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© 1989 British Editorial Society of Bone and Joint Surgery 030l-620X/89/4152 $2.00 J Bone Joint Surg fBr / 1989:71-B:642-4. 642 THE JOURNAL OF BONE AND JOINT SURGERY RESULTS OF DRILLING OSTEOCHONDRITIS DISSECANS BEFORE SKELETAL MATURITY

By J. Bradley and D. J. Dandy

Abstract

We report the arthroscopic drilling of classical lesions of osteochondritis dissecans in 1 1 knees in 10 children with at least six months history and no sign of clinical or radiological improvement. There were eight boys and two girls and the average age at operation was 12 years 1 1 months. Relief of pain was noticed within days of operation; radiological healing occurred within 12 months in nine of the 1 1 knees. Much has been written about osteochondritis dissecans since it was first described by Paget in 1 870, but its cause and treatment remain controversial. Reports on its natural history are sometimes confused by the inclusion of patients with epiphysea! dysplasia (Caffey et a! 1958) and acute osteochondral fractures (Aichroth 1971, 1977), but the patients we have studied a!! had ‘classical’ osteochondritis dissecans of the type described by K#{246}nig (1887), Green and Banks (1953) and Linden (1976). The condition is the same as Smillie’s (1980) juvenile osteochondritis dissecans. Conservative treatment (Ede!stein 1954), drilling (Clanton and DeLee 1982) and cast immobilisation (Smillie 1957) have all been tried with varying degrees of success. Some lesions resolve spontaneously (Edelstein 1954; Lofgren 1954), but others lead to the formation of a loose body and a defect in the femora! condyle. We now report the outcome of drilling to treat persistent symptoms in young patients before epiphysea! closure. PATIENTS AND METHODS Presenting symptoms. No patient had a history of definite trauma, a family history of osteochondritis dissecans, or generalised ligamentous laxity. Apart from one patient who had both knees affected, none had any other joint disorder

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