Poor results from osteochondritis dissecans knee surgery

Q: I am really depressed over the poor results of my knee surgery. I have a condition called osteochondritis dissecans (OCD). Before throwing in the towel, I thought I would check with you and see what you recommend as a next step.

A: As you know, osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). A joint surface damaged by OCD doesn't heal naturally. Even with surgery, OCD can lead to future joint problems, including degenerative arthritis and osteoarthritis.

There are many different ways to treat this problem. The choice often depends on several factors: your age at the time of diagnosis (children and teens who are still growing are treated differently than adults), severity of the lesion(s), patient choice, and surgeon's expertise in this area.

Some patients with minor defects can be treated with conservative (nonoperative) care. Rest, activity modification, and specific exercises may be prescribed. Surgery (when it is advised) can consist of reattaching the fragments that have pulled away from the bone or removing them. Reattachment is called reduction and internal fixation; removal is called debridement.

Other treatment choices also include a procedure called microfracture (drilling tiny holes into the joint surface to stimulate healing), osteochondral grafts (donor tissue used to fill the hole), and autologous chondrocyte implantation (ACI). Since we don't know what type of first procedure you had, we cannot say what the next step may be. But a visit with your surgeon is the first order of events.

Your surgeon will re-evaluate your situation. Reasons for treatment failure may help direct the next treatment choice. For severe and chronic osteochondritis dissecans (OCD) lesions, autologous chondrocyte implantation (ACI) has been reported as a good option. In this procedure, healthy chondrocytes are removed from an area or normal tissue in your knee. They are sent to a lab where more chondrocytes are grown until there is enough graft tissue to fill in the defects.

Knowing what some of the treatment options are will aid you in talking with your surgeon and making the best decision for you. It's a fact that OCD can be a challenging condition to treat successfully. But studies also show that with surgery, the majority of patients with severe lesions do get satisfactory results. With the right treatment for you, you can expect reduced pain and improved function. Sometimes it takes more than one treatment to achieve these results so be patient with the process until you find what works best for you.

Reference: Brian J. Cole, MD, COL (Ret), et al. Outcomes of Autologous Chondrocyte Implantation in Study of the Treatment of Articular Repair (STAR) Patients with Osteochondritis Dissecans. In The American Journal of Sports Medicine. September 2012. Vol. 40. No.9. Pp. 2015-2022.