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Published in: Archives of Orthopaedic and Trauma Surgery 12/2015

01-12-2015 | Arthroscopy and Sports Medicine

Arthroscopic antegrade drilling for unstable juvenile osteochondritis dissecans of the knee: mid-term results

Authors: Hong Chen, Wei Xu, Ning Hu, Dianming Jiang, Wei Huang

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2015

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Abstract

Purpose

The aim of our study was to retrospectively review the mid-term clinical and imaging outcomes of unstable knee juvenile osteochondritis dissecans (JOCD) patients treated with antegrade drilling.

Methods

Knee arthroscopy and antegrade drilling was performed on 63 knee JOCD patients between 2006 and 2012. Lysholm and Tegner, as well as International Knee Documentation Committee (IKDC), scores were recorded and compared preoperatively and at the latest follow-up. Knee radiographs and magnetic resonance imaging were used to examine lesion healing status.

Results

The mean follow-up time was 4.7 years (range 2–7.3 years), and 52 patients finished the follow-up. The average defect size was 2.79 cm2 (range 1–4 cm2). Forty three patients had excellent outcomes with full return to pre-injury activities and reported no symptom recurrence or deterioration over time. The overall healing rate was 82.7 % (43/52). The average Lysholm score was improved from 51.3 to 85.8 (P = 0.001). The mean Tegner activity level was improved from 3.7 to 6.7 (P = 0.013). And the mean IKDC score was improved from 55.7 to 73.2 (P = 0.007). On average, evidence of healing was observed at 11.3 months after surgery (range 6–18 months)

Conclusions

Our series showed good to excellent mid-term results in unstable knee JOCD patients who were treated by antegrade drilling. This technique is minimally invasive and effective, as well as cost effective.

