Internal Fixation of Osteochondritis Dissecans Using PushLock Suture Anchors

Ishibashi, Yasuyuki; Kimura, Yuka; Sasaki, Shizuka; Sasaki, Eiji; Takahashi, Akane

doi:10.1016/j.eats.2020.10.080

Cited by 5 publications

(9 citation statements)

References 8 publications

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“…5,16,47 Limited data are available on the short-term complications and outcomes and the healing rates of OCLs and OCD lesions after suture-bridge fixation. 4,9,23 Thus, the purpose of this study was to evaluate osseous and chondral integration after a suture-bridge construct using magnetic resonance imaging (MRI) scans and/or radiographs. A secondary purpose was to assess the outcomes and short-term complications of suture-bridge fixation of OCLs and OCD lesions in the knee.…”

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confidence: 99%

Suture-Bridge Fixation of Osteochondral Fractures and Osteochondritis Dissecans in the Knee: Excellent Rates of Early Lesion Stability and Osseous Union

et al. 2023

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Background: Preservation of articular cartilage in the setting of acute or chronic injury in the adolescent and young adult knee is paramount for long-term joint health. Achieving osseous union, minimizing implant-related injury, and eliminating the need for reoperation for traumatic chondral and osteochondral lesions (OCLs) and osteochondritis dissecans (OCD) remain a challenge for the orthopaedic surgeon. Purpose: To evaluate radiographic healing, patient-reported outcomes, and short-term complications after suture-bridge fixation of chondral fragments, osteochondral fractures, and OCD lesions in the knee. Study Design: Case series; Level of evidence, 4. Methods: The study included consecutive patients (38 patients, 40 knees) treated within a single academic sports medicine institution who underwent suture-bridge fixation of an OCL or an OCD lesion of the knee from initiation of the technique in October 2019 through March 2021. The suture-bridge technique entailed bioabsorbable knotless anchors placed on the outside margins of the lesion with multiple strands of hand-tensioned absorbable (No. 0 or No. 1 Vicryl) or nonabsorbable (1.3-mm braided polyester tape) bridging suture. Healing was assessed by radiography and magnetic resonance imaging (MRI), with MRI scans obtained on all OCD lesions and any chondral-only lesions. MRI scans were available for 33 of 40 (82.5%) knees within 1 year of surgery and were evaluated for lesion healing. Complications and rates and timing of return to sport were evaluated. Patient-reported outcomes in the OCD cohort were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) to determine early pain and functional improvement. Results: In total, 33 (82.5%) lesions demonstrated full union, and no lesions failed treatment. MRI assessment of healing (mean, 5.8 months; range, 3-12 months) demonstrated 9 (64.3%) OCD lesions with full union, 5 (35.7%) OCD lesions with stable union, and no OCD lesions with nonunion. Of the OCLs, 17 (89.5%) had full union, 2 (10.5%) had stable union, and none had nonunion. The 7 bony OCLs without an MRI scan demonstrated complete radiographic union. In 30 (75.0%) lesions, patients returned to sports at a mean of 6.5 months (range, 3.8-10.2 months). KOOS Activities of Daily Living, Pain, Quality of Life, and Symptoms scores demonstrated significant improvement from baseline at 6 months and at 1 year. There were 2 (5%) complications, consisting of reoperation for marginal chondroplasty on an otherwise stable lesion, and re-operation for intial un-treated patellar instability, with no reoperations for failure or revision of the suture-bridge construct. Conclusion: In this series of OCLs and OCD lesions of the knee, suture-bridge fixation demonstrated excellent rates of MRI and radiographic union and good early outcomes with minimal short-term complications. This technique may be used for lesion salvage as an alternative to metallic and nonmetallic screw/tack constructs in the treatment of these challenging lesions. Longer term follow-up and investigation are warranted.

