Background: Osteochondritis dissecans (OCD) can progress to loose body formation, resulting in a grade IV defect. The decision to fix versus excise the loose body is controversial. Published operative fixation outcomes are small case series with short follow-up.
Hypothesis: Operative fixation (ORIF) of the loose body into the grade IV defect will heal and approximate “normal” knee function at long-term follow-up.
Study Design: Case series; Level of evidence, 4.
Methods: Twelve patients were identified who underwent ORIF of a knee OCD loose body into the grade IV osteochondral defects ranging in size from 2.0 to 8.0 cm 2 (mean, 3.5 cm2). After 12 weeks, hardware was removed, and healing was assessed. Long-term outcomes were assessed with a Knee injury and Osteoarthritis Outcome Score (KOOS) and a Marx activity score.
Results: Arthroscopy for screw removal revealed stable healing in 92% (11 of 12) of patients. No patients required subsequent surgery for a loose body. At an average of 9.2 years’ follow-up (range, 3.8-15.8 years), 83% (10 of 12) of patients completed the KOOS. The KOOS subscale scores for pain (mean, 87.8; range, 67-100), other symptoms (mean, 81.8; range, 61-96), function in activities of daily living (mean, 93.1; range, 72-100), and sports and recreation function (mean, 74.0; range, 40-100) were not significantly lower than those of published age-matched controls. However the KOOS subscale score for knee-related quality of life (mean, 61.9; range, 31-88) was significantly lower (P = .003).
Conclusion: Operative fixation of grade IV OCD loose bodies results in stable fixation. At an average 9 years after surgery, patients did not have symptoms of osteoarthritis pain and had normal function in activities of daily life. However, patients reported significantly lower knee-related quality of life. Operative fixation of OCD loose bodies is a better alternative to lesion excision.
Aglietti P., Buzzi R., Bassi PB, Fioriti M.Arthroscopic drilling of osteochondritis dissecans of the medial femoral condyle . Arthroscopy. 1994;10(3):286-291.
2.
Aichroth P.Osteochondritis dissecans of the knee. J Bone Joint Surg Br . 1971;53(3):440-447.
3.
Anderson AF, Lipscomb AB, Coulam C.Antegrade curettement, bone grafting and pinning of osteochondritis dissecans in the skeletally mature knee. Am J Sports Med. 1990;18(3):254-261.
4.
Anderson AF, Pagnani MJOsteochondritis dissecans of the femoral condyles: long-term results of excision of the fragment. Am J Sports Med. 1997;25(6):830-834.
5.
Anderson AF, Richards DB, Pagnani MJ, Hovis JDAntegrade drilling for osteochondritis dissecans of the knee. Arthroscopy. 1997;13(3):319-324.
6.
Berlet GC, Mascia A., Miniaci AMTreatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). Arthroscopy . 1999;15(3):312-316.
7.
Bradley J., Dandy DJResults of drilling osteochondritis dissecans before skeletal maturity . J Bone Joint Surg Br. 1989;71(4):642-644.
8.
Braune C., Rehart S., Kerschbaumer E., Jager A.Resorbable pin refixation of an osteochondral fracture of the lateral femoral condyle due to traumatic patellar dislocation: case management, follow-up and strategy in adolescents [in German]. Z Orthop Ihre Grenzgeb . 2004;142(1):103-108.
9.
Brittberg M. , Lindahl A., Nilsson A., Ohlsson C., Isaksson O., Peterson L.Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation . N Engl J Med. 1994;331(14):889-895.
10.
Cahill BR, Phillips MR, Navarro R.The results of conservative management of juvenile osteochondritis dissecans using joint scintography: a prospective study. Am J Sports Med. 1989;17(5):601-605.
11.
Cetik O., Turker M., Uslu M.Bilateral osteochondritis dissecans of lateral femoral condyle. Knee Surg Sports Traumatol Arthrosc. 2005;13(6):468-471.
12.
Crawford DC , Safran MROsteochondritis dissecans of the knee. J Am Acad Orthop Surg. 2006;14(2):90-100.
13.
Cugat R., Garcia M., Cusco X., et al. Osteochondritis dissecans: a historical review and its treatment with cannulated screws. Arthroscopy. 1993;9(6):675-684.
