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Operative Fixation of Chondral Loose Bodies in Osteochondritis Dissecans in the Knee: A Report of 5 Cases.

Anderson CN, Magnussen RA, Block JJ, Anderson AF, Spindler KP - Orthop J Sports Med (2013)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Tennessee Orthopaedic Alliance/The Lipscomb Clinic, Nashville, Tennessee, USA.

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 cm(2)). 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.

No MeSH data available.


Related in: MedlinePlus

Patient 5. (A) Preoperative anteroposterior (AP) radiographs demonstrating the osteochondritis dissecans lesion of the medial femoral condyle (black arrows). (B) Coronal proton-density-weighted MRI with fat suppression demonstrates the fragment in situ with fluid signal extending to its undersurface (white arrow). The fragment has a similar signal intensity to normal articular cartilage. At the time of surgery, the fragment was found to be completely disconnected from the underlying crater. (C) AP radiograph 1 week after surgery, showing the mini-fragment screws capturing the articular fragment. The radiograph has been graphically enhanced to show the outline of the radiolucent articular fragment (dashed green line) and demonstrate countersinking of the screws beneath the articular surface (solid white line). (D) AP radiograph 9 months postoperatively. At the time of surgery, the cartilage fragment was found to be thicker than normal articular cartilage. Consequently, bone grafting required to reestablish articular congruity did not reestablish the normal subchondral contour, giving the appearance of a persistent defect. The knee had normal joint spaces and no degenerative changes in the medial compartment. Residual screw tips broken off during removal of hardware were buried within the femoral condyle and caused no sequelae. (E) Coronal proton-density-weighted MRI with fat suppression 9 months after surgery, demonstrating the healed cartilage fragment that has completely filled the defect, has a smooth surface, and is congruent with the remaining portion of the medial femoral condyle (white arrowheads). Metal artifact is visible from the residual hardware (white arrows).
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fig2-2325967113496546: Patient 5. (A) Preoperative anteroposterior (AP) radiographs demonstrating the osteochondritis dissecans lesion of the medial femoral condyle (black arrows). (B) Coronal proton-density-weighted MRI with fat suppression demonstrates the fragment in situ with fluid signal extending to its undersurface (white arrow). The fragment has a similar signal intensity to normal articular cartilage. At the time of surgery, the fragment was found to be completely disconnected from the underlying crater. (C) AP radiograph 1 week after surgery, showing the mini-fragment screws capturing the articular fragment. The radiograph has been graphically enhanced to show the outline of the radiolucent articular fragment (dashed green line) and demonstrate countersinking of the screws beneath the articular surface (solid white line). (D) AP radiograph 9 months postoperatively. At the time of surgery, the cartilage fragment was found to be thicker than normal articular cartilage. Consequently, bone grafting required to reestablish articular congruity did not reestablish the normal subchondral contour, giving the appearance of a persistent defect. The knee had normal joint spaces and no degenerative changes in the medial compartment. Residual screw tips broken off during removal of hardware were buried within the femoral condyle and caused no sequelae. (E) Coronal proton-density-weighted MRI with fat suppression 9 months after surgery, demonstrating the healed cartilage fragment that has completely filled the defect, has a smooth surface, and is congruent with the remaining portion of the medial femoral condyle (white arrowheads). Metal artifact is visible from the residual hardware (white arrows).

Mentions: Most patients included in the study were male (80%) and skeletally mature at the time of the procedure (80%). The mean duration of symptoms was 26.5 months. Three patients developed knee pain gradually over a period of 12 to 48 months (Figure 2A and 2B). One patient developed symptoms acutely after an injury while playing basketball. Another patient had a 3-year history of knee pain that acutely worsened after a fall from a height (Figure 1A). All lesions were chondral loose bodies (grade 5) with no macroscopic evidence of attached subchondral bone noted at surgery. The mean lesion size was 2.5 cm2. Lesions were located on the medial femoral condyle (60%) and lateral trochlea (40%) (Table 1).


