Open Reduction and Internal Fixation for the Treatment of Symptomatic Osteochondritis Dissecans of the Femoral Head in Patients With Sequelae of Legg-Calvé-Perthes Disease

Lamplot, Joseph D.; Schoenecker, Perry L.; Pascual‐Garrido, Cecilia; Nepple, Jeffery J.; Clohisy, John C.

doi:10.1097/bpo.0000000000001192

Cited by 11 publications

(15 citation statements)

References 26 publications

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“…11 Therefore, we suggest that greater OCDs should be treated with reattachment of the fragment through surgical hip dislocation and internal fixation. Lamplot et al 29 have reported predictable x-ray healing and significant clinical improvement following open reduction and internal fixation at mean follow-up of 4.6 years in a series of 7 patients with osteochondritis dissecans with underlying Perthes disease.…”

Section: Discussionmentioning

confidence: 98%

Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series

Slullitel

Nally

García-Mansilla

et al. 2020

Techniques in Orthopaedics

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When femoral head chondropaties are located medially or parafoveal, they pose a challenge to arthroscopically reach the affected area through commonly used portals. Though surgical hip dislocation remains as the gold standard for treatment of such lesions, many patients reject surgery for its potential complications and postoperative demanding rehabilitation protocol. We aimed to describe the surgical technique for microfracturing osteochondral lesions of the femoral head with a 3.2-mm drill in an arthroscopically assisted manner and to describe the outcome of this procedure. We describe 9 transtrochanteric drillings throughout an otherwise uneventful arthroscopic treatment of femoroacetabular impingement pathology. All of them had a parafoveal osteochondral lesion unapproachable with curved awls through routinely used portals. After debriding the cartilage flap with a chondrotome, the surgical technique consisted of a minimally invasive 3.2-mm drilling through the femoral lateral cortex fluoroscopically guided. Mean follow-up was 55.8 months (range, 43 to 113 mo). Outcome was evaluated with the modified Harris Hip Score (mHHS) and healing was assessed through magnetic resonance imaging findings. Overall, all patients showed better results when comparing preoperative and postoperative mHHS (43.8 vs. 79.5; P = 0.0008). No complications were reported due to the surgical technique. Complete healing of the osteochondral lesion was confirmed in 7 of 9 cases, and partially in one. One patient with Tönnis 2 preoperative changes required conversion to total hip arthroplasty at 80-month followup. Retrograde drilling was a valid option for treating small-sized medially located osteochondral lesions of the femoral head which are difficult to treat through standard arthroscopic portals.

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Section: Discussionmentioning

confidence: 98%

Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series

Slullitel

Nally

García-Mansilla

et al. 2020

Techniques in Orthopaedics

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“…Lamplot et al, 9 in a study of 64 patients treated with hip preservation surgery for LCPD, reported that the 7 patients (7 hips) who underwent surgical hip dislocation and ORIF of femoral head OCD had significant improvement in internal rotation in flexion at final follow-up. The authors observed radiographic healing without evidence of implant failure and no progression of osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

“…Osteochondritis Dissecans (OCD) of the femoral head has been reported in 2% to 7% of patients diagnosed with LCP disease. 9 , 14 …”

Section: Introductionmentioning

confidence: 99%

Osteochondritis Dissecans of the Hip in Legg-Calvé-Perthes Disease: Case Report and Review

Angeli,

Serafim,

Cordeiro

et al. 2024

Acta ortop. bras.

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Introduction: Legg-Calvé-Perthes disease (LCPD) is the idiopathic osteonecrosis of the capital femoral epiphysis in children. It is a self-healing condition, and the morphology of the hip may vary according to the severity of the disease, among several other factors. The treatment focuses on attempts to prevent femoral head collapse, obtain functional hip motion recovery, and reduce pain. Osteochondritis Dissecans (OCD) of the femoral head has been reported in 2% to 7% of patients diagnosed with healed LCPD. Although OCD may remain asymptomatic, the osteochondral fragment has the potential to become unstable, evolving into symptoms of pain, locking, catching, and snapping. Case report: We present a case report of a ten-year-old boy with an OCD lesion following LCPD who underwent effective osteochondral fixation through the surgical hip dislocation approach. The patient evolved to excellent functional recovery at 1 year post-operatively. Discussion: The surgical hip dislocation approach allows anatomical fixation of the OCD fragment, as well as improvement of hip biomechanics, decreasing pain, improving range of motion and joint congruency, and preserving the native articular cartilage. It also gives the surgeon the opportunity to assess hip stability, femoroacetabular impingement and labral tears, allowing a wide variety of options for the treatment of the healed LCPD. Level of Evidence IV; Type of study Case Report.

