Operative Fixation of Chondral Loose Bodies in Osteochondritis Dissecans in the Knee

Abstract

Background:Osteochondritis dissecans (OCD) can progress to loose body formation, with or without subchondral bone attachment to the lesion. The efficacy of internal fixation of chondral loose bodies has not been determined.Hypothesis:Operative fixation of cartilaginous loose bodies would result in (1) healed OCD at second-look arthroscopy, (2) restored cartilage appearance on magnetic resonance imaging (MRI), and (3) nearly normal knee function, as determined by patient-reported outcome scores.Study Design:Retrospective case series; Level of evidence, 4.Methods:Five patients who underwent cartilaginous loose body fixation were identified. Lesions were located on the lateral trochlea (n = 2) and medial femoral condyle (n = 3) (mean size, 2.5 cm2). Loose bodies were reattached with compression screws through mini-arthrotomy or arthroscopy. Patients were nonweightbearing for 12 weeks postoperatively. After 12 weeks, screws were removed arthroscopically, and OCD stability was evaluated. Three patients underwent MRI to determine articular cartilage status. Images were evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score. Patients were interviewed and completed the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire.Results:Four patients had stable lesions at 12 weeks after surgery. One patient had slight motion to one-third of the lesion and stability to the remaining two-thirds. Three patients underwent an MRI. The mean time from surgery to MRI was 3.1 years. Mean MOCART score was 72.0 ± 10.4. One patient required repeat arthroscopy 1 year after initial fixation for debridement and arthroscopic drilling of an incompletely healed area of the lesion. Four patients completed the KOOS questionnaire. The mean time to KOOS completion was 4.6 years. Mean KOOS subscales for knee pain (91.0 ± 8.9), knee symptoms (83.0 ± 7.9), and function in activities of daily living (91.9 ± 10.6) were similar to published age-matched controls; however, scores for sports and recreation function (70.0 ± 17.8) and knee-related quality of life (67.2 ± 12.9) were lower.Conclusion:Operative fixation of chondral loose bodies, without macroscopically visible subchondral bone attachment, resulted in lesion stability at second-look arthroscopy. At final follow-up, patients had no substantial pain and normal function in activities of daily life compared with controls; however, knee-related quality of life and sport and recreation function were reduced, and 1 patient required reoperation for an unhealed portion of the lesion.

Internal Fixation of Osteochondritis Dissecans Lesions in the Patellofemoral Joint

“…Various methods of fixation have been reported for OCD lesions, including barbed arrows, bioabsorbable pins, and screws, metal compression screws and other devices. [6][7][8]16,26,27,29,30 Choice of the fixation device may be based on surgeon experience and comfort level, but careful consideration of lesion type and location based on the MRI findings should be considered in device decision-making. In central lesions or Before deciding on fixation, assess the bone.…”

“…Anderson et al reported in 2013 a small series of cartilageonly flap repairs with good healing in the intermediate term. 16 The author's experience echoes these outcomes, and the repair of cartilage-only flaps is only encouraged in the young. One exception is for those cartilage-only fragments that have been loose long enough to expand in thickness.…”

“…11,14,15 New techniques have also expanded the indications for internal fixation to include lesions with minimal subchondral bone or "cartilage-only" lesions. 16 This article will detail the surgical treatment of both classic and cartilage-only patellofemoral OCD lesions.…”

Large chondral fragment of the lateral femoral condyle treated with arthroscopic internal fixation in an elite young athlete

“…While displaced osteochondral lesions amenable to fixation have shown good outcomes [4][5][6], the success of fixation when cartilage fragments are devoid of subchondral bone is rarely described and previously been questioned [7]. The evidence for reduction and internal fixation of large cartilage fragments is limited to case reports [8][9][10][11][12][13][14][15], and the purpose of this study is to contribute yet another case to the literature of successful primary fixation of a large chondral fragment in the knee, here in a highly active young patient.…”

We Miss You, Allen

“…Beginning with his first paper, ''Anterior Calcaneal Osteotomy of Symptomatic Juvenile Pes Planus,'' in 1984, 3 his prolific research continued unabated through the present year. 15 Allen was particularly interested in the welfare of young athletes, leading to important articles on the subjects of osteochondritis dissecans 5,[8][9][10] and anterior cruciate ligament reconstruction in the skeletally immature patient. 2 In an era when many American surgeons felt that randomized trials in orthopaedic surgery were unfeasible, Allen showed us that they could indeed be done.…”