A Staged Arthroscopic Approach to Fixation of Unstable Osteochondritis Dissecans in the Medial Femoral Condyle of the Knee Using Nonabsorbable Fixation Screws

Abstract

Osteochondritis dissecans is a focal lesion of articular cartilage that can result in fragment instability with progression of early osteoarthritis. Regarding the knee joint, salvage of an unstable lesion can be achieved using arthroscopic-assisted reduction and fixation via a 2-stage process. The first involves arthroscopic fixation of the fragment using nonbioabsorbable screws, whereas the second stage performed 12 weeks later involves removal of the screws and confirmation of successful healing of the lesion. Previous studies have demonstrated excellent outcomes in patients undergoing fixation for unstable chondral lesions not amenable to conservative treatment. A critical component of successful treatment is understanding the importance of hardware placement and technique. The purpose of the Technical Note is to describe a method performing this 2-stage arthroscopic repair of an unstable chondral lesion located on the medial femoral condyle of the knee.

Open Treatment for Unstable Osteochondritis Dissecans of the Knee: Autologous Bone Grafting and Bioabsorbable Fixation

“…Certainly, this has been described successfully arthroscopically. 10 , 11 However, in cases in which the bone is significantly involved on preoperative magnetic resonance imaging, we advocate an open approach to achieve optimal visualization and bone grafting ( Table 1 ). Other authors have noted the importance of autologous graft in this setting and have shown good results in terms of bony healing, outcome scores, and return to activity.…”

Clinical Outcomes and Return-to-Sport Rates following Fragment Fixation Using Hydroxyapatite/Poly-L-Lactate Acid Threaded Pins for Knee Osteochondritis Dissecans: A Case Series

“…Currently, several therapeutic options, including refixation of the detached fragment, bone marrow stimulation (enhancing in situ healing), osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques, have been proposed for treating OCD lesions of the knee [4]. When fixing OCD fragments, non-absorbable screws were conventionally used as fixation materials [5,6]. However, bioabsorbable implants have been gaining increased traction as a favorable treatment option for OCD fragment fixation for more than 10 years [7].…”

Internal Fixation of Osteochondritis Dissecans Using PushLock Suture Anchors

“…A variety of fixation techniques are available to treat unstable OCD lesions, including bone pegs, osteochondral plugs, 2 bioabsorbable pins and screws, 1 , 3 and metal screws. 4 , 5 These procedures usually yield satisfactory results. However, it is difficult to fix the lesion firmly, as the bony portion of the OCD is thin.…”