Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2012

01-12-2012 | Knee

Surgical management of juvenile osteochondritis dissecans of the knee

Authors: Thai Q. Trinh, Joshua D. Harris, David C. Flanigan

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2012

Login to get access

Abstract

Purpose

Operative management of osteochondritis dissecans (OCD) in the juvenile knee is generally indicated upon failure of conservative treatment, in unstable lesions, and in lesions nearing physeal closure. We hypothesized that juvenile OCD lesions have improved clinical and radiographic outcomes with surgical treatment following failed non-surgical management, in unstable lesions, and in lesions nearing physeal closure.

Methods

Multiple medical databases were searched for Levels I–IV evidence with specific study inclusion and exclusion criteria. Length of mean follow-up was minimum 2 years. Studies were included if an analysis of clinical outcomes following surgical treatment of juvenile OCD was performed. All surgical techniques and defect classifications were potentially inclusive.

Results

Thirty studies (29 Level IV evidence) were included for analysis (783 subjects, 862 knees). Mean post-operative follow-up was 77 months. Nearly all studies within this review demonstrated significant clinical and radiographic improvements in outcomes in surgically treated juvenile OCD at short-, mid-, and long-term follow-up. Isolated excision of weight-bearing OCD lesions led to poorer clinical and radiographic results than other surgical techniques. Outcomes were significantly better with juvenile OCD versus adult OCD.

Conclusions

Surgical treatment of juvenile OCD has significantly improved clinical and radiographic outcomes at short-, mid-, and long-term follow-up. No difference in clinical or radiographic outcome was demonstrated in comparing different surgical techniques, with the exception of poorer results with isolated fragment excision.

