accessibility, and congruity. The use of alternative cartilage scaffolds should be considered in patients with skeletal maturity who have large lesions that are difficult to access and have poor congruity.