Fixação interna de fragmento osteocondral originado de osteocondrite dissecante do joelho / Internal fixation of osteochondral fragment originated fro dissecting knee osteochondritis

O tratamento da osteocondrite dissecante do joelho com lesão tipo cratera associada a corpo livre intra-articular pode ser realizado pela fixação do fragmento osteocondral no seu local de origem. No entanto, existem controvérsias quanto à indicação e eficácia deste procedimento, principalmente quando o corpo livre está solto por tempo prolongado, já que existem relatos na literatura demonstrando deterioração do revestimento condral do mesmo diretamente relacionado com o intervalo decorrente de sua soltura. Relatamos um caso em que, apesar do fragmento osteocondral estar livre na articulação por aproximadamente cinco semanas, a sua fixação não trouxe complicações e resultou em cicatrização completa da lesão. Nós concluímos que, principalmente nos casos onde a lesão osteocondral no côndilo femoral envolve a superfície de carga, quando então o descarte do fragmento geralmente resultaria em mau prognóstico, as possíveis complicações da fixação tardia são compensadas pelos benefícios obtidos pela redução do fragmento osteocondral no local de origem, resultando na recuperação da congruência articular e possivelmente evitando um processo degenerativo articular precoce.

The treatment of dissecting knee osteochondritis with crater-like lesion associated to intra-articular loose body can be provided by fixating the osteochondral fragment on its original site. However, there is some concern about the efficacy of this approach, since some reports have shown that the cartilage layer in osteochondral loose bodies that have been detached for a long time becomes deteriorated. We report a case where while the osteochondral loose body was detached for as long as five weeks, the fixation to the osteochondral defect was uneventful and resulted in a completely healed lesion. We concluded that, especially in cases in which the lesion involves a weight-bearing area of the knee with a detached osteochondral fragment, when the prognosis is usually worse if the fragment is discarded, potential complications of the fixation are offset by the benefits achieved by reducing the osteochondral fragment at the crater-like lesion, resulting in better joint congruence, and potentially avoiding an early joint degeneration process.

Effect of ultrasound in repair of rabbit articular cartilage injury / 中华创伤杂志

Objective To observe the effect of low intensity pulsed ultrasound (LIPU) in repair of the articular cartilage injury in rabbits. Methods Osteochondral defects in the cartilage surfaces of femoral intercondylar fossae were made in 33 healthy adult New Zealand White rabbits, of which the knee lesions of the left hind legs were treated with LIPU (LIPU group) while that of the right ones used as control group. All animals in two groups were sacrificed respectively at the 2nd, 4th and 8th weeks postoperatively for gross appearance observation and histological examination. Results The ultrasound-treated tissues became more mature with in advance repair or regeneration. The repaired tissues in the LIPU group were near to normal hyaline cartilage tissues at the 8th week postoperatively, while the repaired tissues in the control group were weak, near to fibrocartilaginous tissues. Conclusion LIPU can promote repair of articular cartilage injury in rabbits.