Predictive factors for osteochondritis dissecans of the lateral femoral condyle concurrent with a discoid lateral meniscus

Younger age is a risk factor for developing recurrent or postoperative osteochondritis dissecans after surgery for discoid lateral meniscus with/without preoperative osteochondritis dissecans

PURPOSE

To evaluate the efficacy of surgical treatment of the discoid lateral meniscus with osteochondritis dissecans (OCD) through clinical and radiological evaluations, focusing on recurrent or postoperative OCD occurrence.

METHODS

This retrospective study included patients with symptomatic discoid lateral meniscus with OCD (pre-OCD group) and without OCD (non-OCD group) who had undergone arthroscopic surgery with >5 years of follow-up. Age, sex, Lysholm score, Tegner activity scale, surgical procedure, and recurrent or postoperative OCD lesions were compared. The association between patient variables and postoperative OCD was determined using multivariate logistic regression analysis.

RESULTS

Of the 95 knees, 15 (15%) were in the pre-OCD group. Healing was observed in 14/15 (93%) knees. Recurrent and postoperative OCDs were reported in 4/15 (28.5%) knees in the pre-OCD and 7/80 (8.8%) knees in the non-OCD groups at a mean of 3.2 ± 1.1 and 3.7 ± 1.2 years, respectively. Pre- and postoperative Tegner activity scale and Lysholm scores were higher in the pre-OCD group but similar to those in the non-OCD group. The incidence of recurrent OCD in the pre-OCD group was significantly higher than that of postoperative OCD in the non-OCD group. Younger patients (odds ratio, 0.49; p = 0.003) had an increased risk of experiencing recurrent or postoperative OCD in multivariate analysis. The optimal cutoff age for distinguishing recurrent or postoperative OCD was 9 years.

CONCLUSION

Surgical procedures for OCD lesions in the pre-OCD group were successful. Multivariate analysis identified age as a risk factor for recurrent or postoperative OCD; therefore, conservative treatment is recommended for patients with discoid lateral meniscus before preadolescence to prevent postoperative OCD occurrence.

LEVEL OF EVIDENCE

Level III.

Simultaneous Meniscal Repair and Temporary Guided Growth Using a Tension Band Plate to Correct Alignment in Pediatric Discoid Lateral Meniscus Patients With Valgus Knee

Meniscal stabilization with saucerization has recently been recommended for discoid lateral meniscus (DLM) to preserve the meniscus shape and prevent the progression of osteoarthritis. However, axial alignment of the lower limb causes a significant valgus change after arthroscopic partial meniscectomy and can lead to progressive lateral osteoarthritic changes. Thus, valgus knees in patients with DLM are a suspected predictive factor for poor outcomes after DLM surgery. Valgus malalignment in pediatric patients can be corrected by temporarily tethering one side of the open physis using implant-mediated guided growth to generate differential growth in the coronal plane. This Technical Note describes simultaneous arthroscopic meniscal surgery and temporary hemiepiphysiodesis to treat DLM with valgus deformities to reduce the risk of future chondral damage to the lateral knee compartment.

Juvenile Osteochondritis Dissecans: A Case Report

(1) Background: This report aims to illustrate the development, progression, diagnosis, and treatment of chronically present articular surface lesions. (2) Methods: In this report, two patients are described from the point of the initial presentation of symptoms to surgical consultation based on radiologic findings. These patients underwent corrective surgery in the form of mosaicplasty to repair lesions present on the articular surface and the underlying subchondral bone. (3) Discussion: Diagnosing juvenile OCD remains challenging due to its variable clinical presentation and minute radiologic discoveries. X-rays are useful; however, the gold standard remains arthroscopy, which can be both diagnostic and therapeutic. Future prospects include the use of novel sonographic methods and the use of artificial intelligence within the given modalities. (4) Conclusions: The detailed imaging provided by MRI, combined with the insights from X-rays and potentially other modalities, allows for a nuanced understanding of this disease. This comprehensive approach ensures that treatment decisions are well-informed, optimising outcomes for young patients with this condition.

[Non-traumatic osteochondral lesions of the knee joint during growth : Juvenile osteochondritis dissecans (JOCD) of the knee]

BACKGROUND

Juvenile osteochondritis dissecans of the knee joint is the most common osteochondral lesion during growth, usually occurring between the 10th and 14th year of age.

