Stable Osteochondritis Dissecans Lesions Research Articles

Osteochondritis Dissecans Lesions of the Knee: Evidence-Based Treatment.

Osteochondritis dissecans (OCD) of the knee is a potentially disabling condition in adolescent and young adults, which is likely multifactorial in origin. In recent years, there have been notable improvements in identification and treatment. Clinical presentation varies based mostly on OCD lesion stability. Patients with stable lesions generally present with vague knee pain and altered gait while mechanical symptoms and effusion are more common with unstable lesions. Lesions most commonly occur on the lateral aspect of the medial femoral condyle in patients aged 10 to 20 years. Magnetic resonance imaging is vital to diagnose and predict clinical treatment, which is largely based on stability of the fragment. Conservative treatment of stable lesions in patients with open physis is recommended with protected weight-bearing and gradual progression of activities over the course of 3 to 6 months. Stable OCD lesions which failed a nonsurgical course can be treated with transarticular or retrograde drilling while unstable lesions usually require fixation, autologous chondrocyte implantation (ACI), osteochondral autograft transfer (OATS), or osteochondral allograft transplantation. This review highlights the most current understanding of knee OCD lesions and treatment options with the goal of optimizing outcomes in this difficult pathology.

Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum

To compare the cost-effectiveness of an initial trial of nonoperative treatment to that of early arthroscopic debridement for stable osteochondritis dissecans (OCD) lesions of the capitellum. A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 simulated patients undergoing nonoperative management versus early arthroscopic debridement for stable OCD lesions of the capitellum. Health utility values, treatment success rates, and transition probabilities were derived from the published literature. Costs were determined on the basis of the typical patient undergoing each treatment strategy at our institution. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Mean total costs resulting from nonoperative management and early arthroscopic debridement were $5,330 and $21,672, respectively. On average, early arthroscopic debridement produced an additional 0.64 QALYS, resulting in an ICER of $25,245/QALY, which falls well below the widely accepted $50,000 willingness-to-pay (WTP) threshold. Overall, early arthroscopic debridement was determined to be the preferred cost-effective strategy in 69% of patients included in the microsimulation model. Results of the Monte Carlo microsimulation and probabilistic sensitivity analysis demonstrated early arthroscopic debridement to be a cost-effective treatment strategy for the majority of stable OCD lesions of the capitellum. Although early arthroscopic debridement was associated with higher total costs, the increase in QALYS that resulted from early surgery was enough to justify the cost difference based on an ICER substantially below the $50,000 WTP threshold. Level III, economic computer simulation model.

Efficacy of the pridie drilling technique in knee osteochondritis dissecans among children and young adults: follow-up of 41 cases.

This study aims to examine whether Pridie drilling, a form of bone marrow stimulation, can expedite the healing process and enable a faster return to sports activity in patients with knee Osteochondritis dissecans (OCD). The primary objective is to assess the effectiveness of Pridie drilling in stable OCD lesions that do not respond to non-operative treatment, by evaluating the absence of painful symptoms 6months after the procedure. Secondary objectives include evaluating radiographic reconstruction 6months post-surgery and determining the time it takes to resume sports participation. This single-center retrospective study included all cases of stable OCD in the knee that underwent anterograde chondral drilling between 2008 and 2020. Diagnosis of OCD was established using knee radiographs, and the surgical technique involved multiple multidirectional subchondral drilling. Treatment efficacy was defined by the absence of painful symptoms for 6months postoperatively. A total of 41 knees were included in the study, and no complications were observed before or after surgery. At 6months postoperatively, 32 knees (78%) showed complete resolution of symptoms. Complete radiographic reconstruction was observed in 66% of cases. Asymptomatic patients at 6months returned to sports activity of similar intensity to that practiced previously in an average time of 7.9months; while, patients who were symptomatic at 6months returned in an average time of 16.5months. This study provides evidence supporting the short-term efficacy of anterograde chondral drilling in stable lesion of OCD in children and adolescents after failed functional treatment. Level III (retrospective cohort study).

