Bilateral Osteochondritis Dissecans of the Femoral Condyles in Both Knees: A Report of Two Sibling Cases
A 32-year-old female visited our hospital with a complaint of right knee pain. She had come three months ago for similar symptoms and had been diagnosed with OCD of the right knee based on clinical presentation and imaging studies obtained at that time. At the latest presentation, the pain increased in severity and the patient required a cane for ambulation due to a catching sensation in her right knee. Physical examination revealed moderate swelling and stiffness of the right knee. Localized tenderness was noted on the lateral and medial joint lines and twenty degrees of passive extension was lost.\nStanding weight-bearing posterior-anterior radiographs were obtained and revealed irregularities of bilateral femoral condyles in both knees on the weight-bearing portion of the femur (). Magnetic resonance imaging (MRI) showed a fragment in the center of the both femoral condyles with bone marrow edema. A fissure between the articular fragment and femoral bone base was also seen. Additionally, a 2.8 cm by 2.5 cm displaced articular loose body shadow was noticed on the lateral femoral condyle.\nThe patient was brought to the operating room and prepped and draped in the standard sterile fashion. Arthroscopic examination was performed first and findings revealed a 2.8 cm by 2.5 cm displaced osteochondral fragment from the lateral femoral condyle. The OCD defect was 0.5 cm in depth and contained a subchondral cyst and degeneration. A similar sized loose osteochondral lesion was also found on the medial femoral condyle with degenerative subchondral bone. It was decided that there would be a lower potential for healing if the fragments were simply re-attached. A decision was thus made to proceed with ACI for the lateral lesion and OAT for the medial lesion. Chondrocytes were harvested and the patient was brought back for subsequent operation five weeks later. An 8-cm midline skin incision was made on the right knee and an arthrotomy was performed. The lateral femoral condyle defect was treated with ACI (). Four osteochondral grafts were obtained from the superior aspect of the femoral condyle and trochlea using a special chisel (OATS; Arthrex, Naples, FL, USA). After implanting the donor cylinders using a press fit technique on the medial femoral condyle, the free space between the grafts was filled with remnant chondrocytes from the ACI. The patient was not allowed weight-bearing for six weeks and passive and active range of motion exercises were performed during this period. The patient was followed up for two years after surgical treatment. Her Lysholm score and visual analogue scale score were improved from 32 preoperatively to 90 at the last follow-up and from 9 preoperatively to 1 at the last follow-up, respectively.