PATHOGENESIS

Repetitive microtraumata lead to a subchondral osseus lesion, which is commonly located at the medial aspect of the femoral condyle. Sport activities are considered to be the main cause, although genetic and hereditary factors as well as vitamin D3 deficiency also play a role. Current classification systems distinguish between stable and unstable osteochondral lesions, which is decisive for further treatment.

TREATMENT

Stable lesions may heal through conservative treatment by avoiding weight bearing and sport. Unstable lesions, on the other hand, can lead to a complete defect of the joint surface with the formation of a free joint body. In such cases, various surgical techniques aim at reconstructing the surface of the joint, in order to reduce the risk of secondary arthritis.

Saucerization of complete discoid lateral meniscus is associated with change of morphology of the lateral femoral condyle and tibial plateau

PURPOSE

To determine the effect of saucerization surgery on knee joint morphology associated with a complete discoid lateral meniscus (DLM) using magnetic resonance (MR) imaging.

METHODS

This retrospective study included cases had undergone saucerization surgery for symptomatic DLM between 2007 and 2022. All cases were divided into two by age group: < 12 (U13) and > 13 (O13). The cases in the match group were randomly selected from preoperative cases in the O13 group matched with the age at the final follow-up (F/U) of cases in the U13 group. The following morphological parameters were evaluated using MR images preoperatively and at the final postoperative F/U in each group: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), and the lowest point of the lateral femoral condyle (LPLFC). Each parameter was compared between the U13 preoperative (pre-OP) group and the O13 pre-OP group, the preoperative and final follow-up in the U13, and the U13 group at the final F/U and the match group preoperatively.

RESULTS

A total of 77 cases were evaluated. 31 cases were in the U13 pre-OP group and 46 were in the O13 pre-OP group. With a minimal F/U of 2 years, 27 cases in the U13 group and 36 in the O13 group were included. The mean F/U period was 4.6 years in the U13 group and 3.2 years in the O13 group. 32 cases were included in the match group. In the match group, the inclination of the POLTP was significantly larger (P = 0.042) and the LPLFC was more lateral (P = 0.0034) than at the final F/U in the U13 group.

CONCLUSIONS

Saucerization surgery for DLM in juvenile patients can prevent progression to the characteristic bone morphology DLM. These results could help the surgeon making the decision when the surgery would be performed for symptomatic DLM patients.

LEVEL OF EVIDENCE

Retrospective comparative study; level of evidence, 3.

Prevalence and a correlation analysis of discoid meniscus and femoral trochlear dysplasia

BACKGROUND

Discoid meniscus (DM) and femoral trochlear dysplasia (FTD) are common knee disorders. Both as congenital malformation, whether there is a connection between them is unclear and the research on their prevalence in the general population is inadequate. This study aimed to investigate the prevalence of FTD and DM in the general population through a large sample size, and to explore the relationship between them.

STUDY DESIGN

Retrospective study.

METHODS

Patients undergoing knee magnetic resonance imaging (MRI) examinations at our outpatient clinic were screened and 1003 patients were enrolled in DM group with 989 patients in non-DM (NDM) group. The type of DM and FTD was classified with Watanabe classification and Dejour's classification, respectively. The prevalence of FTD and DM in the general population and the relationship between them were evaluated.

RESULTS

The prevalence of DM and FTD was 10.0% and 14.5%, respectively. The overall percentage of FTD was higher in DM group (P < 0.001). The DM group has a higher percentage of all types of FTD except type D (P < 0.05), and a higher percentage of both low- and high-grade FTD (P < 0.001). There were 633 cases of type I DM and 370 cases of type II DM. The overall percentage of FTD was not significantly different between the two types (P = 0.106). No significant difference was detected for all types of FTD except type B (P < 0.05). The Type I DM group has a significant higher percentage of high-grade FTD than Type II group (P < 0.05).

CONCLUSION

Patients with a DM are more likely to have FTD regardless of the type of DM, while those with a type I DM are more prone to have a high grade FTD.

Effect of the volume of resected discoid lateral meniscus on the contact stress of the tibiofemoral joint: A finite element analysis

BACKGROUND

Partial meniscectomy is commonly performed for symptomatic patients with discoid lateral meniscus (DLM) if conservative treatment fails. However, the development of knee osteoarthritis and osteochondral lesion are detrimental postoperative complications. This study aimed to evaluate the effect of the volume of resected DLM on the contact stress of the tibiofemoral joint using a finite element analysis.

