Comparison of the stability of various internal fixators used in the treatment of osteochondritis dissecans—a mechanical model

Morelli, Moreno; Poitras, Philippe; Grimes, Valentine; Bäckman, David; Dervin, Geoffrey F.

doi:10.1002/jor.20332

Cited by 8 publications

(5 citation statements)

References 23 publications

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“…110 The optimal fragment refixation technique is still under discussion. It has been observed experimentally that screw-fixation gave the best results 117 but that resorbable material can initiate allergic and/or synovial reactions and cartilage damage. 118…”

Section: Treatment Of Ocd Of the Knee Jointmentioning

confidence: 99%

Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

Bruns¹,

2017

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This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an analysis of and outcomes of the treatments available. OCD is seen in children and adolescents with open growth plates (juvenile OCD) and adults with closed growth plates (adult OCD). The etiology of OCD lesions remains unclear and is characterized by an aseptic necrosis in the subchondral bone area. Mechanical factors seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important. Regarding treatment, a tremendous number of publications exist. Spontaneous healing is expected unless there is an unstable fragment, and treatment involves rest and different degrees of immobilization until healing. Patients with open physes and low-grade lesions have good results with conservative therapy. When surgery is necessary, the procedure depends on the stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable. When the cartilage is damaged, several techniques can be used. While techniques such as drilling and microfracturing produce reparative cartilage, other techniques reconstruct the defect with additional osteochondral grafts or cell-based procedures such as chondrocyte transplantation. There is a tendency toward better results when using procedures that reconstruct the bone and the cartilage and there is also a trend toward better long-term results when comorbidities are treated. Severe grades of osteoarthrosis are rare.

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Section: Treatment Of Ocd Of the Knee Jointmentioning

confidence: 99%

Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

Bruns¹,

2017

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“…Unstable "trap door" lesions that are partially elevated from the subchondral bed require fixation. 44,54 If accessible, the base of the lesion and bony surface of the flap are debrided with a curette or rotary shaver. The fibrous tissue from the base (analogous to a fibrous nonunion) is completely debrided.…”

Section: Internal Fixationmentioning

confidence: 99%

Surgical Treatment Options for Osteochondritis Dissecans of the Knee

Pascual‐Garrido¹,

McNickle²,

Cole

2009

Sports Health

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Osteochondritis dissecans of the knee is identified with increasing frequency in the young adult patient. Left untreated, osteochondritis dissecans can lead to the development of osteoarthritis at an early age, resulting in progressive pain and disability. Treatment of osteochondritis dissecans may include nonoperative or operative intervention. Surgical treatment is indicated mainly by lesion stability, physeal closure, and clinical symptoms. Reestablishing the joint surface, maximizing the osteochondral biologic environment, achieving rigid fixation, and ensuring early motion are paramount to fragment preservation. In cases where the fragment is not amenable to preservation, the treatment may include complex reconstruction procedures, such as marrow stimulation, osteochondral autograft, fresh osteochondral allograft, and autologous chondrocyte implantation. Treatment goals include pain relief, restoration of function, and the prevention of secondary osteoarthritis.

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“…In fact, whereas a non-operative treatment with strenuous activity restriction may often lead to OCD lesion healing in young patients with open physis and stable lesions [17], surgery is generally required for unstable lesions and in patients who have reached skeletal maturity. The attempt of preserving the affected osteochondral unit with drilling techniques [18] or fragment fixation [19] should be the primary aim of the treatment. However, especially after skeletal maturity, patients may present with a loose body not suitable for refixation [16].…”

Section: Discussionmentioning

confidence: 99%

Osteochondral autograft transplantation versus autologous bone-cartilage paste grafting for the treatment of knee osteochondritis dissecans

Martino

Silva

Andriolo

et al. 2020

International Orthopaedics (SICOT)

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Purpose To compare the results of two groups of patients affected by osteochondritis dissecans (OCD) of the knee and treated with either osteochondral autologous transplantation (OAT) or bone-cartilage paste grafting (PG). Methods A total of 27 patients affected by OCD lesions of the femoral condyles were included: 15 treated with OAT, 12 with PG, with comparable baseline characteristics (mean age 22.4 ± 7.2 vs. 24.2 ± 8.5 p = n.s., mean defect size 2.2 ± 1 cm2 vs 2.6 ± 1 cm2p = n.s.). Patients were evaluated pre-operatively and at 24 and 84 months post-operatively with the International Knee Documentation Committee (IKDC) subjective and objective scores. Sport activity level was evaluated with the Tegner activity score. Adverse events and failures were also recorded. Results The IKDC subjective score improved significantly in both groups. At 24 months, a significant improvement from 53.4 ± 9.1 to 80.8 ± 12.9 (p = 0.005) was obtained in the OAT group and from 44.6 ± 11.0 to 71.4 ± 25.3 in the PG group (p = 0.008). A further statistically significant increase was observed at 84 months in both groups. No significant differences were found between OAT and PG at both follow-ups. One OAT patient required post-operative knee mobilization under narcosis and two complained of donor site symptoms. More failures were documented in the PG vs OAT group (25% vs 0%; p = 0.043). Conclusion Both PG and OAT provided overall satisfactory results up to 84 months follow-up. However, while PG presents the advantages of a less invasive approach with lower adverse events, the higher failure rate of PG should be considered when choosing between these two surgical treatment options for restoration of the articular surface in patients affected by knee OCD.

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Comparison of the stability of various internal fixators used in the treatment of osteochondritis dissecans—a mechanical model

Cited by 8 publications

References 23 publications

Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

Surgical Treatment Options for Osteochondritis Dissecans of the Knee

Osteochondral autograft transplantation versus autologous bone-cartilage paste grafting for the treatment of knee osteochondritis dissecans

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