Transarticular Versus Retroarticular Drilling of Stable Osteochondritis Dissecans of the Knee: A Prospective Multicenter Randomized Controlled Trial by the ROCK Group

Background: When stable osteochondritis dissecans (OCD) lesions of the femoral condyle in a skeletally immature patient fail to heal with nonoperative methods, the standard of care treatment is condylar OCD drilling. Two primary OCD drilling techniques have been described, but no prospective studies have compared their relative effectiveness. Purpose/Hypothesis: The purpose of this study was to compare the healing and function after transarticular drilling (TAD) with that after retroarticular drilling (RAD). It was hypothesized that there would be no difference in rate or time to healing, rate or time to return to sports, patient-reported outcomes (PROs), or secondary OCD-related surgery. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Skeletally immature patients with magnetic resonance imaging–confirmed stable OCD lesions of the medial femoral condyle who did not demonstrate substantial healing after a minimum of 3 months of nonoperative treatment were prospectively enrolled by 1 of 17 surgeon-investigators at 1 of 14 centers. Patients were randomized to the TAD or RAD group. Tourniquet time, fluoroscopy time, and complications were compared between the treatment groups. Postoperatively, serial radiographs were obtained every 6 weeks to assess healing, and PROs were obtained at 6 months, 12 months, and 24 months. Results: A total of 91 patients were included, consisting of 51 patients in the TAD and 40 patients in the RAD group, who were similar in age, sex distribution, and 2-year PRO response rate. Tourniquet time and fluoroscopy time were significantly shorter with TAD (mean, 38.1 minutes and 0.85 minutes, respectively) than RAD (mean, 48.2 minutes and 1.34 minutes respectively) (P = .02; P = .004). In the RAD group, chondral injury from K-wire passage into the intra-articular space was reported in 9 of 40 (22%) patients, but no associated postoperative clinical sequelae were identified in these patients. No significant differences between groups were detected in follow-up Pediatric–International Knee Documentation Committee, Lysholm, Marx Activity Scale, or Knee injury and Osteoarthritis Outcome Score Quality of Life scores. Healing parameters were superior at 6 months and 12 months in the TAD group, compared with the RAD group, and secondary OCD surgery occurred in 4% of patients who underwent TAD and 10% of patients who underwent RAD (P = .40). Patients in the TAD group returned to sports earlier than those in the RAD group (P = .049). Conclusion: TAD showed shorter operative time and fluoroscopy time and superior healing parameters at 6 and 12 months, but no differences were seen in 24-month healing parameters or PROs at all follow-up time points, when compared with RAD. Registration: NCT01754298 (ClinicalTrials.gov identifier).

Conservative treatment for stable osteochondritis dissecans of the elbow before epiphyseal closure: effectiveness of elbow immobilization for healing.

Stable lesions of osteochondritis dissecans (OCD) of the capitellum have been treated with activity restriction (AR), and the complete healing requires 1 or 2 years. Little is known about the effectiveness of elbow immobilization. We hypothesized that elbow immobilization would have positive effects on healing of stable OCD. The study subjects were 43 patients (mean age: 12.2years) with 43 stable OCD lesions of the prematured elbow (mean skeletal age score: 17.1 points of 0-27 points system). The subjects were divided into 3 groups: group A, AR without elbow immobilization, 22 cases; group B, splint (mean: 8.8weeks) followed by AR, 9 cases; and group C, cast (mean: 3.7weeks) followed by splint (mean: 7.3weeks) and AR, 12 cases. The mean nonoperative observation period was 17.5months (minimum three months). On anteroposterior radiographs of the elbow at 45 degrees of flexion, 5 observers independently assessed the healing of the capitellum, and the interobserver and intraobserver reliabilities were examined. The differences in outcomes among 3 groups were also examined. The interobserver and intraobserver reliabilities of the radiographic assessment were almost perfect (Cohen kappa value: 0.82 and 0.91, respectively). There were no significant differences in age, sports played, or stage of the lesion before the treatment. The proportion of patients returning to sports and the mean period required were 77% and 8.2months in group A, 78% and 5.7months in group B, and 83% and 4.4months in group C, respectively. The proportion of patients showing ossification in the central aspect of the capitellum and the mean period required were 67% and 8.2months in group A, 63% and 4.9months in group B, and 91% and 1.9months in group C, respectively. The proportion of patients showing complete healing and the mean period required were 41% and 16.4months in group A, 67% and 7.0months in group B, and 92% and 5.5months in group C, respectively. Compared to group A, group C showed a significantly earlier return to sports (P=.034), a significantly shorter period required for ossification (P<.001), and significantly higher proportion of patients with complete healing (P=.012) within a significantly shorter period (P=.009). Elbow immobilization had positive effects on healing and enabled both an early return to sports and complete healing. Cast immobilization is recommended as a first choice of nonoperative treatment for stable OCD lesions of the elbow before epiphyseal closure.