METHODS

Subject-specific finite-element models of the knee joint of a patient with DLM were developed from computed tomographic and magnetic resonance images. To evaluate the effect of partial meniscectomy on the contact stress in the lateral tibiofemoral joint, six knee models were created in the study (the native DLM, and five partially meniscectomized DLMs (according to the preserved width of the meniscus: 12 mm, 10 mm, 8 mm, 6 mm, and 4 mm)).

RESULTS

As the volume of resected DLM increased, higher contact stress was applied to the lateral tibiofemoral joint. Greater contact stress was applied to the preserved lateral meniscus than to the native DLM.

CONCLUSIONS

From a biomechanical viewpoint, the native DLM was the most protective against lateral tibiofemoral contact stress in comparison to partially meniscectomized DLMs.

Osteochondritis dissecans of the knee in adolescents: How to treat them?

Background

Osteochondritis dissecans is an acquired condition of the joint that affects the articular surface and the subchondral bone. The juvenile form of osteochondritis dissecans presents in those aged 5-16 years with open growth plates. The causes of osteochondritis dissecans are unknown.

Methods

The goals of treatment are to promote healing of the subchondral bone and prevent chondral collapse, subsequent fracture, osteochondral defect formation, and early joint degeneration. Treatment modality is influenced on clinical symptoms, skeletal maturity, as well as the size, stability, and location of the lesion. This article will review the treatment strategies of juvenile form of osteochondritis dissecans of medial femoral condyle and of atypical regions, such as lateral femoral condyle, patellofemoral joint, and tibial plateau.

Level of evidence

level III.

Osteochondritis dissecans of the knee: Epidemiology, etiology, and natural history

Osteochondritis dissecans of the knee is a disease that typically affects skeletally immature patients. Clinically manifested with knee pain, limping, and joint disfunction, this condition has remained misunderstood and undervalued for a long period. Although being a rare condition, its awareness is of utmost clinical interest because of the possible severe consequences it can bring when misrecognized or inadequately treated. Its etiology remains unclear and is still debated. Many theories have been proposed, including inflammation, local ischemia, subchondral ossification abnormalities, genetic factors, and repetitive mechanical microtrauma, with a likely interplay of the same. This review article aims to deliver and discuss current and up-to-date concepts on epidemiology, etiology, and natural history of this pediatric condition. Level of evidence: level V.

Comparison of the Healing Outcomes of Conservative Treatment for Stable Juvenile Osteochondritis Dissecans of the Lateral Femoral Condyle With Normal Lateral Meniscus and Incomplete Discoid Lateral Meniscus

BACKGROUND

This study aimed to compare the healing outcomes of conservative treatment for osteochondritis dissecans (OCD) of the lateral femoral condyle with normal lateral meniscus and incomplete discoid lateral meniscus (DLM).

METHODS

Forty-four knees in 37 juvenile patients (mean age 9.9 y) with stable OCD and whose lateral meniscus shape was normal or incomplete DLM were enrolled. All patients underwent conservative treatment with physical activities prohibited. For each lateral meniscus group, patient demographics including pretreatment Tegner activity scale, OCD stage, and Lysholm score, radiographic healing status; complete or incomplete healing at 3 months, 6 months, and 1 year, time to complete healing and post-treatment clinical scores were evaluated.

RESULTS

There were 21 (47.8%) and 23 (52.3%) knees with normal menisci and incomplete DLM, respectively. At 3 months, 6 months, and 1 year after conservative treatment, healed OCD status was noted in 3 (14.3%), 12 (57.1%), and 19 (90.5%) knees of the normal type and in 3 (13.0%), 12 (52.2%), and 20 (86.9%) knees of the incomplete DLM type, respectively (P>0.05). The mean time to healing in each group was 198 and 181 days, respectively. No significant differences in terms of OCD healing rate at each time, time to healing, and post-treatment clinical scores were found between the groups.

CONCLUSION

No significant differences in the OCD healing rate or time to healing were found between the normal and incomplete DLM type. Therefore, treatment strategy for OCD with stable and asymptomatic incomplete DLM should be the same as that for those occurring with a normal meniscus.

