Yunus V. SÖZEN, Özgür ÇETİK, Erkal BİLEN, Gökhan HEPGÜR

Diz eklemindeki tip 4 osteokondritis dissekansın iki aşamalı tedavisi

Diz ekleminde lateral femoral kondilin yük binme yüzeyinin büyük bir kısmını tutan osteokondritis dissekanslı 19 yaşındaki bir erkek hastada cerrahi tedavi uyguladık. Yerinden ayrılan osteokondral fragmanın tekrar yerine tespit edilemeyecek kadar parçalandığı ve kemik defektinin fazla olduğu; bu nedenle otojen osteokondral greft naklinin mümkün olmadığı olguda iki aşamalı cerrahi tedavi uyguladık. İlk aşamada, kemik defektinin rekonstrüksiyonu için otojen iliak kortikospongioz greft kondu. İkinci aşamada, greft yerine kaynadıktan sonra, kondral defektin rekonstrüksiyonu için, bu bölgeye otojen osteokondral greft nakli yapıldı. Ameliyat sonrası yedinci ayda yapılan kontrolde klinik olarak hastanın hiçbir şikayetinin olmadığı ve diz hareketlerinin tam olduğu görüldü.

Anahtar Kelimeler:

Artroplasti, Artroskopi, Diz eklemi, Osteokondrit, Kıkırdak, eklem, Nakil, otolog, Artrografi

Two-stage treatment of type 4 osteochondritis dissecans of the knee

We used a new surgical method in the treatment of a 19-year-old male patient with large osteochondritis dissecans involving the lateral femoral condyle of the knee joint. The osteochondral fragment was too comminuted to allow reattachment and the bone defect was considerably large in size, preventing autogenous osteochondral grafting. A two-staged surgical treatment was performed. In the first stage, the osseous defect was reconstructed using an autogenous corticocancellous iliac bone graft. In the second stage, after the graft union, an autogenous osteochondral graft was transplanted over the same area for the reconstruction of chondral defect. In the postoperative follow-up examination in the seventh month, the patient was symptomless, with full range of knee movements.

Keywords:

Arthroplasty, Arthroscopy, Knee Joint, Osteochondritis, Cartilage, Articular, Transplantation, Autologous, Arthrography,

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1.Mitsuoka T, Shino K, Hamada M, Horibe S. Osteochondritis dissecans of the lateral femoral condyle of the knee joint. Arthroscopy 1999;15:20-6.
2. Schenck RC Jr, Goodnight JM. Osteochondritis dissecans. J Bone Joint Surg [Am] 1996;78:439-56.
3. Berlet GC, Mascia A, Miniaci A. Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). Arthroscopy 1999;15:312-6.
4. Cugat R, Garcia M, Cusco X, Monllau JC, Vilaro J, Juan X, et al. Osteochondritis dissecans: a historical review and its treatment with cannulated screws. Arthroscopy 1993;9:675-84.
5. Federico DJ, Lynch JK, Jokl P. Osteochondritis dissecans of the knee: a historical review of etiology and treatment. Arthroscopy 1990;6:190-7.
6.Johnson LL, Uitvlugt G, Austin MD, Detrisac DA, Johnson C. Osteochondritis dissecans of the knee: arthroscopic compression screw fixation. Arthroscopy 1990;6:179-89.
7. Matava MJ, Brown CD. Osteochondritis dissecans of the patella: arthroscopic fixation with bioabsorbable pins. Arthroscopy 1997;13:124-8.
8. Victoroff BN, Marcus RE, Deutsch A. Arthroscopic bone peg fixation in the treatment of osteochondritis dissecans in the knee. Arthroscopy 1996;12:506-9.
9. Convery FR, Akeson WH, Amiel D, Meyers MH, Monosov A. Long-term survival of chondrocytes in an osteochondral articular cartilage allograft. A case report. J Bone Joint Surg [Am] 1996;78:1082-8.
10. Hangody L, Kish G, Karpati Z, Szerb I, Udvarhelyi I. Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc 1997;5:262-7.
11. Anderson AF, Pagnani MJ. Osteochondritis dissecans of the femoral condyles. Long-term results of excision of the fragment. Am J Sports Med 1997;25:830-4.
12.Williams JS Jr, Bush-Joseph CA, Bach BR Jr. Osteochondritis dissecans of the knee. Am J Knee Surg 1998;11:221-32.