An Adult Case Of Spontaneous Healing Of Concurrent Osteochondritis Dissecans Of The Lateral Femoral Condyle After Saucerization With Meniscal Repair For Discoid Lateral Meniscus: A Case Report
Nishino, K., Hashimoto, Y., Nishida, Y., Yamasaki, S., & Nakamura, H. (2021). An adult case of spontaneous healing of concurrent osteochondritis dissecans of the lateral femoral condyle after saucerization with meniscal repair for discoid lateral meniscus: A case report. International journal of surgery case reports, 87, 106427. https://doi.org/10.1016/j.ijscr.2021.106427
View Original Source →Abstract
BACKGROUND: The treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear. CASE PRESENTATION: A 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points. CONCLUSIONS: We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.
Case Details
Disease Location
Lateral femoral condyle
Personal Characteristics
22-year-old male
Clinical Characteristics
Complained of sharp pain in the left knee. He twisted his left knee in a motorcycle accident two weeks earlier. He complained of pain when his knee flexed deeply. Mcmurray test was positive on the lateral side. Osteochondritis dissecans (ocd) was detected on the lateral femoral condyle. A complete discoid lateral meniscus (dlm) with a longitudinal tear was found on arthroscopy, extending from the mid-body to the posterior horn. After confirming dlm, saucerization was started at the free edge of the meniscus. Postoperative rehabilitation began with a range of motion exercise one week postoperatively. The patient's knee was supported by a brace one week after surgery.
Remission Characteristics
One year after surgery, CT scan demonstrated bone union of the previous ocd lesion of the lateral femoral condyle
Treatment & Mechanisms
Proposed Remission Mechanisms
For lesions of the lateral femoral condyle with concurrent dlm, removing abnormal stress from the meniscus is a significant factor for healing.
Clinical Treatment
Arthroscopy saucerization physical therapy knee brace