Osteochondral Allograft for Unsalvageable Osteochondritis Dissecans in the Skeletally Immature Knee

Background:

While an excellent option for osteochondral defects in the adult knee, fresh osteochondral allograft (FOCA) in the skeletally immature adolescent knee has been infrequently studied.

Purpose:

To compare radiographic and patient-reported outcomes (PROs) in skeletally mature and immature adolescents after FOCA in the knee for treatment of unsalvageable osteochondritis dissecans (OCD).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Included were 34 patients (37 knees) who underwent size-matched FOCA of the knee for unsalvageable OCD lesions. All patients were aged ≤19 years and had a minimum of 12 months of follow-up. Patient characteristics, lesion characteristics, reoperations, and PROs were evaluated and compared between patients with open physes (skeletally immature; n = 20) and those with closed physes (skeletally mature; n = 17). Graft failure was defined as the need for revision osteochondral grafting. Postoperative radiographs were analyzed at 1 year and the final follow-up for graft incorporation and classified as A (complete), B (≥50% healed), or C (<50% healed).

Results:

The mean patient age was 15.4 years (range, 9.6-17.6 years), and the mean follow-up was 2.1 years (range, 1-5.3 years). The mean graft size was 5.0 cm² and did not differ significantly between the study groups. Patients with open physes were younger (14.7 vs 16.2 years; P = .002) and more commonly male (80% vs 35%; P = .008). At the 1-year follow-up, 85% of immature patients and 82% of mature patients had radiographic healing grades of A or B. Patients with open physes were more likely to achieve complete radiographic union at 1 year (65% vs 15%; P = .007) and demonstrated better Knee injury and Osteoarthritis Outcome Score (KOOS) Daily Living (96.8 vs 88.5; P = .04) and KOOS Quality of Life (87.0 vs 56.8; P = .01) at the final follow-up. Complications were no different in either group, and graft failure occurred in only 1 skeletally mature patient with a trochlear lesion.

Conclusion:

FOCA treatment for unsalvageable OCD in the young knee may be expected to yield excellent early results. Despite the presence of open physes and immature epiphyseal osteochondral anatomy, equivalent or improved healing and PRO scores compared with those of skeletally mature patients may be expected.

Examination of refractory discoid lateral meniscus injury

BACKGROUND

Lateral discoid meniscus (LDM) should be treated and preserved with saucerization and/or suture repair. However, repair of the meniscal hoop structure is sometimes difficult due to displacement or large defects. In this study, we aimed to examine tear patterns based on the Ahn classification in those requiring meniscal repair and those undergoing subtotal meniscectomy.

METHODS

Twenty-three patients were evaluated (mean age, 27.4 years; mean follow-up period, 2.5 years). The following were evaluated: displacement morphology based on the Ahn classification, site of tear under arthroscopy, morphology, surgical procedure, Lysholm score at final postoperative follow-up, and clinical outcome of meniscus using Barrett's criteria.

RESULT

There were 16 knees without displacement (saucerization with suture repair, 13 knees; subtotal meniscectomy, 3 knees) and 10 knees with displacement (reduction with suture repair, 3 knees; subtotal meniscectomy, 7 knees). Subtotal meniscectomy was performed more often in cases with dislocation, especially in the central shift type as defined by the Ahn classification. The mean Lysholm score was 65.0 points preoperatively and 95.3 points postoperatively. Twenty-three knees (88%) were postoperatively categorized under the Barrett's criteria as healing and 3 knees (12%) were categorized as non-healing. The number of non-healing cases that underwent subtotal meniscectomy was relatively small (1 of 10 knees), and the short-term results were not poor.

CONCLUSION

Localized peripheral longitudinal tears tended to be repairable even with displacement, while peripheral tears covering the entire meniscus or with severe defects/tears in the body of the meniscus tended to be difficult to repair, leading to subtotal meniscectomy.

An adult case of spontaneous healing of concurrent osteochondritis dissecans of the lateral femoral condyle after saucerization with meniscal repair for discoid lateral meniscus: A case report

BACKGROUND

The treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear.

CASE PRESENTATION

A 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points.

CONCLUSIONS

We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.

The postoperative shorter meniscal width was the risk factor of lateral meniscal extrusion in the middle portion for juvenile and adolescent knees with discoid lateral meniscus

PURPOSE

The study aim was to clarify the risk factors for postoperative meniscal extrusion in a middle portion in juvenile and adolescent knees with DLM.

