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

Abstract

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.

Functional and Radiographic Outcomes of Unstable Juvenile Osteochondritis Dissecans of the Knee Treated With Lesion Fixation Using Bioabsorbable Pins

“…[11][12][13][14][15][16][17][18][19][20][21][22] There have been several surgical fixation methods using different devices such as bone pegs, metal screws, bioabsorbable pins, and recently, osteochondral plugs. After Bandi and Allgower first demonstrated fixation of the OCD lesion using autogenous bone pegs through arthrotomy, good results of fixation of the OCD lesion were reported.…”

Arthroscopic Delivery of Cancellous Tibial Autograft for Unstable Osteochondral Lesions in the Adolescent Knee

“…2,6 Traditionally, an arthrotomy has been used to deliver autologous bone graft to the lesion site. 2,6 With advancements in arthroscopy, methods for less invasive treatment of orthopaedic disease are being developed. Wong and Yip 7 detailed the use of a chest tube and metal trocar to introduce bone graft into the femoral tunnel during revision anterior cruciate ligament reconstruction.…”

Osteochondral Injuries of the Knee in Pediatric Patients

“…Several authors have shown rates of healing from 88% to 100% with screw fixation. [56][57][58][59][60] In 2007, Kocher et al treated 26 juvenile OCD lesions with a variety of fixation methods (variable pitch screws, partially threaded cannulated screws, and bioabsorbable pins or tacks) and achieved an overall healing rate of 84.6%, with a 100% healing rate in completely detached lesions. 61 If headed screws are used for fixation of either a juvenile OCD lesion or a traumatic osteochondral fracture, they are removed around 6 to 12 weeks following implantation.…”