Cost-Effectiveness Analysis of Nonoperative Management Versus Early Drilling for Stable Osteochondritis Dissecans Lesions of the Knee in Skeletally Immature Patients

To evaluate the cost-effectiveness of a trial of nonoperative management versus early drilling in the treatment of skeletally immature patients with stable osteochondritis dissecans (OCD) of the knee. A decision tree model was used to compare the cost-effectiveness of a trial of nonoperative management versus early drilling (within 6 weeks of the first office visit) from payer and societal perspectives over a 3-year time horizon. Relevant transition probabilities, costs (in 2019 US dollars based on Medicare reimbursement), health state utilities, and times to healing were derived from the literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). One- and 2-way sensitivity analyses were performed on pertinent model parameters to validate the robustness of the base-case results using a conservative willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life-year (QALY). The Consolidated Health Economic Evaluation Reporting Standards checklist for reporting economic evaluations was used. In the base-case analysis from a payer perspective, early drilling was more effective (2.51 versus 2.27 QALYs), more costly ($4,655 versus $3,212), and overall more cost-effective (ICER $5,839/QALY) relative to nonoperative management. In the base-case analysis from a societal perspective, early drilling dominated nonoperative management owing to its increased effectiveness (2.51 versus 2.27 QALYs) and decreased cost ($13,098 versus $18,149). These results were stable across broad ranges on sensitivity analysis. Based on 1-way threshold analyses from a payer perspective, early drilling remained cost-effective as long it cost less than $19,840, the disutility of surgery was greater than -0.40, or the probability of successful early drilling was greater than 0.62. Although the traditional approach to stable OCD lesions of the knee in skeletally immature patients has been a trial of nonoperative management, our data suggest that early drilling may be cost-effective from both payer and societal perspectives. III, economic and decision analysis.

ADJUVANT TREATMENT OF OCD LESIONS OF THE KNEE WITH BONE STIMULATORS

Background:Recently, bone stimulators have been increasingly used for fracture care, particularly in the context of delayed healing and nonunions. Bone stimulation provides upregulation of osteogenic factors and stimulation of osteoblasts to create new bone.Hypothesis/Purpose:The purpose of this study was to determine if adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee. Methods: Forty patients who presented with a stable OCD lesion of the knee were included in the present retrospective study. All patients were managed with operative intervention with anterograde drilling by a single senior surgeon. The patients in the two groups, those with or without the use of bone stimulators post-operatively, were matched for skeletal maturity, lesion location, gender and age at surgery. The primary outcome measure of the rate of healing was determined from 3 month post-operative MRIs and clinical results were also analyzed.Results:At two years, 36 patients (90%) in both groups went on to clinical healing without further interventions. Two patients in each group required re-operations. The bone stimulator group had a mean decrease of 0.9 (± 1.8) mm in lesion coronal width and had 12 patients (63%) who had overall improved healing as compared to the non-bone stimulator group which had a 0.8 (± 3.6) mm decrease in coronal width and 14 patients (78%) with improved healing (p=0.272). No statistical differences in imaging or clinical healing were found between the two groups. Male patients were seen to have a clinically important decreased time from surgery to sports clearance (4 versus 5.5 months, p=0.063), discharge (7.8 versus 13.4 months, p=0.057), and increased overall healing (81% versus 55%, p=0.187) as compared to females. Skeletally immature patients had a decreased time from surgery to discharge (7.0 versus 18.3 months, p=0.005), improved overall healing (79% versus 50%, p=0.158), and decreased reoperation rate (3% versus 30%, p=0.042) when compared to the skeletally mature patients.Conclusion:In the surgical treatment of stable knee OCD lesions, bone stimulator use did not appear to improve radiographic or clinical healing. However, this study was not powered to examine the clinically important differences between the patients with and without the use of bone stimulators. Further multi-institutional studies will be needed to further elucidate differences. This study did find that skeletally immature patients had improved outcomes both clinically and on imaging as compared to skeletally mature patients.

SURGICAL MANAGEMENT OF OSTEOCHONDRITIS DISSECANS OF THE ELBOW IN CHILDREN: IS THERE CONSENSUS AMONG EXPERTS?