METHODS

Forty-six patients with symptomatic DLM who underwent surgery were retrospectively assessed. Inclusion criteria were set as follows: (1) aged ≤ 17 years with an open growth plate, (2) preoperative and postoperative follow-up MRI, and 3) reshaping surgeries comprising of saucerization alone or with meniscal repair. Average (95%CI) age during surgery, body mass index (BMI), and follow-up duration were 12 years (11-13), 19.9 kg/m² (18.7-21.0), and 26.4 months (19.5-33.3), respectively. Age, sex, sports activities, BMI, postoperative rehabilitation, preoperative shift of DLM by Ahn's classification, surgical procedures, postoperative meniscal width of all portions, and meniscal healing were analyzed.

RESULTS

Postoperatively, eight knees in the no-extrusion group and 38 knees in the extrusion group were observed. In the univariate logistic regression analysis, shorter meniscal width in a middle portion (OR = 1.580, p = 0.006), shorter minimum width of all portions (OR = 1.674, p = 0.024), and meniscal healing (OR = 0.160, p = 0.028) were the risk factors for meniscal extrusion in a middle portion. Multiple logistic regression analysis demonstrated that shorter meniscal width in a middle portion was the risk factor.

CONCLUSIONS

As the clinical relevance, to prevent postoperative meniscal extrusion of the middle portion with DLM, surgeons are necessary to pay attention to maintain the adequate meniscal width for juvenile and adolescent knees.

LEVEL OF EVIDENCE

III.

Comparison of Weightbearing and Nonweightbearing Juvenile Osteochondritis Dissecans Lesions of the Lateral Femoral Condyle

Background:

Repetitive microtrauma may contribute to osteochondritis dissecans (OCD) lesions of the femoral condyle. The effect of differential loading between OCD weightbearing (WB) zones has not been studied.

Purpose:

To determine whether clinical and radiographic variables differ by WB zone in lateral femoral condyle OCD lesions.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We retrospectively reviewed a consecutive series of patients aged <18 years with lateral femoral condyle OCD lesions presenting at a single institution between 2004 and 2018. Patients with OCD lesions outside of the lateral femoral condyle were excluded. Lesions were localized on radiographs using the Cahill and Berg classification, referencing the Blumensaat line and an extension of the posterior femoral cortex. Progeny bone characteristics evaluated at baseline and 24-month follow-up included ossification, distinct borders from parent bone, and displacement. Baseline lesion dimensions were measured on magnetic resonance imaging (MRI) scans. We evaluated posttreatment pain level, return-to-activity rate, and patient-reported outcome measures (PROMs) including the Pediatric International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Pediatric Functional Activity Brief Scale.

Results:

A total of 62 lateral femoral condyle OCD lesions (mean follow-up, 24.1 months) presented within the study period: 26 WB lesions and 36 nonweightbearing (NWB) lesions. At presentation, no differences between the lesion types were observed in symptom chronicity or symptomatology. NWB lesions were deeper on MRI scans (sagittal depth, 7.11 vs 5.96 mm; P = .046; coronal depth ratio, 0.05 vs 0.01 mm; P = .003), were more likely to develop progeny bone (69.4% vs 44%; P = .047), and demonstrated higher radiographic healing rates (52.8% vs 24%; P = .025) compared with WB lesions. PROMs at follow-up were available for 25 of 62 patients (40.3%), with no statistically significant differences between cohorts at any time. Return to full activity was observed in 72% of WB and 82.1% of NWB lesions (P = .378).

Conclusion:

Lateral femoral condyle OCD lesions of the knee in WB and NWB zones presented similarly at initial evaluation; however, NWB lesions demonstrated higher rates of progeny bone formation and radiographic healing at mean 2-year follow-up.

Management of bilateral osteochondritis dissecans of the trochlea in a skeletally immature patient

Osteochondritis dissecans (OCD) lesions are injuries that occur more commonly in the skeletally immature population. In most cases, the aetiology is not well understood, but fortunately, many OCD lesions may heal on their own over time, particularly in skeletally immature patients with open physes. Conversely, if the lesion is considered unstable, surgical intervention may be required. This case demonstrates an especially rare presentation of bilateral OCD lesions within the lateral femoral trochlear facet. The lesions became symptomatic approximately 1 year apart without a specific injury. Non-operative treatment was not recommended in either case due to the size and instability of each lesion. The surgical treatment used an augmented microfracture technique. At 12 and 23 months after surgery, both knees remain asymptomatic and the patient has returned to their desired activities.

