Internal Fixation of Lateral Trochlear Groove Osteochondritis Dissecans With Simultaneous Lateral Retinacular Lengthening in Adolescent Athletes

Abstract

Background: The goals of operative treatment for the adolescent athlete with unstable osteochondritis dissecans (OCD) lesion are rigid fixation and prevention of recurrence. Purpose: To evaluate clinical and radiological outcomes of internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening. Study Design: Case series; Level of evidence, 4. Methods: Adolescent athletes who had undergone internal fixation and simultaneous lateral retinacular lengthening for an unstable OCD lesion of the lateral trochlear groove were retrospectively reviewed. Subjective assessments included the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity scale, and an athletic questionnaire. Functional tests included isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance. Pre- and postoperative radiographs and magnetic resonance images were reviewed. Results: The mean ± SD age of the 17 patients included in this study was 15.9 ± 0.9 years; last clinical follow-up duration was 37.7 ± 8.1 months. At the last follow-up, the Lysholm score improved from 68.7 ± 15.3 to 93.4 ± 12.4 and the IKDC subjective score from 60.2 ± 14.7 to 88.7 ± 12.7 ( P < .001). The mean Tegner activity scale score was 9.4 ± 0.5 before injury and 8.9 ± 1.2 at the last follow-up ( P = .059). The limb symmetry indices of isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance improved at the last follow-up; the mean limb symmetry index was ≥85% in each functional test. Regarding the athletic questionnaire, 16 (94.1%) patients were satisfied with the surgery. At the last follow-up, 2 patients had higher ability after returning to sports, 11 had the same ability, and 3 had lower ability than the preinjury level. Postoperative magnetic resonance imaging at 12-month follow-up showed that the OCD lesion appeared healed in 7 (41.2%) patients and partially healed in 9 (52.9%). Conclusion: Internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening in adolescent athletes achieved satisfactory clinical and radiological outcomes. Therefore, this combined surgical technique could be considered an effective treatment for lateral trochlear groove OCD, with a high rate of return to sport.

Patella and Trochlea Osteochondritis Dissecans: Demographics and Treatment Paradigms

“…Our rate of healing radiographically was higher than the rate seen in a previous case series with a follow-up of ~3 years, which found only 41% of patients had full healing on imaging 19 . Return to activity and satisfaction with treatment varies widely, with studies reporting rates of positive outcomes from 38% to 100% 3,16,19,20,21 .…”

“…Our rate of healing radiographically was higher than the rate seen in a previous case series with a follow-up of ~3 years, which found only 41% of patients had full healing on imaging. 19 Return to activity and satisfaction with treatment varies widely, with studies reporting rates of positive outcomes from 38% to 100%. 3,16,19,20,21 A major caveat is that the literature uses a variety of outcome measures, including "improvement" and "patient satisfaction"; therefore, it is difficult to compare across studies.…”

“…19 Return to activity and satisfaction with treatment varies widely, with studies reporting rates of positive outcomes from 38% to 100%. 3,16,19,20,21 A major caveat is that the literature uses a variety of outcome measures, including "improvement" and "patient satisfaction"; therefore, it is difficult to compare across studies. RTS, pain resolution, and radiographic healing did not differ by treatment type.…”

High rates of return to sport following management of osteochondritis dissecans of the femoral trochlea: A systematic review

“…The 20 studies in this review included one case-control (level of evidence (III), six case series (level of evidence IV), and 13 case reports (level of evidence V) [5,7,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. All noncase reports studies were noncomparative, with a mean MINORS score of 8/16.…”

Osteochondritis dissecans of the knee in adolescents: How to treat them?

“…Internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening in adolescent athletes achieved satisfactory clinical and radiological outcomes. Therefore, this combined surgical technique could be considered an effective treatment for lateral trochlear groove OCD, with a high rate of return to sport 31 , 32 ( Figures 10 and 11 ).…”