Surgical Treatment Of Osteochondritis Dissecans Research Articles

No difference in patient reported outcomes between cohorts undergoing lesion-specific surgery for osteochondritis dissecans of the knee

IntroductionThere is a paucity of data on patient reported outcome measures (PROMs) associated with surgical treatment of osteochondritis dissecans (OCD). As a result, preoperative patient and family counseling regarding expected outcomes is difficult. The purpose of this study was to compare pre-to post-operative changes in PROMs amongst cohorts of patients with OCD that underwent one of three lesion-specific surgical treatments: 1) transarticular drilling for stable lesions, 2) drilling and fixation for unstable lesions 3) grafting for unsalvageable lesions. MethodsThe electronic medical records of pediatric and adolescent patients with knee OCD, at a single institution between January 2017 and August 2019, were reviewed. Patients were categorized into one of three surgical groups, with initial determination confirmed at the time of surgery during diagnostic knee arthroscopy. Differences between groups were assessed with one-way analysis of variance (ANOVA). ResultsOf the 78 patients included in this study, 49 (62.8%) were male with a mean age of 13.5 ± 2.2 years. There was no significant difference between the surgical groups for baseline HSS Pedi-FABS (P = 0.58) or PROMIS Mobility (P = 0.47). There were no significant differences in PROMIS PI scores at baseline (P = 0.32), at latest follow-up (P = 0.72), or in interval change from baseline to follow-up (P = 0.42), between the three surgical groups. ConclusionLesion-specific surgical management of OCD led to similar improvements in PROMIS PI at a minimum of one-year follow-up. These results may better allow surgeons to reassure patients and families that outcomes are similar when lesions are treated through a lesion-specific algorithm. Level of evidenceLevel IV: Retrospective cohort study.

A high rate of children and adolescents return to sport after surgical treatment of osteochondritis dissecans of the elbow: a systematic review and meta-analysis.

The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow. The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score. Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10-18.5) and a median follow-up of 39months (range 5-156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic-assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8-99.5%, I2 = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70-87.1%, I2 = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3-94.5%, I2 = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5-95.1%, I2 = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3-99.6%, I2 = 1%) and for an open procedure was 97.8% (95% CI 93.7-99.9%, I2 = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients). Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures. Level IV.

Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) scores compared with legacy metrics in evaluating outcomes after surgical treatment for osteochondritis dissecans of the humeral capitellum

Patient-Reported Outcomes Measurement Information System (PROMIS) scores have not previously been used to measure long-term outcomes in operatively treated capitellar osteochondritis dissecans (OCD) patients. The aims of our study were to (1) assess patients' long-term outcomes using PROMIS scores, (2) compare the performance of PROMIS with other validated elbow legacy metrics, and (3) evaluate ceiling and floor effects in these outcome measures in patients undergoing surgical treatment for capitellar OCD. We evaluated demographic characteristics, procedure details, preoperative PROMIS scores, and associated sports information in surgically treated pediatric capitellar OCD patients. An online survey was sent to the study participants, including the Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow score, the quick Disabilities of the Arm, Shoulder and Hand questionnaire, and the Liverpool Elbow Score patient-answered questionnaire, as well as the Mobility, Pain Interference, and Upper Extremity questionnaires from the PROMIS pediatrics bank. Correlations were evaluated between outcome measures. Ceiling and floor effects were evaluated for each outcome measure. Completed surveys were obtained for 57 patients (59 elbows). The mean patient age at surgery was 14 years (range, 10-18 years). The mean follow-up time was 6 years (standard deviation, 5 years; range, 1-18 years). The mean PROMIS Mobility score improved from 41.2 preoperatively to 55.2 postoperatively (P < .001). The mean Pain Interference score decreased from 46.9 preoperatively to 38 postoperatively (P < .001). The mean Upper Extremity score improved from 42.7 preoperatively to 53.2 postoperatively (P < .001). Significant correlations were observed between all legacy metrics and postoperative PROMIS scores (|r| > 0.54, P < .001). Ceiling or floor effects were seen in all legacy metrics and PROMIS scores. The KJOC score was least affected by ceiling or floor effects. There is a strong correlation between PROMIS scores and legacy measures evaluating outcomes after surgical management of capitellar OCD. However, large ceiling and floor effects were present in all measures, likely owing to the favorable clinical results. The KJOC score was limited the least by ceiling and floor effects.