14.
de Smet AA, Fisher DR, Graf BK, Lange RHOsteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. Am J Roentgenol. 1990;155(3):549-553.
15.
Denoncourt PM, Patel D., Dimakopoulos P.Treatment of osteochondritis dissecans of the knee by arthroscopic curettage, follow-up study. Orthop Rev. 1986;15(10):652-657.
16.
Dervin GF, Keene GCR, Chissell HRBiodegradable rods in adult osteochondritis dissecans of the knee . Clin Orthop Relat Res. 1998;356:213-221.
17.
Ehrich EW, Davies GM, Watson DJ, Bolognese JA, Seidenberg BC, Bellamy N.Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. J Rheumatol. 2000;27(11):2635-2641.
18.
Englund M., Roos EM, Lohmander LSImpact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls . Arthritis Rheum. 2003;48(8):2178-2187.
19.
Ewing JW, Voto SJArthroscopic surgical management of osteochondritis dissecans of the knee . Arthroscopy. 1998;4(1):37-40.
20.
Flynn JM, Kocher MS, Ganley TJOsteochondritis dissecans of the knee. J Pediatr Orthop . 2004;24(4):434-443.
21.
Gepstein R. , Conforty B., Weiss RE, Hallel T.Surgery for early stage osteochondritis dissecans of the knee in young adults: a preliminary report. Orthopedics. 1986;9(8):1087-1089.
22.
Gillespie HS , Day B.Bone peg fixation in the treatment of osteochondritis dissecans of the knee joint. Clin Orthop Relat Res. 1979; 143:125-129.
23.
Green JPOsteochondritis dissecans of the knee. J Bone Joint Surg Br . 1966;48(1):82-91.
24.
Green WT, Banks HHOsteochondritis dissecans in children. J Bone Joint Surg Am . 1953;35:26-47.
Hangody L., Fules P.Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience . J Bone Joint Surg Am. 2003;85 (Suppl 2):25-32.
27.
Hefti F., Beguiristain J., Krauspe R., et al. Osteochondritis dissecans: a multicenter study of the European Orthopedic Society. J Pediatr Orthop. 1999 ;8(4):231-245.
28.
Hughston JC , Hergenroeder PT, Courtenay BGOsteochondritis dissecans of the femoral condyles . J Bone Joint Surg Am. 1984; 66(9):1340-1348.
29.
Jaberi FMOsteochondritis dissecans of the weight-bearing surface of the medial femoral condyle in adults. Knee. 2002;9:201-207.
30.
Jakob RP, Miniaci AMA compression pinning system for osteochondritis dissecans of the knee. Acta Orthop Scand. 1989;60(3):319-321.
31.
Johnson EW, McLeod TLOsteochondral fragments of the distal end of the femur fixed with bone pegs . J Bone Joint Surg Am. 1977;59(5):677-679.
32.
Johnson LL, Uitvlugt G., Austin MD, Detrisac DA, Johnson C.Osteochondritis dissecans of the knee: arthroscopic compression screw fixation . Arthroscopy. 1990;6(3):179-189.
33.
Karataglis D., Green MA, Learmonth DJAutologous osteochondral transplantation for the treatment of chondral defects of the knee. Knee. 2006;13(1):32-35.
34.
Kennedy JC, Grainger RW, McGraw RWOsteochondral fractures of the femoral condyles. J Bone Joint Surg Br. 1966;48(3):436-440.
35.
Kim J., Lonner JH, Nelson CL, Lotke PAResponse bias: effect on outcomes evaluation by mail surveys after total knee arthroplasty. J Bone Joint Surg Am. 2004;86(1):15-21.
36.
Kivisto R., Pasanen L., Leppilahti J., Jalovaara P.Arthroscopic repair of osteochondritis dissecans of the femoral condyles with metal staple fixation: a report of 28 cases. Knee Surg Sports Traumatol Arthrosc. 2002;10(5):305-309.
37.
Kouzelis A. , Spyros P., Papadopoulos AX, Gliatis I., Lambiris E.Herbert screw fixation and reverse guided drillings, for treatment of types III and IV osteochondritis dissecans. Knee Surg Sports Traumatol Arthrosc. 2006;14:70-75.
38.