Background:Although the available evidence generally supports surgical treatment of unstable osteochondritis dissecans (OCD) lesions of the elbow, the optimal surgical management lacks consensus. Given the myriad of options available for skeletally immature patients, the purpose of this study was to identify preferred surgical procedures based upon patient and OCD characteristics among a group of high volume surgeons.Hypothesis/Purpose:To understand current treatment practices for experts on OCD of the elbow.Methods:A survey evaluating the surgical treatment strategies for twenty-three clinical vignettes of skeletally immature patients with OCD of the elbow was created and distributed electronically to members of the Research on Osteochondritis Dissecans (ROCK) study group using REDCap. Each vignette described an OCD lesion of varying location, size, degree of cartilage involvement, and depth. Multiple-choice answers related to specific treatment strategies and technique were provided for each lesion. Standard descriptive statistics were used to summarize and compare responses for each vignette.Results:Fifteen surgeons treating OCD of the elbow participated in the study. All respondents were attending-level surgeons. One-third of responding surgeons treat elbow OCD weekly, 53% monthly, and 13% every six months. In skeletally immature patients with stable, intact elbow OCD lesions, 80% of surgeons would treat with transarticular (58%), retroarticular (33%), or combined trans/retroarticular (8%) drilling. For full-thickness (FT) osteochondral defects occupying 33% or 66% of capitellar width, the preferred treatment modality varied substantially based on lesion depth. Overall, the preferred strategies for these lesions were (1) debridement with marrow stimulation for FT defects with 1-2 mm subchondral bone loss and (2) internal fixation for trap-door lesions with either trace or > 4 mm of subchondral bone. There was substantial heterogeneity with respect to treatment strategy for FT defects with > 4 mm bone loss. For a lesion occupying 33% of capitellar width, 47% of surgeons would treat with debridement and marrow stimulation, 47% would treat with an osteochondral transfer, and 6% would perform both. For larger lesions of 66% width, slightly more would treat with osteochondral transfer (47% vs. 40%). Ultimately, > 75% agreement was only reached in 19% of the vignettes, highlighting the high degree of variability in the treatment of elbow OCD.Conclusion:For elbow OCD in skeletally immature patients, the greatest agreement exists for (1) the drilling of stable OCD lesions, though there is variability with respect to technique (transarticular/retroarticular/combined) and (2) internal fixation for trap-door lesions with > 5mm of subchondral bone. Nonetheless, high-quality clinical data to guide decision-making is currently lacking for capitellar OCD. Even among a group of experienced experts, there is significant disagreement regarding preferred surgical methods. Our study ultimately highlights the need for multicenter, prospective investigations to evaluate the clinical outcomes of various treatment strategies for OCD of the elbow.Table I.Preferred intra-operative treatment principles and techniques for a central, full-thickness OCD lesion of the capitellum. Lesion Depth Treatment Principle % of Surgeons Central, Contained 33% Width of Capitellum Full-Thickness Defect 4 mm Bone Loss Transarticular/Retroarticular Drilling0 Debridement +/- Marrow Stimulation 46.7 Debridement Only0Debridement + Marrow Stimulation100Drilling of Full-Thickness Defect28.6Awl42.9Abrasion14.3Other14.3Internal Fixation0 Osteochondral Transfer 46.7 Allograft28.6Autograft71.4Biopsy and ACI0Figure 1.Treatment principles and techniques for skeletally immature patients with central, contained OCD lesions occupying 33% width of the capitellum with varying articular cartilage and subchondral bone involvement. (FT = full-thickness; TD = trap-door)

Osteochondritis Dissecans of the Elbow in Children: MRI Findings of Instability.

OBJECTIVE. The purpose of this study was to investigate the performance of MRI criteria for predicting instability of osteochondritis dissecans (OCD) lesions of the elbow in children. MATERIALS AND METHODS. This retrospective study included 41 children with 43 OCD lesions of the elbow who underwent an MRI examination between April 1, 2010, and May 31, 2018. Two radiologists blinded to clinical outcomes reviewed MRI studies to determine the presence or absence of joint effusion, osteochondral defect, intraarticular body, overlying cartilage changes, subchondral bone disruption, rim of high signal intensity on T2-weighted images, cysts, marginal sclerosis, and perilesional bone marrow edema. The stability of OCD lesions was determined with clinical follow-up and surgical findings as reference standards. Mann-Whitney U, chi-square, Fisher exact, and Cochran-Armitage tests were used to compare MRI findings between stable and unstable OCD lesions. RESULTS. There were 20 stable and 23 unstable OCD lesions. An osteochondral defect (p = 0.01), intraarticular body (p < 0.001), overlying cartilage changes (p = 0.001), subchondral bone plate disruption (p = 0.02), and hyperintense rim (p = 0.01) were significantly more common in unstable than stable OCD lesions. However, only osteochondral defect and intraarticular body were 100% specific for OCD instability. There was no significant difference between stable and unstable OCD lesions in the presence of joint effusion (p = 0.10), cysts (p = 0.45), marginal sclerosis (p = 0.70), or perilesional bone marrow edema (p = 1.00). CONCLUSION. MRI findings of OCD instability of the elbow include an osteochondral defect, intraarticular body, overlying cartilage changes, subchondral bone disruption, and rim of high signal intensity on T2-weighted MR images.