Outcomes of surgical treatment for osteochondritis dissecans of the elbow: evaluation by lesion location

For treatment of advanced elbow osteochondritis dissecans (OCD), we have used surgical treatment. Although favorable treatment outcomes have been reported for centrally located OCD, treatment outcomes are generally questionable and the choice of surgical method is controversial for laterally located OCD. Our purpose was to evaluate the treatment outcomes based on lesion location. The patients were 30 young (mean age, 14 years) male athletes who underwent surgical treatment of elbow OCD and were monitored for more than 1 year. Osteochondral autografts harvested from the knee were transplanted to centralized (13 patients) or lateral localized (9 patients) OCD lesions. For lateral widespread (8 patients) OCD lesions, a detached osteochondral fragment was fixed using small osteochondral plugs. When the remaining cartilage defect was large after fragment fixation, a large-sized osteochondral plug was transplanted to the defect. Treatment outcomes were evaluated by the Japanese Orthopaedic Association score, elbow range of motion (ROM), and radiographic findings. The Japanese Orthopaedic Association score significantly improved in patients with centralized, lateral localized, and lateral widespread types of OCD. ROM significantly improved in patients with centralized and lateral localized, and they returned to playing sports within 6 months. However, patients with lateral widespread OCD exhibited no significant ROM improvement, and returning to sports was difficult for 3 patients because of poor osseous integration of the fixed osteochondral fragment. Osteochondral autograft transplantation provided favorable outcomes for centralized and lateral localized elbow OCD lesions. However, for lateral widespread OCD lesions, reconstruction of the entire capitellar lesion area may be necessary.

RESULTS OF EARLY SURGICAL TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE KNEE JOINT IN CHILDREN

The results of surgical treatment of osteochondritis dissecans (OCD) of a knee joint in children were studied. Three groups of monitoring were formed: arthroscopic treatment of early stages — 31 children, arthroscopic treatment of late stages — 14 children, arthrotomic treatment of late stages — 14 children. Immediate results are comparable in all the groups. The best long-term results were observed in groups of arthroscopic treatment, especially in early stages. Simultaneous application of bone marrow stimulation techniques and symptomatic treatment is more effective.

Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans

We present the case of a 17-year-old ice-hockey player, who complained about persistent left medial knee pain having undergone a refixation of a grade III osteochondritis dissecans with biodegradable pins, a reconstruction of the anterior cruciate ligament (ACL) and a medial meniscal repair 1year previously. Sequential MRIs performed 8 and 12months after surgery were inconclusive, and failed to show the insufficient integration of the osteochondral fragment. Combined single photon emission and conventional computerized tomography (SPECT/CT) clearly revealed the cause of the patient's persistent knee problems-the osteochondral fragment had not integrated. SPECT/CT may hold great clinical value for symptomatic patients who have previously undergone treatment for osteochondral lesions, and it should be considered as alternative diagnostic imaging modality.

Fresh Osteochondral Allografting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle

