Current treatment modalities of osteochondritis dissecans of the knee joint: results of a nation-wide German survey.

In a nation-wide survey 350 knee surgeons were asked for their current diagnostic and treatment modalities in patients with osteochondritis dissecans (OD) of the knee joint: 255 questionnaires were analyzed. With respect to the different imaging techniques, standard xray studies were performed by all surgeons. Other techniques were used in the following decreasing order of preference: xray tomography, MRI, CT-scan, ultrasound, bone scan, and arthrography. The indication for surgery was primarily influenced by the standard xray, and secondarily by xray tomography, then by MRI, and CT-scan. Regarding cartilage-inducing treatment methods, Pridie drilling (antegrade) was by far predominant over abrasion arthroplasties and Beck drilling (retrograde). Cartilage or perichondrium transplantation was performed rarely. For fixation of a loose fragment most of the surgeons preferred "Ethipins" followed by screws and K wires. Only one-third of the surgeons used MRI as one of the first diagnostic tools, but a higher percentage of surgeons recommended MRI in special cases. Especially in young patients MRI was used as often as plain xray, whereas the use of MRI in older patients was remarkably reduced. Concerning treatment modalities, the majority of surgeons treated young patients with protection from weight bearing. For cartilage stabilization, "Ethipins" were preferred, whereas screws were rarely recommended. Approximately 25% of the physicians would not treat asymptomatic patients at all. Even patients with typical symptoms were not treated by less than 15% of the surgeons. In general, adults with OD still embedded in the cartilage bed are treated more aggressively. In cases with a loose body the cartilage-inducing procedures are preferred. Perichondrium or cartilage transplantations are only rarely performed.