The Surgical Management of Osteochondritis Dissecans of the Knee in the Skeletally Immature: A Survey of the Pediatric Orthopaedic Society of North America (POSNA) Membership.

While the characteristics of osteochondritis dissecans (OCD) of the knee that require surgery to heal have been described, several surgical techniques/procedures exist with no consensus established regarding timing of treatment and specific surgical intervention. In this study, we aim to determine current trends in surgical treatment for OCD lesions in the skeletally immature who have failed 6 months of nonoperative management by surveying a large cohort of orthopaedic surgeons. An electronic survey designed using REDCap to capture surgeon treatment preferences for OCD lesions was distributed to members of the Pediatric Orthopaedic Society of North America (POSNA). The survey inquired about treating physicians' training and demographics. It then offered a series of clinical vignettes alongside imaging describing patients with varying degrees of severity of OCD following nonoperative treatment. Surgeons were prompted to select from a variety of multiple-choice-based options for further patient management. Standard descriptive statistics were used to summarize and compare the responses. Of the 129 POSNA members completing the pediatric survey, 97.7% were attending level orthopaedic surgeons, the majority identifying with an academic institution and treating mostly skeletally immature patients. In the skeletally immature population, the majority would treat intact, stable OCD lesions with drilling in a retroarticular or transarticular manner. Preferred treatment for unstable, salvageable lesions was screw fixation using bioabsorble materials or metal with variable pitch with no bone graft. The majority of respondents would treat unstable, unsalvageable OCD lesions with chondroplasty and osteochondral transplant/transfer or microfracture/drilling. The POSNA membership appears to agree on principle in terms of treatment modalities for various stages of OCD lesions in the skeletally immature, whereas individual techniques of achieving these principles may vary. Members endorse drilling for stable intact lesions; fixation for unstable, salvageable lesions; and "defect fill" for unsalvageable lesions. OCD surgical treatment patterns can be used in future studies to determine which techniques are most effective for given indications, with the goal of designing a research-proven optimal treatment regimen for skeletally immature patients.

Extra-articular, Intraepiphyseal Drilling for Osteochondritis Dissecans of the Knee

Symptomatic osteochondritis dissecans lesions of the knee frequently occur in skeletally immature patients. When conservative treatment fails, retro-articular drilling, also known as intraepiphyseal extra-articular drilling, becomes a viable treatment option. The purpose of this article is to describe our surgical technique and postoperative management of patients with stable osteochondritis dissecans lesions involving the femoral condyles. This technique is reproducible, uses readily available equipment, and has yielded good clinical outcomes with high healing rates and relatively early return to sports.

Osteochondritis dissecans of the knee in children and adolescents

Osteochondritis dissecans (OCD) of the knee is a well-described condition that can cause significant morbidity in children and adolescents; timely diagnosis is key to preventing compromise to the articular cartilage and maximizing opportunity to perform a restorative procedure. Juvenile OCD has a better prognosis than does adult OCD, with higher rates of spontaneous healing with conservative treatment. Still, there are certain indications for surgical restoration procedures. Controversies arise over when to decide surgical procedure and what is the best surgical treatment option in this young population. Some authors believe nonoperative management should be the first-line treatment for stable OCD lesions in children. The only consensus in regard to this modality is that, if a patient is truly asymptomatic or experiencing low-level symptoms, then the duration of nonoperative treatment should be at least 3-6 months before opting for operative treatment. In the case of failed nonsurgical management or in the setting of an unstable fragment, surgical intervention should be implemented. Recent published data suggest no difference in clinical or radiographic outcome when comparing different surgical techniques. OCD of the knee requires a timely diagnosis to maximize opportunity to perform a reparative procedure. Indications for surgical treatment are based on lesion stability, skeletal maturity, and clinical symptoms. Reestablishing the joint surface, improving the blood supply of the fragment, rigid fixation, and early motion are primary goals for osteochondral fragment preservation. When the fragment is not suitable for preservation, careful consideration of defect location and the patient's clinical presentation will determine when cartilage restoration procedures should be utilized.