Level of evidence

IV.
Literature
1.
Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M (2009) Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy 25(2):145–152PubMedCrossRef
2.
Aglietti P, Buzzi R, Bassi PB, Fioriti M (1994) Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy 10(3):286–291PubMedCrossRef
3.
Aichroth P (1971) Osteochondritis dissecans of the knee. A clinical survey. J Bone Joint Surg Br 53(3):440–447PubMed
4.
Anderson AF, Pagnani MJ (1997) Osteochondritis dissecans of the femoral condyles. Long-term results of excision of the fragment. Am J Sports Med 25(6):830–834PubMedCrossRef
5.
Anderson AF, Richards DB, Pagnani MJ, Hovis WD (1997) Antegrade drilling for osteochondritis dissecans of the knee. Arthroscopy 13(3):319–324PubMedCrossRef
6.
Bedouelle J (1988) L’oste’ochondrite disse’quante des condyles fe’moraux chez l’enfant et l’adolescent. Expansion Scientifique Franc¸aise. In: Cahiers d’enseignement de la SOFCOT
7.
Berndt AL, Harty M (2004) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 86-A(6):1336PubMed
8.
Bohndorf K (1998) Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification. Eur Radiol 8(1):103–112PubMedCrossRef
9.
Bradley J, Dandy DJ (1989) Osteochondritis dissecans and other lesions of the femoral condyles. J Bone Joint Surg Br 71(3):518–522PubMed
10.
Bradley J, Dandy DJ (1989) Results of drilling osteochondritis dissecans before skeletal maturity. J Bone Joint Surg Br 71(4):642–644PubMed
11.
Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl 2):58–69PubMed
12.
Bruckl R, Rosemeyer B, Thiermann G (1984) Osteochondrosis dissecans of the knee. Results of operative treatment in juveniles. Arch Orthop Trauma Surg 102(4):221–224PubMedCrossRef
13.
Bruns J, Rayf M, Steinhagen J (2008) Longitudinal long-term results of surgical treatment in patients with osteochondritis dissecans of the femoral condyles. Knee Surg Sports Traumatol Arthrosc 16(5):436–441PubMedCrossRef
14.
Cahill BR (1995) Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg 3(4):237–247PubMed
15.
Cahill BR, Berg BC (1983) 99 m-Technetium phosphate compound joint scintigraphy in the management of juvenile osteochondritis dissecans of the femoral condyles. Am J Sports Med 11(5):329–335PubMedCrossRef
16.
Camathias C, Festring JD, Gaston MS (2011) Bioabsorbable lag screw fixation of knee osteochondritis dissecans in the skeletally immature. J Pediatr Orthop B 20(2):74–80PubMedCrossRef
17.
Cepero S, Ullot R, Sastre S (2005) Osteochondritis of the femoral condyles in children and adolescents: our experience over the last 28 years. J Pediatr Orthop B 14(1):24–29PubMedCrossRef
18.
De Smet AA, Ilahi OA, Graf BK (1997) Untreated osteochondritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings. Skeletal Radiol 26(8):463–467PubMedCrossRef
19.
Din R, Annear P, Scaddan J (2006) Internal fixation of undisplaced lesions of osteochondritis dissecans in the knee. J Bone Joint Surg Br 88(7):900–904PubMedCrossRef
20.
Dipaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7(1):101–104PubMedCrossRef
21.
Donaldson LD, Wojtys EM (2008) Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee. J Pediatr Orthop 28(8):831–835PubMedCrossRef
22.
Edmonds EW, Albright J, Bastrom T, Chambers HG (2010) Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr Orthop 30(8):870–878PubMedCrossRef
23.
Ewing JW, Voto SJ (1988) Arthroscopic surgical management of osteochondritis dissecans of the knee. Arthroscopy 4(1):37–40PubMedCrossRef
24.
25.
Gudas R, Simonaityte R, Cekanauskas E, Tamosiunas 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(7):741–748PubMedCrossRef
26.
Guhl JF (1982) Arthroscopic treatment of osteochondritis dissecans. Clin Orthop Relat Res 167(167):65–74PubMed
27.
Hefti F, Beguiristain J, Krauspe R, Moller-Madsen B, Riccio V, Tschauner C, Wetzel R, Zeller R (1999) Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B 8(4):231–245PubMed
28.
Hughes JA, Cook JV, Churchill MA, Warren ME (2003) Juvenile osteochondritis dissecans: a 5-year review of the natural history using clinical and MRI evaluation. Pediatr Radiol 33(6):410–417PubMed
29.
Hughston JC, Hergenroeder PT, Courtenay BG (1984) Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 66(9):1340–1348PubMed
30.
Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E (2010) Association between mechanical axis of the leg and osteochondritis dissecans of the knee: radiographic study on 103 knees. Am J Sports Med 38(7):1425–1428PubMedCrossRef
31.
Kocher M (2010) Juvenile and adult osteochondritis dissecans: cases for the best operative and non-operative treatment. Instr Course Lect ICL # 231
32.
Kocher MS, Czarnecki JJ, Andersen JS, Micheli LJ (2007) Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med 35(5):712–718PubMedCrossRef
33.
Kocher MS, Micheli LJ, Yaniv M, Zurakowski D, Ames A, Adrignolo AA (2001) Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med 29(5):562–566PubMed
34.
35.
Krishnan SP, Skinner JA, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2006) Collagen-covered autologous chondrocyte implantation for osteochondritis dissecans of the knee: two- to seven-year results. J Bone Joint Surg Br 88(2):203–205PubMedCrossRef
36.
Linden B (1976) The incidence of osteochondritis dissecans in the condyles of the femur. Acta Orthop Scand 47(6):664–667PubMedCrossRef
37.
Linden B (1977) Osteochondritis dissecans of the femoral condyles: a long-term follow-up study. J Bone Joint Surg Am 59(6):769–776PubMed
38.
