Abstract
Refixation with resorbable implants is acommon surgical treatment in patients who suffer an injury with shearing of an osteochondral flake due to trauma of the knee or the upper ankle joint. To date there are no studies which outline long-term outcomes for this procedure. The aim of this study was to evaluate long-term clinical and magnetic resonance imaging (MRI) results after refixation with resorbable polylactide (PLLA) implants. In this retrospective study 12patients with 13injuries were examined 13.9 years (±1.2 years) after refixation of an osteochondral fragment of the knee (10patients) and the upper ankle joint (2patients) with amean size of 3.33 cm2 (±2.33) by resorbable polylactide (PLLA) implants (nails, pins, screws, Bionx, Tampere, Finland). To objectify the clinical results eight established clinical scores (VASS, Tegner, Lysholm, McDermott, KSS, WOMAC, AOFAS, FADI+Sports) were used. Furthermore, the morphological integration of bone and cartilage was assessed by MRI (3 T) using proton-weighted and cartilage-sensitive 3D double-echo steady-state (DESS) sequences. The morphological results were objectified with amodified MRI score according to Henderson etal. After 13.9 years (±1.2) the patients with an injury of the knee as well as of the upper ankle joint showed good to excellent results (knee: VASS 1.2 (±1.7), Tegner 4.4 (±1.3), Lysholm 85.7 (±12.2), McDermott 90.7 (±8.6), KSS 189 (±14.2), WOMAC (6.16% (±8.45)) (upper ankle joint: VASS 2.5 (±2.5), Tegner 5.5 (±1.5), Lysholm 87 (±13), McDermott 88 (±12); WOMAC (8.54% (±8.54), AOFAS 75.5 (±24.5), FADI+Sports 118 (±18)). In all cases there was evidence of good integration of the osteochondral fragment in MRI. In five patients there was moderate subchondral cyst formation (∅ ≤1 mm); however, mild changes of the cartilage contour were found in all patients. The mean modified Henderson score achieved was 14.4 (±2.0, best 8, worst 32), which corresponds to a good morphological result. Because of good clinical and morphological results shown by MRI, refixation through resorbable implants (PLLA) can be recommended for treatment of traumatic osteochondral flakes.
Highlights
a common surgical treatment in patients who suffer an injury with shearing of an osteochondral flake
the morphological integration of bone and cartilage was assessed by MRI
The morphological results were objectified with a modified MRI score according to
Summary
In dieser Arbeit wurden die langfristigen klinischen und MR-morphologischen Ergebnisse nach Refixation osteochondraler Fragmente mit PLLA-Implantaten nachuntersucht. Bei Kindern im Durchschnittsalter von 14 Jahren zeigte sich bei 88 Patienten mit 109 Patellaluxationen in 9 % der Fälle [17], über die gesamte Population gesehen, bei ca. Liegt ein Knorpelschaden vor, zeigt die Literatur in Abhängigkeit von der Größe des Fragments und der Schwere des Schadens verschiedene Therapieoptionen. Die Transplantation von osteochondralen Zylindern wird von vielen Autoren zunehmend kritisch gesehen und hat einen abnehmenden Stellenwert [28]. Alle Methoden haben jedoch gemeinsam, dass keine vollwertige Wiederherstellung des Ausgangszustands und Überdeckung des Defekts mit hyalinem Knorpel erfolgt. In allen Fällen entwickelt sich langfristig ein Mischknorpelgewebe mit unterschiedlichen Anteilen von Faser- und hyalinem Knorpel [7].
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