Arthroscopic Fixation of Osteochondritis Dissecans of the Knee

Makino, Arturo; Múscolo, D. Luis; Puigdevall, Miguel; Paz, Matías Costa; Ayerza, Miguel A.

doi:10.1177/0363546505274717

Cited by 77 publications

(23 citation statements)

References 32 publications

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“…In one study utilizing titanium Herbert screw fixation, Makino et al . 16 demonstrated a 93% rate of healing as demonstrated on MRI and confirmed during arthroscopic screw removal. Another study assessing metal fixation of OCD lesions demonstrated 16/17 patients to be healed by arthroscopic inspection at 12 weeks.…”

Section: Discussionmentioning

confidence: 65%

“…Only 70% of our adult patients had good or excellent results based on their IKDC scoring as opposed to over 90% in studies including skeletally immature patients. 16 , 20 Patients who did not achieve radiographic healing had worse clinical outcome scores. Fragment excision for clinical and radiographic nonunion regardless of subsequent treatment had inferior IKDC (76 vs. 87), KOOS Sports (70 vs. 84), and KOOS QOL (67 vs. 78) and Marx scores (4.6 vs. 7.9) relative to the healed group.…”

Section: Discussionmentioning

confidence: 99%

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Internal Fixation of Unstable Osteochondritis Dissecans in the Skeletally Mature Knee with Metal Screws

et al. 2015

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PurposeSeveral bioabsorbable and metal options are available for internal fixation of an unstable osteochondritis dissecans (OCD) lesion, but currently there are little data on outcomes with metal headless compression screws in the adult knee. The purpose of this study was to determine (1) the radiographic healing rates, (2) midterm clinical outcomes, and (3) comparison between healed and unhealed OCD fragments after use of headless metal compression screws for the treatment of unstable OCD lesions in the knees of skeletally mature patients.MethodsRetrospective chart review for all skeletally mature patients who presented with unstable femoral condyle OCD lesions of the knee was conducted. All patients underwent open or arthroscopic reduction and internal fixation using headless metal compression screws. Preoperative and postoperative radiographs were reviewed with healing defined as radiographic evidence of union of the OCD progeny fragment with the condyle. Clinical outcome data were collected retrospectively using 3 validated outcome scores: International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Marx.ResultsTwenty-two knees in 22 patients with a mean age of 21 years (range= 14-37 years) were followed for an average of 8.7 years (range = 2-22 years). Metal, headless, cannulated compression screws were used in all 22 cases. At a mean of 31 months postoperatively (range = 2-262), fragment union was observed in 18 knees (82%). The remaining 4 knees (18%) required loose fragment excision and hardware removal at a mean of 9 months (range = 2-16 months) postoperatively. Mean postoperative Marx score was 7 (range = 0-16), the mean postoperative IKDC score was 85 (range = 62-100), and mean KOOS scores included KOOS Pain (93; range = 69-100), KOOS Symptoms (86; range = 71-100), KOOS ADL (98; range = 90-100), KOOS Sports (82; range = 50-100), and KOOS QOL (76; range = 50-100).ConclusionHeadless metal compression screws provide a satisfactory union rate for treatment of unstable OCD lesions of the femoral condyles in skeletally mature patients. Patients achieving union have good knee function, maintain satisfactory activity levels, and have superior knee outcomes compared with those that failed to heal after fixation at mid to long-term follow-up.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Internal Fixation of Unstable Osteochondritis Dissecans in the Skeletally Mature Knee with Metal Screws

et al. 2015

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“…A study of Herbert compression screw fixation yielded the following outcomes: 87% (13/15) of the knees healed to normal per IKDC grading and 93% (14/15) per radiographic assessment. 37 Gomoll et al 21 evaluated 12 adolescent patients with unstable Cahill type 2C lesions treated with compression screw fixation with average 6-year follow-up. All lesions healed without clinical or radiographic evidence of degenerative disease.…”

Section: Surgical Optionsmentioning

confidence: 99%

Surgical Treatment Options for Osteochondritis Dissecans of the Knee

Pascual‐Garrido¹,

McNickle²,

Cole

2009

Sports Health: A Multidisciplinary Approach

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Osteochondritis dissecans of the knee is identified with increasing frequency in the young adult patient. Left untreated, osteochondritis dissecans can lead to the development of osteoarthritis at an early age, resulting in progressive pain and disability. Treatment of osteochondritis dissecans may include nonoperative or operative intervention. Surgical treatment is indicated mainly by lesion stability, physeal closure, and clinical symptoms. Reestablishing the joint surface, maximizing the osteochondral biologic environment, achieving rigid fixation, and ensuring early motion are paramount to fragment preservation. In cases where the fragment is not amenable to preservation, the treatment may include complex reconstruction procedures, such as marrow stimulation, osteochondral autograft, fresh osteochondral allograft, and autologous chondrocyte implantation. Treatment goals include pain relief, restoration of function, and the prevention of secondary osteoarthritis.

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“…12, 20, 29, 60 Reported healing rates by radiograph have been between 80 and 100% with good to excellent clinical outcomes in the majority of patients. 1, 13, 16, 21, 28, 30, 34, 40, 43, 44, 48, 54 …”

Section: Introductionmentioning

confidence: 99%

Does Operative Fixation of an Osteochondritis Dissecans Loose Body Result in Healing and Long-Term Maintenance of Knee Function?

2009

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Background Osteochondritis dissecans (OCD) can progress to loose body formation resulting in a Grade IV defect. The decision to fix versus excise the loose body is controversial. Published operative fixation outcomes are small case series with short follow-up. Hypothesis Operative fixation (ORIF) of the loose body into the grade IV defect will heal and approximate “normal” knee function at long-term follow-up. Study Design Case series Methods Twelve patients were identified who underwent ORIF of a knee OCD loose body into the Grade IV osteochondral defects ranging in size from 2.0 to 8.0 cm2 (mean 3.5 cm2). After 12 weeks, hardware was removed and healing was assessed. Long-term outcomes were assessed with a Knee injury and Osteoarthritis Outcome Score (KOOS) and a Marx activity score. Results Arthroscopy for screw removal revealed stable healing in 92% (11/12) of patients. No patients required subsequent surgery for a loose body. At an average of 9.2 years follow-up (range 3.8-15.8 years) 83 % (10/12) of patients completed the KOOS. KOOS subscale scores for pain (mean 87.8, range 67-100), other symptoms (mean 81.8, range 61-96), function in activities of daily living (mean 93.1, range 72-100), and sports and recreation function (mean 74.0, range 40-100) were not significantly lower than published age matched controls. However the KOOS subscale for knee related quality of life (mean 61.9, range 31-88) was significantly lower (p = 0.003). Conclusions Operative fixation of Grade IV OCD loose bodies results in stable fixation. At an average 9 years after surgery, patients did not have symptoms of osteoarthritis pain and had normal function in activities of daily life. However, patients reported significantly lower knee related quality of life. Operative fixation of OCD loose bodies is a better alternative to lesion excision.

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Arthroscopic Fixation of Osteochondritis Dissecans of the Knee

Cited by 77 publications

References 32 publications

Internal Fixation of Unstable Osteochondritis Dissecans in the Skeletally Mature Knee with Metal Screws

Internal Fixation of Unstable Osteochondritis Dissecans in the Skeletally Mature Knee with Metal Screws

Surgical Treatment Options for Osteochondritis Dissecans of the Knee

Does Operative Fixation of an Osteochondritis Dissecans Loose Body Result in Healing and Long-Term Maintenance of Knee Function?

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