Stable Juvenile Osteochondritis Dissecans Research Articles

Extraarticular Drilling for Stable Osteochondritis Dissecans in the Skeletally Immature Knee

Osteochondritis dissecans of the knee is an increasingly frequent diagnosis in the skeletally immature, in whom it is known as juvenile osteochondritis dissecans (JOCD). Although many stable lesions heal with nonoperative treatment, surgical management may be necessary when this treatment fails. Our objective is to determine if extraarticular drilling is an effective treatment for JOCD. Patients who underwent extraarticular drilling for stable JOCD of the knee at the authors' institution between 1998 and 2006 were identified. Demographic information, the location of the lesion, duration of symptoms before surgery, occurrence of complications, postoperative course, and length of follow-up were documented from each patient's medical record. The outcome measures were normal examination, radiographic evidence of healing, and full return to activity. Fifteen skeletally immature patients (16 knees) were identified. There were 8 boys and 7 girls, with 8 right and 8 left knees. One girl had bilateral lesions. The lesions were located in the medial femoral condyle in 12 knees and in the lateral femoral condyle in 4 knees. The average duration of symptoms before surgery was 21 months (range, 3 months-9 years). The average age at the time of surgery was 12 years, 4 months (range, 9-15 years). There were no intraoperative or postoperative complications. The average follow-up was 21 months (range, 8-38 months). Three of the 15 patients were lost to follow-up. In the remaining 12 patients, 12 knees had excellent outcomes with full return to activities, normal examinations, and radiographic evidence of healing. One knee had fair results. On average, these criteria were met at 8.5 months after surgery. When nonoperative management of stable JOCD fails, arthroscopic extraarticular drilling is an effective treatment to protect the articular surface and promote bone healing. Level IV case series.

The Healing Potential of Stable Juvenile Osteochondritis Dissecans Knee Lesions

The purpose of the present study was to determine if patient age, lesion size, lesion location, presenting knee symptoms, and sex predict the healing status after six months of a standard protocol of nonoperative treatment for stable juvenile osteochondritis dissecans of the knee. Forty-two skeletally immature patients (forty-seven knees) who presented with a stable osteochondritis dissecans lesion were included in the present study. All patients were managed with temporary immobilization followed by knee bracing and activity restriction. The primary outcome measure of progressive lesion reossification was determined from serial radiographs every six weeks, for up to six months of nonoperative treatment. A multivariable logistic regression model was used to determine potential predictors of healing status from the listed independent variables. After six months of nonoperative treatment, sixteen (34%) of forty-seven stable lesions had failed to progress toward healing. The mean surface area (and standard deviation) of the lesions that showed progression toward healing (208.7 +/- 135.4 mm(2)) was significantly smaller than that of the lesions that failed to show progression toward healing (288.0 +/- 102.6 mm(2)) (p = 0.05). A logistic regression model that included patient age, normalized lesion size (relative to the femoral condyle), and presenting symptoms (giving-way, swelling, locking, or clicking) was predictive of healing status. Age was not a significant contributor to the predictive model (p = 0.25). In two-thirds of immature patients, six months of nonoperative treatment that includes activity modification and immobilization results in progressive healing of stable osteochondritis dissecans lesions. Lesions with an increased size and associated swelling and/or mechanical symptoms at presentation are less likely to heal.

Functional and Radiographic Outcome of Stable Juvenile Osteochondritis Dissecans of the Knee Treated With Retroarticular Drilling Without Bone Grafting

The purpose of this study was to evaluate the functional and radiographic outcome of retroarticular drilling for patients with juvenile osteochondritis dissecans after 6 months of unsuccessful nonoperative treatment. A total of 20 osteochondritis dissecans lesions in 12 skeletally immature patients were treated with retroarticular drilling without bone grafting. There were 10 boys and 2 girls with a mean age of 12.0 years (range, 9 to 15 years). The functional outcomes were evaluated by use of the Lysholm score at a mean follow-up of 2.7 years after drilling, and healing of the lesions was confirmed by use of plain radiographs and magnetic resonance imaging. The mean Lysholm score significantly improved postoperatively (from 72.3 to 95.8). All lesions except 1 healed after retroarticular drilling. Healing was achieved at a mean of 4.4 months on plain radiographs and 7.6 months on magnetic resonance imaging. This study shows that retroarticular drilling without bone grafting leads to improved clinical outcomes and high healing rates. We advocate retroarticular drilling for patients with stable juvenile osteochondritis dissecans of the knee whose initial nonoperative treatment has failed.