Predictive factors for developing osteochondritis dissecans after surgery for discoid lateral meniscus are younger age and shorter meniscal width

PURPOSE

This study aimed to identify the predictive factors for postoperative osteochondritis dissecans (OCD) in juvenile and adolescent knees with discoid lateral meniscus (DLM).

METHODS

In total, 242 patients with symptomatic DLM who underwent surgery were identified. Inclusion criteria were set as follows: (1) age ≤ 17 years with an open growth plate, (2) follow-up magnetic resonance imaging, and (3) absence of preoperative OCD. Consequently, 52 patients were retrospectively investigated. Average age during surgery, body mass index (BMI), and follow-up duration were 12 years [95% confidence interval (CI) 11-13], 19.2 kg/m² (95% CI 18.4-20.1), and 27.3 months (95% CI 20.9-33.7), respectively. Age, sex, sports activities, BMI, symptomatic OCD in other joints, postoperative rehabilitation, preoperative shift of DLM by Ahn's classification, surgical procedures (saucerization alone or with stabilization, and subtotal meniscectomy), and postoperative meniscal width were analyzed as possible predictive factors.

RESULTS

Postoperatively, 42 patients without OCD and 10 with OCD were observed. In univariate analysis, younger age [odds ratio (OR) 1.5; p = 0.003], subtotal meniscectomy (OR 6.3; p = 0.027), and shorter meniscal width (OR 2.7; p = 0.005) were predictive factors for postoperative OCD. Multivariate analysis demonstrated that younger age (OR 1.6; p = 0.009) and shorter meniscal width (OR 1.5; p = 0.003) were predictive factors.

CONCLUSIONS

To prevent postoperative OCD after DLM surgeries, achieving stabilization with adequate meniscal width is necessary for juvenile knees.

LEVEL OF EVIDENCE

III.

Factors Related to Postoperative Osteochondritis Dissecans of the Lateral Femoral Condyle After Meniscal Surgery in Juvenile Patients With a Discoid Lateral Meniscus

PURPOSE

The purpose was to assess the incidence of postoperative osteochondritis dissecans (OCD) and the related epidemiologic factors following meniscal surgery for juvenile discoid lateral meniscus (DLM).

METHODS

The study was a retrospective review of 103 knees in 89 patients with a mean age of 12.1 years who underwent arthroscopic meniscal surgery for DLM. Mean follow-up was 4.2 years. The surgical procedures were either saucerization, saucerization with repair or subtotal meniscectomy, depending on the type of DLM tear. Postoperative OCD lesions were identified radiographically. Age, sex, weight, Lysholm score, Tegner activity scale, exercise frequency, and surgical procedure were compared between the postoperative OCD diagnosis group and non-OCD control group.

RESULTS

Postoperative OCD was diagnosed in 8/103 (7.8%) knees following DLM surgery. The incidence of postoperative OCD was significantly greater for patients age less than 10 years old, and male sex, low weight, Lysholm score, Tegner activity scale preinjury and after returning to sports, and exercise frequency per week on univariate analyses. On multivariate analyses, postoperative OCD occurred more commonly with subtotal meniscectomy than with saucerization or saucerization with repair, and in patients less than 11 years of age. Receiver operating characteristic curve analysis revealed a cutoff value of age at surgery of 10 years.

CONCLUSIONS

Subtotal meniscectomy and patients younger than 10 years at the time of surgery are at greater risk for postoperative OCD. To decrease this risk, if possible, we recommend performing saucerization or saucerization with repair in patients undergoing surgery for DLM.

LEVEL OF EVIDENCE

Level III-retrospective comparative study.

Osteochondritis Dissecans of the Tibial Plateau in Children and Adolescents: A Case Series

Background:

Osteochondritis dissecans (OCD) of the knee is a relatively well-known condition, most commonly arising in the femoral condyle. Lesions arising in the tibial plateau are rarely described.

Purpose:

To present a case series of OCD lesions of the tibial plateau.

Study Design:

Case series; Level of evidence, 4.

