Open Treatment for Unstable Osteochondritis Dissecans of the Knee: Autologous Bone Grafting and Bioabsorbable Fixation

Heiden, Jace J.; Amirtharaj, Mark J.; Tao, Matthew A.

doi:10.1016/j.eats.2020.07.024

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…The prevalence of complications related to countersunk bioabsorbable implants in the fixation of osteochondritis dissecans fragments is currently the subject of controversy in the literature. 7,17,22,27 In our study, 1 fragment was fixated with a metallic screw that necessitated planned hardware removal 6 months after index surgery. The use of biodegradeable implants eliminates this second surgical procedure, which is associated with further comorbidities and potential damage of the opposing cartilage surface.…”

Section: Discussionmentioning

confidence: 99%

Successful Fixation of Traumatic Articular Cartilage–Only Fragments in the Juvenile and Adolescent Knee: A Case Series

Husen

Krych

Stuart

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Some surgeons are now considering fixation of traumatic chondral-only fragments in juvenile knees, but few data remain to guide treatment. Purpose: To determine if surgical fixation of chondral-only fragments in the juvenile knee results in an adequate healing response with successful imaging and clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: Data were collected on 16 skeletally immature patients treated with fixation of chondral-only fragments with a minimum 1-year follow-up. Patients were selected by the operating surgeons based on the quality and size of the chondral fragment. Demographic data, lesion characteristics, surgical procedure details, complications, and postoperative imaging were assessed. Validated outcome measures were collected pre- and postoperatively and included the following scores: International Knee Documentation Committee (IKDC), Marx Activity Scale, Knee injury and Osteoarthritis Outcome Score (KOOS), Hospital for Special Surgery Pediatric Functional Activity–Brief Scale (HSS Pedi-FABS), Patient-Reported Outcomes Measurement Information System (PROMIS)–Physical Health and PROMIS–Psychological Health, and Tegner. Results: The mean age of our patient cohort was 14.9 years. The mean size of the repaired defects measured 3.2 cm2. Injury sites included the patella (n = 1), medial femoral condyle (n = 3), trochlea (n = 4), and lateral femoral condyle (n = 8). Within the mean follow-up time of 42.3 months (range, 15-145), there was 1 clinical failure with loosening of the chondral fragment and the need for reoperation. At a mean follow-up of 3.5 years, the mean (interquartile range) patient-reported outcome scores were as follows: IKDC, 95.2 (94.3-100); Marx Activity Scale, 11.5 (11.5-16); KOOS, 95.81 (93.5-95.81); HSS Pedi-FABS, 16.94 (11.5-26); PROMIS–Physical Health, 93.75% (90%-100%); PROMIS–Psychological Health, 90% (88.75%-100%); and Tegner, 5.69 (4.75-7). All patients who were engaged in sports before injury returned to the same or higher level of competition with the exception of 1 patient. Conclusion: Primary repair of chondral-only injuries with internal fixation can be a successful treatment option in selected patients. Clinical and imaging results at final follow-up suggest that reintegration of the cartilage fragment is achievable and leads to excellent clinical function and a high return-to-sports rate.

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Section: Discussionmentioning

confidence: 99%

Successful Fixation of Traumatic Articular Cartilage–Only Fragments in the Juvenile and Adolescent Knee: A Case Series

Husen

Krych

Stuart

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Fixation of unstable OCD lesions is more common in skeletally immature athletes and studies have shown return to sport rates range from 6 to 12 months in this population. 71,72 Microfracture Studies looking at the efficacy of microfracture have demonstrated successful short-term outcomes and fairly successful return to sport. 73 Concerns about the durability of the resultant fibrocartilage repair tissue have been largely proven accurate as long-term outcomes studies suggest deteriorating outcomes over time with this approach.…”

Section: Fixation Of Unstable Lesionsmentioning

confidence: 99%

“…Limited data exists regarding postoperative outcomes and return to sport for athletes who have undergone fixation of unstable osteochondral lesions. Fixation of unstable OCD lesions is more common in skeletally immature athletes and studies have shown return to sport rates range from 6 to 12 months in this population 71,72 …”

Section: Surgical Outcomes and Return To Sportmentioning

confidence: 99%

Treatment of Knee Chondral Defects in Athletes

Thacher,

Pascual-Leone,

Rodeo

2024

Sports Medicine and Arthroscopy Review

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Cartilage lesions of the knee are a challenging problem, especially for active individuals and athletes who desire a return to high-load activities. They occur both through chronic repetitive loading of the knee joint or through acute traumatic injury and represent a major cause of pain and time lost from sport. They can arise as isolated lesions or in association with concomitant knee pathology. Management of these defects ultimately requires a sound understanding of their pathophysiologic underpinnings to help guide treatment. Team physicians should maintain a high index of suspicion for underlying cartilage lesions in any patient presenting with a knee effusion, whether painful or not. A thorough workup should include a complete history and physical examination. MRI is the most sensitive and specific imaging modality to assess these lesions and can provide intricate detail not only of the structure and composition of cartilage, but also of the surrounding physiological environment in the joint. Treatment of these lesions consists of both conservative or supportive measures, as well as surgical interventions designed to restore or regenerate healthy cartilage. Because of the poor inherent capacity for healing associated with hyaline cartilage, the vast majority of symptomatic lesions will ultimately require surgery. Surgical treatment options range from simple arthroscopic debridement to large osteochondral reconstructions. Operative decision-making is based on numerous patient- and defect-related factors and requires open lines of communication between the athlete, the surgeon, and the rest of the treatment team. Ultimately, a positive outcome is based on the creation of a durable, resistant repair that allows the athlete to return to pain-free sporting activities.

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“…O steochondritis dissecans (OCD) is a pathologic condition, most commonly affecting adolescents and young adults, in which a portion of the subchondral bone detaches from its surrounding superficial structures and results in subsequent cartilage injury. 1,2 Surgical intervention is often reserved for juvenile lesions that fail conservative management, unstable lesions, detached lesions in which physeal closure will occur within 6 to 12 months, and osteochondral fragment nonunion. 1,[3][4][5] Surgical options for juvenile OCD lesions include transarticular drilling for stable lesions and fixation for unstable lesions.…”

mentioning

confidence: 99%

Osteochondral Allograft Transplantation of the Lateral Femoral Condyle and Distal Femoral Osteotomy in the Setting of Failed Osteochondritis Dissecans Fixation

Swindell

Kerzner

Obioha

et al. 2022

Arthroscopy Techniques

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Open Treatment for Unstable Osteochondritis Dissecans of the Knee: Autologous Bone Grafting and Bioabsorbable Fixation

Cited by 5 publications

References 18 publications

Successful Fixation of Traumatic Articular Cartilage–Only Fragments in the Juvenile and Adolescent Knee: A Case Series

Successful Fixation of Traumatic Articular Cartilage–Only Fragments in the Juvenile and Adolescent Knee: A Case Series

Treatment of Knee Chondral Defects in Athletes

Osteochondral Allograft Transplantation of the Lateral Femoral Condyle and Distal Femoral Osteotomy in the Setting of Failed Osteochondritis Dissecans Fixation

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