Surgical Management of Osteochondritis Dissecans Lesions of the Patella and Trochlea in the Pediatric and Adolescent Population

Abstract

Surgical treatment of patellofemoral OCD in children and adolescents produces a high rate of satisfaction and return to sports. Female sex, prolonged duration of symptoms, and internal fixation may be associated with worse outcomes.

Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents

“…c After osteochondral plugs implantation To date, no study on the treatment of OCDP by autologous osteochondral mosaicplasty in children has been published. Rare series are reported in the literature concerning the management of OCDP in children and adolescents using the conventional techniques [10,24]. Resection of the osteochondral fragment followed by perforation [9] or curettage [8,10] of the subchondral bone often results in poor outcomes [8,25].…”

Internal Fixation of Osteochondritis Dissecans Lesions in the Patellofemoral Joint

“…MRI allows axial imaging of the patellofemoral joint with the knee in full extension, allowing better characterization and localization of patellofemoral chondral defects and aids in evaluation of the subchondral bone. 6,[21][22][23][24] In select patients, computed tomography arthrogram may improve the definition of the lesion.…”

“…Studies have shown success with fixation of these lesions in both skeletally immature and mature populations, using both metal and bioabsorbable screws, but careful preoperative evaluation of imaging and individual patient factors should be fully assessed. [6][7][8]25,26 Hardware prominence, loss of fixation, and screw breakage are frequently reported complications resulting from internal fixation of OCD lesions. 6,27,28 Preoperative assessment of lesion size, overall patella size and depth, available subchondral bone, and implant choice should all be considered.…”

“…4,5 An increased rate of OCD lesion instability (stage III/IV) in the patellofemoral joint versus the femoral condyle has also been shown, possibly related to the frequent delay in diagnosis of these lesion. 6 While the patellofemoral joint may not be "weight-bearing" in a sense as the femoral condyles, it is subjected to high joint contact pressures (weight-bearing), particularly with daily activities, such as stair climbing, or sporting activities, such as running or jumping. As such, OCD lesions of the patellofemoral joint can become a severely debilitating condition for the patient over time.…”

“…Surgical management has been shown to produce a high rate of satisfaction and return to sport (►Table 1). [6][7][8] Numerous surgical techniques of stable OCD lesions have been described, including both retrograde and antegrade drilling, compression screw fixation, and subchondral bone grafting. [9][10][11][12] Internal fixation has historically been limited to lesions which are "classic," or classified as: salvageable, unstable lesions with minimal fragmentation, and at least 3 mm of subchondral bone attached.…”