Operative Fixation of Chondral Loose Bodies in Osteochondritis Dissecans in the Knee: A Report of 5 Cases.

Anderson CN, Magnussen RA, Block JJ, Anderson AF, Spindler KP - Orthop J Sports Med (2013)

Patient 5. (A) Preoperative anteroposterior (AP) radiographs demonstrating the osteochondritis dissecans lesion of the medial femoral condyle (black arrows). (B) Coronal proton-density-weighted MRI with fat suppression demonstrates the fragment in situ with fluid signal extending to its undersurface (white arrow). The fragment has a similar signal intensity to normal articular cartilage. At the time of surgery, the fragment was found to be completely disconnected from the underlying crater. (C) AP radiograph 1 week after surgery, showing the mini-fragment screws capturing the articular fragment. The radiograph has been graphically enhanced to show the outline of the radiolucent articular fragment (dashed green line) and demonstrate countersinking of the screws beneath the articular surface (solid white line). (D) AP radiograph 9 months postoperatively. At the time of surgery, the cartilage fragment was found to be thicker than normal articular cartilage. Consequently, bone grafting required to reestablish articular congruity did not reestablish the normal subchondral contour, giving the appearance of a persistent defect. The knee had normal joint spaces and no degenerative changes in the medial compartment. Residual screw tips broken off during removal of hardware were buried within the femoral condyle and caused no sequelae. (E) Coronal proton-density-weighted MRI with fat suppression 9 months after surgery, demonstrating the healed cartilage fragment that has completely filled the defect, has a smooth surface, and is congruent with the remaining portion of the medial femoral condyle (white arrowheads). Metal artifact is visible from the residual hardware (white arrows).
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fig2-2325967113496546: Patient 5. (A) Preoperative anteroposterior (AP) radiographs demonstrating the osteochondritis dissecans lesion of the medial femoral condyle (black arrows). (B) Coronal proton-density-weighted MRI with fat suppression demonstrates the fragment in situ with fluid signal extending to its undersurface (white arrow). The fragment has a similar signal intensity to normal articular cartilage. At the time of surgery, the fragment was found to be completely disconnected from the underlying crater. (C) AP radiograph 1 week after surgery, showing the mini-fragment screws capturing the articular fragment. The radiograph has been graphically enhanced to show the outline of the radiolucent articular fragment (dashed green line) and demonstrate countersinking of the screws beneath the articular surface (solid white line). (D) AP radiograph 9 months postoperatively. At the time of surgery, the cartilage fragment was found to be thicker than normal articular cartilage. Consequently, bone grafting required to reestablish articular congruity did not reestablish the normal subchondral contour, giving the appearance of a persistent defect. The knee had normal joint spaces and no degenerative changes in the medial compartment. Residual screw tips broken off during removal of hardware were buried within the femoral condyle and caused no sequelae. (E) Coronal proton-density-weighted MRI with fat suppression 9 months after surgery, demonstrating the healed cartilage fragment that has completely filled the defect, has a smooth surface, and is congruent with the remaining portion of the medial femoral condyle (white arrowheads). Metal artifact is visible from the residual hardware (white arrows).
Mentions: Most patients included in the study were male (80%) and skeletally mature at the time of the procedure (80%). The mean duration of symptoms was 26.5 months. Three patients developed knee pain gradually over a period of 12 to 48 months (Figure 2A and 2B). One patient developed symptoms acutely after an injury while playing basketball. Another patient had a 3-year history of knee pain that acutely worsened after a fall from a height (Figure 1A). All lesions were chondral loose bodies (grade 5) with no macroscopic evidence of attached subchondral bone noted at surgery. The mean lesion size was 2.5 cm2. Lesions were located on the medial femoral condyle (60%) and lateral trochlea (40%) (Table 1).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Tennessee Orthopaedic Alliance/The Lipscomb Clinic, Nashville, Tennessee, USA.

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 cm(2)). 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.

No MeSH data available.


Related in: MedlinePlus