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Transarticular drilling for stable juvenile osteochondritis dissecans of the medial femoral condyle

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Drilling is the most common operative treatment for stable juvenile osteochondritis dissecans (OCD) of the knee. However, prognostic factors remain unclear because of lack of precise radiographic and histopathologic investigations. The purpose of this study was to evaluate the clinical results and prognostic factor of the arthroscopic drilling for juvenile OCD lesions at the medial femoral condyle (MFC), using computed tomography (CT) images.

Methods

Eighteen skeletally immature patients (boys, n = 16; girls, n = 2, mean age, 12 years) underwent arthroscopic antegrade transarticular drilling for a total of 19 OCD lesions of MFC. Functional outcomes were evaluated with the Lysholm score at follow-up (mean, 30 months). Preoperative osteochondral condition and postoperative healing were evaluated by CT images.

Results

All 18 patients returned to their previous level of sports activity and showed excellent functional outcomes (mean Lysholm score, 77.2 ± 9.4 preoperative vs. 99.5 ± 1.6 postoperative). There were 10 osteochondral lesions and 9 subchondral bone defect lesions under preoperative CT examination. Postoperatively, 15 of 19 lesions healed completely at a mean of 6 months; however, the remaining four lesions (all osteochondral types) did not achieve complete radiographic healing after 2 years.

Conclusion

Transarticular drilling for stable juvenile OCD produced excellent functional outcomes. However, the osteochondral type may influence radiographic outcome.

Level of evidence

Case series, Level IV.

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References

  1. Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M (2009) Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy 25(2):145–152

    Article  PubMed  Google Scholar 

  2. Aglietti P, Buzzi R, Bassi PB, Fioriti M (1994) Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy 10(3):286–291

    Article  PubMed  CAS  Google Scholar 

  3. Anderson AF, Richards DB, Pagnani MJ, Hovis WD (1997) Antegrade drilling for osteochondritis dissecans of the knee. Arthroscopy 13(3):319–324

    Article  PubMed  CAS  Google Scholar 

  4. Barrie HJ (1987) Osteochondritis dissecans 1887–1987. A centennial look at Konig’s memorable phrase. J Bone Joint Surg 69(5):693–695

    CAS  Google Scholar 

  5. Bradley J, Dandy DJ (1989) Results of drilling osteochondritis dissecans before skeletal maturity. J Bone Joint Surg 71(4):642–644

    CAS  Google Scholar 

  6. Brittberg M, Agloetti P, Gambardella R, Hangody L, Hauselmann HJ, Jakob RP, Levine D, Lohmander S, Mandelbaum BR, Peterson L, Staubli HU (2000) ICRS classification of OCD-lesions(osteochondritis-dissecans). In: ICRS cartilage injury evaluation package. International Cartilage Repair Society. Available via DIALOG. http://www.cartilage.org/_files/contentmanagement/ICRS_evaluation.pdf

  7. Donaldson LD, Wojtys EM (2008) Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee. J Pediatr Orthop 28(8):831–835

    Article  PubMed  Google Scholar 

  8. Guhl JF (1982) Arthroscopic treatment of osteochondritis dissecans. Clin Orthop Relat Res 167:65–67

    PubMed  Google Scholar 

  9. Kawasaki K, Uchio Y, Adachi N, Iwasa J, Ochi M (2003) Drilling from the intercondylar area for treatment of osteochondritis dissecans of the knee joint. Knee 10(3):257–263

    Article  PubMed  Google Scholar 

  10. Kocher MS, Micheli LJ, Yaniv M, Zurakowski D, Ames A, Adrignolo AA (2001) Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med 29(5):562–566

    PubMed  CAS  Google Scholar 

  11. Kocher MS, Tucker R, Ganley TJ, Flynn JM (2006) Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 34(7):1181–1191

    Article  PubMed  Google Scholar 

  12. Louisia S, Beaufils P, Katabi M, Robert H (2003) Transchondral drilling for osteochondritis dissecans of the medial condyle of the knee. Knee Surg Sports Traumatol Arthrosc 11(1):33–39

    PubMed  CAS  Google Scholar 

  13. Schenck RC Jr, Goodnight JM (1996) Osteochondritis dissecans. J Bone Joint Surg 78(3):439–456

    PubMed  Google Scholar 

  14. Smillie IS (1957) Treatment of osteochondritis dissecans. J Bone Joint Surg 39-B(2):248–260

    CAS  Google Scholar 

  15. Uozumi H, Sugita T, Aizawa T, Takahashi A, Ohnuma M, Itoi E (2009) Histologic findings and possible causes of osteochondritis dissecans of the knee. Am J Sports Med 37(10):2003–2008

    Article  PubMed  Google Scholar 

  16. Yonetani Y, Nakamura N, Natsuume T, Shiozaki Y, Tanaka Y, Horibe S (2010) Histological evaluation of juvenile osteochondritis dissecans of the knee: a case series. Knee Surg Sports Traumatol Arthrosc 18(6):723–730

    Article  PubMed  Google Scholar 

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Correspondence to Yasukazu Yonetani.

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Yonetani, Y., Tanaka, Y., Shiozaki, Y. et al. Transarticular drilling for stable juvenile osteochondritis dissecans of the medial femoral condyle. Knee Surg Sports Traumatol Arthrosc 20, 1528–1532 (2012). https://doi.org/10.1007/s00167-011-1736-1

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  • DOI: https://doi.org/10.1007/s00167-011-1736-1

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