Background The treatment of osteochondritis dissecans in the adult knee can be challenging. As part of our comprehensive treatment program, fresh osteochondral allografts have been used in the surgical management of osteochondritis dissecans of the femoral condyle. Hypothesis Fresh osteochondral allograft transplantation will provide a successful surgical treatment for osteochondritis dissecans of the femoral condyle. Study Design Case series; Level of evidence, 4. Methods Sixty-six knees in 64 patients underwent fresh osteochondral allografting for the treatment of osteochondritis dissecans. Each patient was evaluated both preoperatively and postoperatively using an 18-point modified D'Aubigné and Postel scale. Subjective assessment was performed using a patient questionnaire. Radiographs were evaluated preoperatively and postoperatively. Results Mean follow-up was 7.7 years (range, 2-22 years). There were 45 men and 19 women with a mean age of 28.6 years (range, 15-54 years). All patients had undergone previous surgery. Forty-one lesions involved the medial femoral condyle, and 25 involved the lateral femoral condyle. All were osteochondritis dissecans type 3 or 4. The mean allograft size was 7.5 cm2. One knee was lost to follow-up. Of the remaining 65 knees, 47 (72%) were rated good/excellent, 7 (11%) were rated fair, and 1 (2%) was rated poor. Ten patients (15%) underwent reoperation. The mean clinical score improved from 13.0 preoperatively to 16.4 postoperatively (P < .01). Fifty-nine of 64 patients completed questionnaires. Subjective knee function improved from a mean of 3.4 to 8.4 on a 10-point scale (P < .01). Conclusion With greater than 70% good or excellent results, fresh osteochondral allograft transplantation is a successful surgical treatment for osteochondritis dissecans of the femoral condyle.

Arthroscopic Anatomy of the Equine Femoropatellar Joint and Approaches for Treatment of Osteochondritis Dissecans

Arthroscopic approaches to the femoropatellar joint were developed to determine their usefulness for evaluation and surgical treatment of osteochondritis dissecans. It was found that the articular cartilage of the lateral trochlear ridge, medial trochlear ridge, intertrochlear groove, patella, and the lateral and medial reflections of the joint capsule could be examined from an infrapatellar arthroscopic portal. The suprapatellar pouch could be examined partially. Lateral and medial instrument portals were evaluated to determine the accessibility of the lateral and medial trochlear ridges of the femur in the areas where osteochondritis dissecans lesions frequently occur. Sliding the arthroscope sleeve beneath the patella when entering the joint was associated with iatrogenic cartilage lesions. A new technique that directed the arthroscope lateral to the lateral trochlear ridge eliminated iatrogenic cartilage damage.

The surgical treatment of osteochondritis dissecans and ununited coronoid process in the canine elbow joint

ABSTRACTThe case details of ten dogs with osteochondritis dissecans of the medial condyle of the humerus and seven dogs with ununited coronoid process are presented. Seventeen dogs were treated surgically and the medial approach to the elbow is described.

The surgical treatment of osteochondritis dissecans of the humeral head in dogs.

ABSTRACTThe authors record their experiences of the surgical treatment of twenty‐one unilateral and thirteen bilateral cases of osteochondritis dissecans of the humerus of the dog. The operative technique and the clinical pathology of the condition are described. In nearly all cases there was complete restoration of limb function within 3 months of surgery; this is a much better result than that obtained in a previous series treated conservatively. Nineteen of the affected dogs had signs of hip dysplasia.Résumé. Les auteurs rapportent leurs expériences concernant le traitemerit chirurgical de 21 cas unilatéraux et de 13 cas bilatéraux d'ostéochondrite dissécante de l'humérus du chien. On décrit les techniques opératoires et les données de l'examen clinique. Dans presque tous les cas, on a obtenu une restauration presque complète de la fonction du membre dans les 3 mois qui ont suivi l'opération, ce qui représente un résultat nettement supérieur à celui obtenu dans des séries précédentes traitées par un mode conservateur. Dix‐neuf des chiens atteints ont présenté des signes de dysplasie de la hanche.Zusammenfassung. Die Autoren geben ihre Erfahrungen mit der chirurgischen Behandlung von 21 einseitigen und 13 beidseitigen Fällen von Osteochondritis dissecans des Humerus des Hundes bekannt. Die Operationstechnik und die klinische Pathologie des Zustands werden beschrieben. In fast allen Fällen wurde die vollständige Wiederherstellung der Extremitätenfunktion innerhalb von drei Monaten nach dem chirurgischen Eingriff erreicht; dies ist ein viel besseres Ergebnis, als mit einer früheren Reihe von Fällen durch konservative Behandlung erzielt wurde. Neunzehn der erkrankten Hunde wiesen Anzeichen von Hüftdysplasie auf.