Surgical Fixation of Chondral-Only Fragments of the Knee: A Case Series With a Mean 4-Year Follow-up

Abstract

Background: Chondral-only fragments of the knee have traditionally been treated with excision, with or without cartilage restoration procedures. This is because of the historical assumption that cartilage has limited ability to heal to cancellous or subchondral bone. There is now a growing body of evidence supporting surgical fixation of these fragments. Hypothesis: We hypothesized that surgical fixation of chondral fragments would result in acceptable rates of healing with improvement in clinical outcome scores. Study Design: Case series; Level of evidence, 4. Methods: Data were collected on 15 surgically fixed chondral-only fragments in 14 patients. We retrospectively collected participant demographic information, lesion characteristics, primary mechanism (osteochondritis dissecans vs traumatic shear injury), fixation methods, reoperation information, second-look arthroscopic information, and clinical outcome scores. The mean clinical follow-up was 3.96 years, with a minimum of 1-year follow-up. All patients underwent follow-up magnetic resonance imaging at a mean of 2 years after the index procedure. Results: The mean age of our cohort was 17.7 years. We found an 80% survival rate for fixation of the fragments at a mean 4-year follow-up. There were statistically significant improvements in postoperative Knee injury and Osteoarthritis Outcome Score and Tegner scores compared with preoperative scores. Follow-up magnetic resonance imaging scans showed complete healing in 10 knees, partial healing in 2 knees, and loss of fixation in 3 knees. Second-look arthroscopic surgery of 3 knees for reasons other than fragment symptoms showed healing of the fragment, while arthroscopic surgery of 3 symptomatic knees showed loss of fixation. Conclusion: Surgical fixation of chondral-only lesions showed an 80% success rate with improvements in the KOOS and Tegner scores.

Chondral lesion of the patella in a junior football player: chondral-only fragment fixation

“…Despite the belief that direct cartilage-to-bone healing may lead to a biomechanically inferior repair, a slowly growing number of cases have reported successful outcomes after fragment fixation in both OCD lesions and traumatic shear injuries. 13,16 A recent case series of 3 patients who underwent fragment fixation, reported a full integration on postoperative MRI scans and "second look" arthroscopy. 17 A relevant publication by Fabricant et al reported a 7% loss of fixation rate and a 33% of full integration rate, however the study population consisted of patients with OCD.…”

“…[13][14][15] Fragment fixation has some advantages over excision or restorative and be performed in one time procedure, and restoration procedures can still be performed if fixation fails. 16 While recent case reports show promising evidence supporting fixation of chondral-only fragments, they are few in total number. The purpose of this case report was to add to this growing body of evidence.…”

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

“…Hence, due to the improved understanding of patellofemoral pathologies, a variety of arthroscopic and open surgical concepts for the repair of osteochondral lesions and the restoration of joint stability have been developed [25][26][27][28][29]. Furthermore, additional techniques for deformity correction (e.g., HTO) are inconsistently applied within the body of literature [30].…”

“…While some authors report that the subsequent swelling of the fragment is a concern in shear-off lesions because the anatomic reduction is impaired, a recent innovation takes advantage of the increased fragment dimensions. Jeuken et al reported a modified Hedgehog technique in order to repair pure chondral shear-off lesions in pediatric knees [30]. Therefore, the chondral fragments were multiply incised and trimmed obliquely for an interlocking fit in the defect site, and the autograft was attached with fibrin glue and, if indicated, with sutures.…”