Treatment of Osteochondritis Dissecans of the Knee with Autologous Iliac Bone Graft and Hyaluronic Acid Scaffold

Osteochondritis dissecans (OCD) is a condition described in 1870 by König as an idiopathic focal lesion affecting the subchon dral bone with possible compromise of the stability of the adja cent cartilage.The condition can cause arthrosis at a young age 1) .The spectrum of lesions is broad and ranges from the superficial compromise of the cartilage to osteochondral collapse and the formation of intraarticular loose bodies 2) .There has yet to be a consensus about the aetiology, and it has been associated with avascular necrosis of the subchondral bone, genetic causes, abnormal calcification patterns, and endocrine abnormalities 2) .Genetic studies have associated specific altera tions with OCD, such as the ACAN gene; however, a pattern has not yet been identified 3) .The most commonly affected joint is the knee, specifically the medial femoral condyle.OCD mainly affects men (2:1 compared to women) in the adolescent stage between the second and third decades 4) .The most frequent clinical presentation is knee pain of increasing intensity during daily and sports activities that may be accompanied by a sensation of locking knee 2,5) .Many classifications for OCD has been proposed.According to the review performed by Jacobs et al. 1) the first classification proposed for OCD was the one proposed by Guhl y cols in 1979.This classification consisted of 4 stages: grade 1, lesion is present yet intact; grade 2, superficial fissure of the cartilage; grade 3, par tial detachment of the cartilage; and grade 4, complete detach ment of the cartilage, loose bodies and the presence of a crater in the subchondral bone.Classification systems have been modified and adapted for magnetic resonance imaging (MRI) 1) .The treat ment of grade 4 OCD lesions depends on the size, cartilage sta bility, and the physeal status 6) .This case report aims to present a novel technique to treat grade 4 OCD with good functional outcomes at oneyear followup.