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confidence: 99%

Suture-Bridge Fixation of Osteochondral Fractures and Osteochondritis Dissecans in the Knee: Excellent Rates of Early Lesion Stability and Osseous Union

et al. 2023

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“…Recently, some surgical osteochondral fragment fixation techniques using suture anchors were proposed. 8 , 9 , 10 Ishibashi et al. 9 demonstrated the suture anchor fixation technique, which is used in this experiment.…”

Section: Discussionmentioning

confidence: 95%

“…Recently, some surgical osteochondral fragment fixation techniques using suture anchors were proposed. [8][9][10] Ishibashi et al 9 demonstrated the suture anchor fixation technique, which is used in this experiment. They suggested that this technique could fix and press down over a wide area in a triangular structure without suture tying.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the same advantage, it has been reported in recent years that a knotless suture anchor is useful for osteochondral fragment fixation. 8 , 9 , 10 This technique can provide a wider compression force distribution from the suture bridge configuration. In addition, this procedure has the advantages that the anchor is completely buried under the cartilage, and the implant does not need to be removed.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Analysis of Unstable Osteochondral Fragment Fixation Using Three Different Techniques: Osteochondral Plug, Bioabsorbable Pin, and Suture Anchor with Tape

Sasaki

Yamauchi

Sasaki

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To compare the initial fixation strength of osteochondral fragment fixations using osteochondral plugs, bioabsorbable pins, and knotless suture anchors. Methods: Eighteen fresh-frozen immature (6 month old) porcine knees were used. An osteochondral fragment, cut from the articular surface of the medial femoral condyle to achieve a thickness of 5 mm, was used to mimic the unstable osteochondral fragment. It was fixed using three techniques, including two osteochondral plugs (osteochondral plug group), four full-threaded poly L-lactic acid pins (bioabsorbable pin group), and three suture anchors with a 2-0 tape (suture anchor group). Tensile loads at displacements of 1 and 2 mm and ultimate failure load were measured at a cross-head speed of 100 mm/min, and the variables of the three groups were compared statistically using a one-way ANOVA with Tukey's honestly significant difference test. Results: There was no significant difference in the tensile load to achieve 1-mm displacement. The load to achieve 2-mm displacement and the ultimate failure load were significantly greater in the suture anchor group than the osteochondral plug group and the bioabsorbable pin group. Conclusions: Single-pull destructive testing of a fixed articular osteochondral fragment with the force perpendicular to the articular surface, demonstrated no statistical difference in the tensile load to achieve 1-mm displacement, but the load to achieve 2-mm displacement was significantly greater for the three suture anchorinterlocking 2-0 tape constructs than the dual osteochondral plug fixation and the four bioabsorbable pin fixation constructs. Additionally, the three suture anchor-interlocking 2-0 tape construct's mean single-pull failure load was greater than other two fixation procedures. Clinical Relevance: To achieve osteochondral fragment union, sufficient fixation strength is critical. However, the initial fixation strength of osteochondral plugs, bioabsorbable pins, and knotless suture anchors for unstable osteochondral lesions remains unclear.

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“…Multiple methods for OCD fragment fixation have been reported, using metallic or bioabsorbable compression screws, and bioabsorbable nails and darts. The most recent reports include techniques using suture tape and solid press-fit anchors demonstrated through a mini-open approach, 5 as well as fixation with solid anchors and sutures arthroscopically tied to secure down the fragment. 6 …”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Fixation of Knee Osteochondritis Dissecans With Interlinked Knotless All-Suture Anchors

Hsu¹,

Tran²

2022

Arthroscopy Techniques

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Internal Fixation of Osteochondritis Dissecans Using PushLock Suture Anchors

Cited by 5 publications

References 8 publications

Suture-Bridge Fixation of Osteochondral Fractures and Osteochondritis Dissecans in the Knee: Excellent Rates of Early Lesion Stability and Osseous Union

Suture-Bridge Fixation of Osteochondral Fractures and Osteochondritis Dissecans in the Knee: Excellent Rates of Early Lesion Stability and Osseous Union

Biomechanical Analysis of Unstable Osteochondral Fragment Fixation Using Three Different Techniques: Osteochondral Plug, Bioabsorbable Pin, and Suture Anchor with Tape

Arthroscopic Fixation of Knee Osteochondritis Dissecans With Interlinked Knotless All-Suture Anchors

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