LaPrade RF, Bursch LS, Olson EJ, Havlas V., Carlson CSHistologic and immunohistochemical characteristics of failed articular cartilage resurfacing procedures for osteochondritis of the knee: a case series . Am J Sports Med. 2008;36(2):360-368.
39.
Linden B.Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am. 1977;59(6):769-776.
40.
Lindholm S. , Pylkkanen P.Internal fixation of the fragment of osteochondritis dissecans in the knee by means of bone pins. Acta Chir Scand . 1974;140:626-629.
41.
Lindholm S. , Pylkkanen P., Osterman K.Fixation of osteochondral fragments in the knee joint. Clin Orthop Relat Res. 1977;126:256-260.
42.
Lipscomb PR Jr, Lipscomb PR Sr, Bryan RSOsteochondritis dissecans of the knee with loose fragments: treatment by replacement and fixation with readily removed pins. J Bone Joint Surg Am. 1978;60(2):235-240.
43.
Mackie IG, Pemberton DJ, Maheson M.Arthroscopic use of the Herbert screw in osteochondritis dissecans . J Bone Joint Surg Br. 1990;72(4):1076.
44.
Makino A., Muscolo DL, Puigdevall M., Costas-Paz M., Ayerza M.Arthroscopic fixation of osteochondritis dissecans of the knee. Am J Sports Med. 2005;33(10):1499-1504.
45.
Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RFDevelopment and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med. 2001;29(2):213-218.
46.
Matsusue Y. , Nakamura T., Suzuki S., Iwasaki R.Biodegradable pin fixation of osteochondral fragments of the knee. Clin Orthop Relat Res. 1996;322:166-173.
47.
Nakagawa T. , Kurosawa H., Ikeda H., Nozawa M., Kawakami A.Internal fixation for osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc. 2005;13:317-322.
48.
Navarro R., Cohen M., Filho MC, da Silva RTThe arthroscopic treatment of osteochondritis dissecans of the knee with autologous bone sticks. Arthroscopy. 2002;18(8):840-844.
49.
Outerbridge REOsteochondritis dissecans of the posterior femoral condyle. Clin Orthop Relat Res. 1983 ;175:121-129.
50.
Paradowski PT, Bergman S., Sunden-Lundius A., Lohmander S., Roos EWKnee complaints vary with age and gender in the adult population: population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord. 2006;7:38.
51.
Peterson L. , Brittberg M., Kiviranta I., Akerlund EL, Lindahl A.Autologous chondrocyte transplantation: biomechanics and long-term durability. Am J Sports Med. 2002;30(1):2-12.
52.
Peterson L. , Minas T., Brittberg M., Nilsson A., Sjogren-Jansson E., Lindahl A.Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000;374:212-234.
53.
Roos EM, Lohmander LSThe Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64.
54.
Scott DJ, Stevenson CAOsteochondritis dissecans of the knee in adults. Clin Orthop Relat Res. 1971;76:82-86.
55.
Smillie ISTreatment of osteochondritis dissecans. J Bone Joint Surg Br. 1957;39(2):248-260.
56.
Thomson NLOsteochondritis dissecans and osteochondral fragments managed by Herbert compression screw fixation. Clin Orthop Relat Res. 1987 ;224:71-78.
57.
Tuompo P., Arvela V., Partio EK, Rokkanen P.Osteochondritis of the knee fixed with biodegradable self-reinforced polyglycolide and polylactide rods in 24 patients. Int Orthop . 1997;21:355-360.
58.
Twyman RS, Desai K., Aicroth PMOsteochondritis dissecans of the knee. J Bone Joint Surg Br . 1991;73(3):461-464.
59.
Victoroff BN , Marcus RE, Deutsch A.Arthoscopic bone peg fixation in the treatment of osteochondritis dissecans in the knee. Arthroscopy. 1996;12(4):506-509.
60.
Wall E., Von Stein D.Juvenile osteochondritis dissecans. Orthop Clin North Am. 2003;34:341-353.
61.
Zarzycki W.[Evaluation of treatment results for osteochondritis dissecans of the knee joint]. Chir Narzadow Ruchu Ortop Pol . 2001;66(1):61-66.
62.
Zuniga JJR , Sagastibelza JJ, Blasco JJL , Grande MMArthroscopic use of Herbert screw in osteochondritis dissecans of the knee . Arthroscopy. 1993 ;9(6):668-670.
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