Level of evidence

4.
Literature
1.
go back to reference Kocher MS, Tucker R, Ganley TJ, Flynn JM (2006) Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 34:1181–1191CrossRefPubMed Kocher MS, Tucker R, Ganley TJ, Flynn JM (2006) Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 34:1181–1191CrossRefPubMed
2.
go back to reference Hefti F, Beguiristain J, Krauspe R, Möller-Madsen B, Riccio V, Tschauner C et al (1999) Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B 8:231–245PubMed Hefti F, Beguiristain J, Krauspe R, Möller-Madsen B, Riccio V, Tschauner C et al (1999) Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B 8:231–245PubMed
3.
go back to reference Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 391:S362–S369CrossRefPubMed Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 391:S362–S369CrossRefPubMed
4.
go back to reference Frisbie DD, Oxford JT, Southwood L, Trotter GW, Rodkey WG, Steadman JR et al (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res 407:215–227CrossRefPubMed Frisbie DD, Oxford JT, Southwood L, Trotter GW, Rodkey WG, Steadman JR et al (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res 407:215–227CrossRefPubMed
5.
go back to reference Mithoefer K, Williams RJ 3rd, Warren RF, Wickiewicz TL, Marx RG (2006) High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 34:1413–1418CrossRefPubMed Mithoefer K, Williams RJ 3rd, Warren RF, Wickiewicz TL, Marx RG (2006) High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 34:1413–1418CrossRefPubMed
6.
go back to reference Gudas R, Kalesinskas RJ, Kimtys V, Stankevicius E, Toliusis V, Bernotavicius G et al (2005) A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy 21:1066–1075CrossRefPubMed Gudas R, Kalesinskas RJ, Kimtys V, Stankevicius E, Toliusis V, Bernotavicius G et al (2005) A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy 21:1066–1075CrossRefPubMed
7.
go back to reference Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484CrossRefPubMed Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484CrossRefPubMed
8.
go back to reference Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M et al (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14:1119–1125CrossRefPubMed Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M et al (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14:1119–1125CrossRefPubMed
9.
go back to reference Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am 75:532–553PubMed Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am 75:532–553PubMed
10.
go back to reference Dipaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7:101–104CrossRefPubMed Dipaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7:101–104CrossRefPubMed
11.
go back to reference Gudas R, Simonaityte R, Cekanauskas E, Tamosiūnas R (2009) A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop 29:741–748CrossRefPubMed Gudas R, Simonaityte R, Cekanauskas E, Tamosiūnas R (2009) A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop 29:741–748CrossRefPubMed
12.
go back to reference Kocher MS, Czarnecki JJ, Andersen JS, Micheli LJ (2007) Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med 35:712–718CrossRefPubMed Kocher MS, Czarnecki JJ, Andersen JS, Micheli LJ (2007) Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med 35:712–718CrossRefPubMed
13.
go back to reference Chen H, Sun J, Hoemann CD, Lascau-Coman V, Ouyang W, McKee MD et al (2009) Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair. J Orthop Res 27:1432–1438CrossRefPubMed Chen H, Sun J, Hoemann CD, Lascau-Coman V, Ouyang W, McKee MD et al (2009) Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair. J Orthop Res 27:1432–1438CrossRefPubMed
14.
go back to reference Chen H, Hoemann CD, Sun J, Chevrier A, McKee MD, Shive MS et al (2011) Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair. J Orthop Res 29:1178–1184CrossRefPubMed Chen H, Hoemann CD, Sun J, Chevrier A, McKee MD, Shive MS et al (2011) Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair. J Orthop Res 29:1178–1184CrossRefPubMed
15.
go back to reference Chen H, Chevrier A, Hoemann CD, Sun J, Ouyang W, Buschmann MD (2011) Characterization of subchondral bone repair for marrow-stimulated chondral defects and its relationship to articular cartilage resurfacing. Am J Sports Med 39:1731–1740CrossRefPubMed Chen H, Chevrier A, Hoemann CD, Sun J, Ouyang W, Buschmann MD (2011) Characterization of subchondral bone repair for marrow-stimulated chondral defects and its relationship to articular cartilage resurfacing. Am J Sports Med 39:1731–1740CrossRefPubMed
16.
go back to reference Gudas R, Stankevicius E, Monastyreckiene E, Pranys D, Kalesinskas RJ (2006) Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes. Knee Surg Sports Traumatol Arthrosc 14:834–842CrossRefPubMed Gudas R, Stankevicius E, Monastyreckiene E, Pranys D, Kalesinskas RJ (2006) Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes. Knee Surg Sports Traumatol Arthrosc 14:834–842CrossRefPubMed
17.
go back to reference Parikh SN, Allen M, Wall EJ, May MM, Laor T, Zbojniewicz AM et al (2012) The reliability to determine “healing” in osteochondritis dissecans from radiographic assessment. J Pediatr Orthop 32:e35–e39CrossRefPubMed Parikh SN, Allen M, Wall EJ, May MM, Laor T, Zbojniewicz AM et al (2012) The reliability to determine “healing” in osteochondritis dissecans from radiographic assessment. J Pediatr Orthop 32:e35–e39CrossRefPubMed
18.
go back to reference Chen CH, Liu YS, Chou PH, Hsieh CC, Wang CK (2013) MR grading system of osteochondritis dissecans lesions: comparison with arthroscopy. Eur J Radiol 82:518–525CrossRefPubMed Chen CH, Liu YS, Chou PH, Hsieh CC, Wang CK (2013) MR grading system of osteochondritis dissecans lesions: comparison with arthroscopy. Eur J Radiol 82:518–525CrossRefPubMed
19.
go back to reference Gunton MJ, Carey JL, Shaw CR, Murnaghan ML (2013) Drilling juvenile osteochondritis dissecans: retro- or transarticular? Clin Orthop Relat Res 471:1144–1151PubMedCentralCrossRefPubMed Gunton MJ, Carey JL, Shaw CR, Murnaghan ML (2013) Drilling juvenile osteochondritis dissecans: retro- or transarticular? Clin Orthop Relat Res 471:1144–1151PubMedCentralCrossRefPubMed
20.
go back to reference Abouassaly M, Peterson D, Salci L, Farrokhyar F, D’Souza J, Bhandari M, Ayeni OR (2014) Surgical management of osteochondritis dissecans of the knee in the paediatric population: a systematic review addressing surgical technique. Knee Surg Sports Traumatol Arthrosc 22:1216–1224CrossRefPubMed Abouassaly M, Peterson D, Salci L, Farrokhyar F, D’Souza J, Bhandari M, Ayeni OR (2014) Surgical management of osteochondritis dissecans of the knee in the paediatric population: a systematic review addressing surgical technique. Knee Surg Sports Traumatol Arthrosc 22:1216–1224CrossRefPubMed
21.
go back to reference Sasaki K, Matsumoto T, Matsushita T, Kubo S, Ishida K, Tei K, Akisue T, Kurosaka M, Kuroda R (2012) Osteochondral autograft transplantation for juvenile osteochondritis dissecans of the knee: a series of twelve cases. Int Orthop 36:2243–2248PubMedCentralCrossRefPubMed Sasaki K, Matsumoto T, Matsushita T, Kubo S, Ishida K, Tei K, Akisue T, Kurosaka M, Kuroda R (2012) Osteochondral autograft transplantation for juvenile osteochondritis dissecans of the knee: a series of twelve cases. Int Orthop 36:2243–2248PubMedCentralCrossRefPubMed
22.
go back to reference Martincic D, Radosavljevic D, Drobnic M (2014) Ten-year clinical and radiographic outcomes after autologous chondrocyte implantation of femoral condyles. Knee Surg Sports Traumatol Arthrosc 22:1277–1283CrossRefPubMed Martincic D, Radosavljevic D, Drobnic M (2014) Ten-year clinical and radiographic outcomes after autologous chondrocyte implantation of femoral condyles. Knee Surg Sports Traumatol Arthrosc 22:1277–1283CrossRefPubMed
Metadata
Title
Arthroscopic antegrade drilling for unstable juvenile osteochondritis dissecans of the knee: mid-term results
Authors
Hong Chen
Wei Xu
Ning Hu
Dianming Jiang
Wei Huang
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 12/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-015-2332-5

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