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“…Finally, although this study furthers our understanding of the revascularization process in LCPD, at this time we cannot offer clinical guidance based on the results of this study. One area in which the ligamentum teres may be jeopardized during surgery is through techniques in hip preservation, specifically with surgical hip dislocation, which is increasingly utilized in management of hip deformity related to LCPD 12–17. However, the safe surgical hip dislocation approach, which may involve transection of the ligamentum teres and disruption of the ligamentum teres vessels, is generally performed in the healed stage of LCPD after which time the perfusion from the ligamentum teres vasculature has again subsided in favor of the MFCA vessels 4,5…”

Section: Discussionmentioning

confidence: 99%

“…One area in which the ligamentum teres may be jeopardized during surgery is through techniques in hip preservation, specifically with surgical hip dislocation, which is increasingly utilized in management of hip deformity related to LCPD. [12][13][14][15][16][17] However, the safe surgical hip dislocation approach, which may involve transection of the ligamentum teres and disruption of the ligamentum teres vessels, is generally performed in the healed stage of LCPD after which time the perfusion from the ligamentum teres vasculature has again subsided in favor of the MFCA vessels. 4,5 In conclusion, this study provides further evidence of the role of the artery of ligamentum teres in the revascularization of the femoral head in the early stages (Waldenström I to IIa) of LCPD.…”

Section: Discussionmentioning

confidence: 99%

The Role of the Artery of Ligamentum Teres in Revascularization in Legg-Calve-Perthes Disease

Morris

Valencia

McGuire

et al. 2022

Journal of Pediatric Orthopaedics

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Introduction: A recent cadaveric study supported that most immature hips are supplied by the artery of ligamentum teres and suggested this medial vascular source may influence the pattern of revascularization in Legg-Calve-Perthes disease (LCPD). The purposes of this study were to characterize the perfusion pattern of the capital femoral epiphysis and determine the role of the artery of ligamentum teres in early revascularization of LCPD. Methods: Retrospective review of perfusion magnetic resonance imaging (pMRI) from 64 hips in early stage LCPD (Waldenström stage I to IIa) was performed. Two independent graders categorized perfusion pattern based on the presence of perfusion medially (from artery of ligamentum teres) and/or laterally (from the medial femoral circumflex artery) on coronal and sagittal MRI series: type 1—lateral perfusion only, type 2—separate medial and lateral perfusion, or type 3—coalescent medial and lateral perfusion. Lateral pillar classification was obtained for hips that reached mid-fragmentation. Results: We identified 64 patients (75% male) with mean age at diagnosis of 8.5±2.1 years. 36% (23/64) hips underwent pMRI during stage I and 64% (41/64) during stage IIa. pMRI revealed separate and distinct medial and lateral sources of perfusion (type 2) in 50% (32/64) hips. In stage I, the distribution of type 1/2/3 hips was found to be 26%/52%/22%. However, in stage IIa there was a nonsignificant trend toward greater coalescence of the medial and lateral perfusion with a distribution of type 1/2/3 of 7%/49%/44% (P=0.07). There was a nonsignificant trend toward weak negative linear correlation between lower initial perfusion grade and worsened lateral pillar classification at mid-fragmentation (r=−0.25, P=0.05). Conclusion: The presence of separate and distinct areas of perfusion of medial and lateral capital femoral epiphysis provides further evidence of the role of the ligamentum teres vessels in revascularization during the early stages of LCPD. The changes in perfusion pattern with disease progression likely reflect that medial femoral circumflex artery and ligamentum teres vessel revascularization occur separately, but ultimately coalesce posteriorly over time. Level of Evidence: Level II—prognostic study.

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Open Reduction and Internal Fixation for the Treatment of Symptomatic Osteochondritis Dissecans of the Femoral Head in Patients With Sequelae of Legg-Calvé-Perthes Disease

Abstract: Level IV-case series.

Cited by 11 publications

References 26 publications

Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series

Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series

Osteochondritis Dissecans of the Hip in Legg-Calvé-Perthes Disease: Case Report and Review

The Role of the Artery of Ligamentum Teres in Revascularization in Legg-Calve-Perthes Disease

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