Osteochondral Fracture Fixation With Fragment Preserving Suture Technique

Yamauchi

Arthroscopy, Sports Medicine, and Rehabilitation

et al. 2022

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.

Section: Discussionmentioning

confidence: 97%

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

Yamauchi

Arthroscopy, Sports Medicine, and Rehabilitation

et al. 2022

“…10,15,16,19,20 Suture-only techniques have been shown to have adequate fixation strength, can be used for smaller osteochondral fragments, and do not necessitate subsequent hardware removal. 12,21 However, they provide minimal compression across the fracture fragment and are biomechanically inferior to screws and anchors. Therefore, suture-only techniques often necessitate minimal early range of motion and prolonged nonweightbearing postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Knotless Suture Anchor Fixation of a Traumatic Osteochondral Lesion of the Lateral Femoral Condyle

Goldenberg

Nuelle²

2021

Arthroscopy Techniques

Osteochondral injuries commonly occur after lateral patellar instability events. Recognition and early intervention of displaced fragments is key to maintaining the viability of the fragment and congruency of the articular surface. Multiple fixation techniques exist for achieving stable fixation of displaced osteochondral lesions, including metal or bioabsorbable screws and all suture techniques. In this Technical Note, we describe a technique for internal fixation of a displaced osteochondral fragment of the lateral femoral condyle using knotless suture anchors. This technique affords minimally invasive restoration of the native anatomy with excellent stability of the fracture fragment, allowing early range of motion and ambulation.

“…The reviewed literature predominantly comprises low level and quality evidence and is based on variable treatment protocols (Table 1). Furthermore, various methods of internal fixation are employed, including metallic (headless) and resorbable compression screws [23,24,26], Kirschner wires [26], resorbable polylactid implants (nails, pins and darts) [15,[19][20][21][22]25,27,28,31,33], sutures (e.g., PDS) and suture-anchor constructs [29,34,35,47,48], fibrin sealants [19], and bone pegs [32]. Different main outcome measures and follow-up time periods are reported.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques

Weber

Migliorini

Hildebrand

2021

Life

Large (>3 cm2), focal osteochondral lesions (OCL) may result in poor functional outcomes and early secondary osteoarthritis of the knee. The surgical management of these OCL remains challenging. The treatment strategy must be tailored to various aspects, including lesion-specific (e.g., size, location, chronicity), joint-specific (e.g., instability, limb alignment, meniscal status), and patient-specific factors (e.g., age, activity level, comorbidities). Simple chondroplasty and bone marrow stimulation (BMS) techniques should be reserved for smaller lesions, as they only realize midterm clinical benefits, related to inferior wear characteristics of the induced fibrocartilage (type I collagen). Therefore, much attention has been focused on surgical restoration with hyaline cartilage (type II collagen), based on chondrocyte transplantation and matrix-assisted autologous chondrocyte implantation (MACI). Limited graft availability, staged procedures (MACI), and high treatment costs are limitations of these techniques. However, acute traumatic OCL of the femoral condyles and patellofemoral joint may also be suitable for preservation by surgical fixation. Early detection of the fragment facilitates primary repair with internal fixation. The surgical repair of the articular surface may offer promising clinical and cost-effective benefits as a first-line therapy but remains under-investigated and potentially under-utilized. As a unique characteristic, the fixation technique allows the anatomic restoration of the hyaline articular surface with native cartilage and the repair of the subchondral bone. In this manuscript, we present a case series of large OCL around the knee that were preserved by surgical fixation. Furthermore, various implants and techniques reported for this procedure are reviewed.