Louisia S, Beaufils P, Katabi M, Robert H (2003) Transchondral drilling for osteochondritis dissecans of the medial condyle of the knee. Knee Surg Sports Traumatol Arthrosc 11(1):33–39PubMed
39.
Mackie T, Wilkins RM (2010) Case report: osteochondritis dissecans in twins: treatment with fresh osteochondral grafts. Clin Orthop Relat Res 468(3):893–897PubMedCrossRef
40.
Magnussen RA, Carey JL, Spindler KP (2009) Does operative fixation of an osteochondritis dissecans loose body result in healing and long-term maintenance of knee function? Am J Sports Med 37(4):754–759PubMedCrossRef
41.
Makino A, Muscolo DL, Puigdevall M, Costa-Paz M, Ayerza M (2005) Arthroscopic fixation of osteochondritis dissecans of the knee: clinical, magnetic resonance imaging, and arthroscopic follow-up. Am J Sports Med 33(10):1499–1504PubMedCrossRef
42.
Micheli LJ, Moseley JB, Anderson AF, Browne JE, Erggelet C, Arciero R, Fu FH, Mandelbaum BR (2006) Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation. J Pediatr Orthop 26(4):455–460PubMedCrossRef
43.
Miniaci A, Tytherleigh-Strong G (2007) Fixation of unstable osteochondritis dissecans lesions of the knee using arthroscopic autogenous osteochondral grafting (mosaicplasty). Arthroscopy 23(8):845–851PubMedCrossRef
44.
Miura K, Ishibashi Y, Tsuda E, Sato H, Toh S (2007) Results of arthroscopic fixation of osteochondritis dissecans lesion of the knee with cylindrical autogenous osteochondral plugs. Am J Sports Med 35(2):216–222PubMedCrossRef
45.
Mizuta H, Nakamura E, Otsuka Y, Kudo S, Takagi K (2001) Osteochondritis dissecans of the lateral femoral condyle following total resection of the discoid lateral meniscus. Arthroscopy 17(6):608–612PubMedCrossRef
46.
Nakagawa T, Kurosawa H, Ikeda H, Nozawa M, Kawakami A (2005) Internal fixation for osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc 13(4):317–322PubMedCrossRef
47.
Navarro R, Cohen M, Filho MC, da Silva RT (2002) The arthroscopic treatment of osteochondritis dissecans of the knee with autologous bone sticks. Arthroscopy 18(8):840–844PubMedCrossRef
48.
Nelson DW, DiPaola J, Colville M, Schmidgall J (1990) Osteochondritis dissecans of the talus and knee: prospective comparison of MR and arthroscopic classifications. J Comput Assist Tomogr 14(5):804–808PubMedCrossRef
49.
O’Connor MA, Palaniappan M, Khan N, Bruce CE (2002) Osteochondritis dissecans of the knee in children. A comparison of MRI and arthroscopic findings. J Bone Joint Surg Br 84(2):258–262PubMedCrossRef
50.
Obremskey WT, Pappas N, Attallah-Wasif E, Tornetta P 3rd, Bhandari M (2005) Level of evidence in orthopaedic journals. J Bone Joint Surg Am 87(12):2632–2638PubMedCrossRef
51.
Peterson CA, Peterson HA (1972) Analysis of the incidence of injuries to the epiphyseal growth plate. J Trauma 12(4):275–281PubMedCrossRef
52.
Pritchett JW (1992) Longitudinal growth and growth-plate activity in the lower extremity. Clin Orthop Relat Res 275(275):274–279PubMed
53.
Ramirez A, Abril JC, Chaparro M (2010) Juvenile osteochondritis dissecans of the knee: perifocal sclerotic rim as a prognostic factor of healing. J Pediatr Orthop 30(2):180–185PubMedCrossRef
54.
Reddy AS, Frederick RW (1998) Evaluation of the intraosseous and extraosseous blood supply to the distal femoral condyles. Am J Sports Med 26(3):415–419PubMed
55.
Ribbing S (1955) The hereditary multiple epiphyseal disturbance and its consequences for the aetiogenesis of local malacias–particularly the osteochondrosis dissecans. Acta Orthop Scand 24(4):286–299PubMed
56.
Rodegerdts U, Gleissner B (1979) Langzeiterfabrung mit der operativen therapie der osteochondrosis dissecans des kniegelenkes. Orthopadische Praxis 8:612–622
57.
Tabaddor RR, Banffy MB, Andersen JS, McFeely E, Ogunwole O, Micheli LJ, Kocher MS (2010) Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop 30(1):14–20PubMedCrossRef
58.
Twyman RS, Desai K, Aichroth PM (1991) Osteochondritis dissecans of the knee. A long-term study. J Bone Joint Surg Br 73(3):461–464PubMed
59.
Uematsu K, Habata T, Hasegawa Y, Hattori K, Kasanami R, Takakura Y, Fujisawa Y (2005) Osteochondritis dissecans of the knee: long-term results of excision of the osteochondral fragment. Knee 12(3):205–208PubMedCrossRef
60.
Wall EJ, Vourazeris J, Myer GD, Emery KH, Divine JG, Nick TG, Hewett TE (2008) The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am 90(12):2655–2664PubMedCrossRef
61.
Yonetani Y, Nakamura N, Natsuume T, Shiozaki Y, Tanaka Y, Horibe S (2010) Histological evaluation of juvenile osteochondritis dissecans of the knee: a case series. Knee Surg Sports Traumatol Arthrosc 18(6):723–730PubMedCrossRef
Metadata
Title
Surgical management of juvenile osteochondritis dissecans of the knee
Authors
Thai Q. Trinh
Joshua D. Harris
David C. Flanigan
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-1917-6

Other articles of this Issue 12/2012

Knee Surgery, Sports Traumatology, Arthroscopy 12/2012 Go to the issue

Knee

Comparison of the minimally invasive and standard medial parapatellar approaches for primary total knee arthroplasty

Knee

Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers

Knee

Radiographic parameters associated with lateral patella degeneration in young patients

Shoulder

Extracorporeal shock wave therapy is not useful after arthroscopic rotator cuff repair

Knee

Radiographic landmarks for tunnel placement in reconstruction of the medial patellofemoral ligament

Shoulder

An arthroscopic pleated capsular shift for recurrent anterior dislocation of the shoulder