Functional and Radiographic Outcomes of Juvenile Osteochondritis Dissecans of the Knee Treated With Extra-Articular Retrograde Drilling

Background: Osteochondritis dissecans (OCD) lesions of the medial femoral condyle in the adolescent population can cause significant impairment and restriction in physical activity. Studies have established the efficacy of transarticular antegrade drilling for juvenile OCD lesions of the knee, although concerns of consequences from drilling through the articular cartilage remain. Alternatively, retrograde extra-articular drilling avoids drilling the cartilage while ensuring adequate channels for revascularization and healing. Purpose: The authors present the results of 31 skeletally immature patients who underwent retrograde drilling of OCD lesions of the knee with an average follow-up of 4 years. Study Design: Case series; Level of evidence, 4. Methods: The procedure consisted of a standard arthroscopic evaluation of the knee and subsequent percutaneous retrograde drilling obliquely through the condylar epiphysis starting distal to the physis and ending in the center-center of the OCD lesion. Outcome measures included radiographic signs of healing, Lysholm scoring and the Tegner activity scale to measure performance and activity restriction, and visual analog scale (VAS) pain scores. Results: Average follow-up for the 31 patients was 4 years (range, 1.5-7 years). Sixteen of the 34 lesions were grade I or II based on radiographic findings with signs and symptoms greater than 6 months. The remaining 18 were grade III secondary to a sclerotic rim surrounding the defect. Overall, improvement in Lysholm scores (70 to 95; standard deviation [SD] ± 14.95), Tegner scores (4 to 7; SD ± 2.31), and VAS pain scores (6.9 to 1.3; SD ± 2.16) were found to be statistically significant. Radiographs showed stable or improved lesions in all cases. Conclusion: Retrograde extra-articular drilling provided clinical and radiographic improvement in most juveniles with OCD lesions who failed nonoperative management. This method serves to decompress the lesion and allow revascularization without disrupting the articular cartilage surface in stable OCD lesions.

MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the knee

The purpose of this study was to evaluate the feasibility of a new method for osteochondritis dissecans (OCD) treatment. Ten OCD lesions of the knee unresponsive to conservative management were treated with MRI-guided percutaneous retrograde drilling to reduce symptoms and promote ossification of the lesion. All lesions were located in distal femoral condyles. Only stable OCD lesions were included (preprocedural MRI grade I or II). Five lesions were of juvenile type and five lesions were of adult type OCD. All the patients had severe limitation of activity due to the OCD-related pain. By using a 0.23 T open MRI scanner and spinal anesthesia, percutaneous retrograde drilling of the OCD lesions was performed (3 mm cylindrical drill, one to three channels). Optical tracking and MRI imaging were used to guide instruments during the procedure. Mean postprocedural clinical follow-up time was 3 years. Eight patients had a post-procedural follow-up MRI within 1 year. All the OCD lesions were located and drilled using the 0.23 T open MRI scanner without procedural complications. All the patients had pain relief, mean visual analog score (VAS) declined from 6 to 2. Follow-up MRI showed ossification in all lesions. Eight patients could return to normal physical activity with no or minor effect on function (Hughston score 3-4). Treatment failed in two cases where the continuation of symptoms led to arthroscopy and transchondral fixation. [corrected] MR-guided retrograde OCD lesion drilling is an accurate, feasible, and effective cartilage-sparing techique in OCD management.

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.

MRI Findings of Osteochondritis Dissecans of the Capitellum with Surgical Correlation

Few studies have described the MRI findings of osteochondritis dissecans of the capitellum. Our objective was to describe the MRI findings of 10 patients with osteochondritis dissecans of the capitellum and to correlate the imaging findings with surgical findings of stability and instability. The MRI findings of unstable and stable osteochondritis dissecans of the capitellum are similar to the findings described for osteochondritis dissecans of the femoral condyles and talar dome. Unstable osteochondritis dissecans lesions are surrounded by a rim of high signal intensity or a fluid-filled cyst on T2-weighted images. Stable osteochondritis dissecans lesions show no surrounding signal abnormality on T2-weighted images.