Clin Orthop Surg.  2016 Mar;8(1):57-64. 10.4055/cios.2016.8.1.57.

Arthroscopic Bioabsorbable Screw Fixation of Unstable Osteochondritis Dissecans in Adolescents: Clinical Results, Magnetic Resonance Imaging, and Second-Look Arthroscopic Findings

• Chun KC
• Kim KM
• Jeong KJ
• Lee YC
• Kim JW
• Chun CH

• KMID: 2363946
• DOI: http://doi.org/10.4055/cios.2016.8.1.57

Abstract

BACKGROUND
This study aimed to evaluate the clinical and radiological outcomes of arthroscopic bioabsorbable screw fixation in osteochondritis dissecans (OCD) in adolescent patients with unstable lesions causing pain.
METHODS
The study included 11 patients (10 males and 1 female) with OCD who underwent arthroscopic bioabsorbable screw fixation between July 2007 and February 2014 and were available for follow-up for more than 12 months. The mean age at diagnosis was 16.3 years (range, 11 to 19 years), and the average follow-up period was 51 months (range, 12 to 91 months). Clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, and International Knee Documentation Committee (IKDC) score measured before surgery and at follow-up. Functional evaluation was made using the Tegner activity scale. Magnetic resonance imaging (MRI) and second-look arthroscopy were performed at the 12-month follow-up.
RESULTS
Between the preoperative assessment and follow-up, improvements were seen in the KOOS (range, 44.9 to 88.1), Lysholm knee score (range, 32.6 to 82.8), and IKDC score (range, 40.8 to 85.6). The Tegner activity scale also improved from 2.8 to 6.1. Based on postoperative MRI, there were eight Dipaola grade I cases and three grade II cases. No complications due to fixation failure developed in any case. Second-look arthroscopy at 12 months postoperatively revealed that the lesion was covered with cartilage in all cases.
CONCLUSIONS
For unstable OCD lesions causing pain in adolescents, arthroscopic bioabsorbable screw fixation provided favorable outcomes with reduced pain and restoration of movement. Therefore, it should be considered as an effective treatment for OCD.

Keyword

Knee; Osteochondritis dissecans; Bioabsorbable implant

MeSH Terms

*Absorbable Implants
Adolescent
Adult
Arthroscopy/adverse effects/*instrumentation/methods
*Bone Screws
Child
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Osteochondritis Dissecans/*diagnostic imaging/*surgery
Range of Motion, Articular
Treatment Outcome
Young Adult

Figure

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  Fig. 1 Study participant flow chart. Pt.: patients, Tx.: treatment.

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  Fig. 2 (A) The arthroscopic image from case no.2 shows an unstable lesion of the medial femoral condyle. (B) The drill guide is inserted in the vertical position into the lesion. (C) A bioabsorbable screw is inserted with vertical compression force. (D) The arthroscopic image shows three bioabsorbable screws in the osteochondritis dissecans lesion.

• 

  Fig. 3 (A, B) The preoperative magnetic resonance imaging (T2 fat suppression) scans from case no.2 show osteochondritis dissecans of the medial femoral condyle (arrow). (C, D) The magnetic resonance imaging scans taken at follow-up, 12 months after operation, show three bioabsorbable screws (arrows) fixed with nearly normal congruency of the articular surface overlying the fixation site.

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  Fig. 4 (A) The preoperative arthroscopic image shows bioabsorbable screw fixation of the osteochondritis dissecans lesion. (B) The second-look arthroscopy image at 12 months postoperatively revealed that the lesion is covered with cartilage.

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