Methods:

Medical records and diagnostic imaging of patients <20 years of age with confirmed diagnosis of OCD of the tibial plateau from a single institution were retrospectively reviewed. Characteristic and radiographic features as well as details of both nonoperative and surgical management were investigated. Lesion characteristics and treatment outcomes were also analyzed.

Results:

A total of 9 lesions were identified in 9 patients (5 females, 4 males) who fit the inclusion criteria. The mean age at diagnosis was 14.2 years (range, 9-17 years). Knee pain (8/9) of longer than 1 year in duration was the most common presenting symptom. All 9 lesions were located on the lateral tibial plateau, and concomitant lateral compartment pathology was present in 5 of 9 patients (4 lateral femoral condyle OCDs, 3 lateral meniscal tears [1 discoid], and 1 discoid meniscus). Only 2 lesions were visible on initial radiographs; all 9 were visible on magnetic resonance imaging. All patients underwent initial nonoperative treatment; 2 patients demonstrated resolution of symptoms. Two patients underwent surgery for concomitant pathology, and the OCD was not addressed surgically. A total of 5 patients continued to be symptomatic after nonoperative treatment, prompting surgical intervention, which consisted of microfracture and chondroplasty in all 5 cases. A total of 2 of the 5 microfracture patients had resolution of symptoms, while another 2 patients had continued symptoms ultimately responsive to steroid injection treatment. One patient had revision microfracture, followed by autologous chondrocyte implantation and an arthroscopic lysis of adhesions. At final follow-up, ranging from 7 months to 10 years, 8 patients were asymptomatic, while 1 patient had developed early osteoarthritis.

Conclusion:

OCD of the tibial plateau in young patients is rare, usually involves the lateral side, and may have significant long-term implications for knee function. Presenting symptoms are often vague, and lesions may not always be visible on initial radiographs, which may lead to delayed treatment and adversely affect outcomes.

Osteochondritis Dissecans of the Knee: Etiology and Pathogenetic Mechanisms. A Systematic Review

OBJECTIVE

The purpose of this manuscript is to analyze the evidence regarding etiopathogenesis of knee osteochondritis dissecans (OCD) lesions through a systematic review, so to summate the current understanding of the origin and progression of this pathologic articular processes.

DESIGN

A systematic review of the literature was performed on the PubMed and Cochrane databases on October 2017 by 2 independent authors and included all levels of evidence. This included all English language literature, pertaining specifically to etiopathology of knee OCD with exclusions for review articles and expert opinion. Of 965 identified records, 154 full-text articles were assessed for eligibility and 86 studies met the inclusion criteria.

RESULTS

According to these studies, the etiology of OCD can be of a biological or mechanical origin: 40 articles proposed a biological hypothesis, including genetic causes (27), ossification center deficit (12), and endocrine disorders (9); conversely, 52 articles supported a mechanical hypothesis, including injury/overuse (18), tibial spine impingement (5), discoid meniscus (16), and biomechanical alterations (20) as the cause of the onset of OCD. The pathogenic processes were investigated by 36 of these articles, with a focus on subchondral bone fracture and ischemia as the ultimate events leading to OCD.

CONCLUSIONS

Biological and mechanical factors are found to result in subchondral bone remodeling alterations, acting independently or more likely synergically in the progression of knee OCD. The former includes genetic causes, deficit of ossification centers and endocrine disorders; the latter, tibial spine impingement, discoid meniscus, and biomechanical alterations, together with injuries and overuse. The resultant subchondral bone ischemia and/or fracturing appears to determine the onset and progression of OCD.

LEVEL OF EVIDENCE

Systematic review of level II-IV studies, level IV.

Juvenile osteochondritis dissecans (JOCD) of the knee: current concepts review

Juvenile osteochondritis dissecans (JOCD) is a joint disorder of the subchondral bone and articular cartilage that affects skeletally immature patients.

The aetiology of JOCD is unknown and the natural history is poorly characterized in part due to inconsistent and largely retrospective literature.

Most OCD in children and adolescents presents as a stable lesion amenable to non-operative treatment or minimally invasive drilling. However, unstable forms can require a more aggressive approach.

This article reviews the most recent literature available and focuses on the pathophysiology, diagnosis and treatment of JOCD of the knee.

Cite this article: EFORT Open Rev 2019;4:201-212. DOI: 10.1302/2058-5241.4.180079