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Kostyun RO, Nguyen JC, Chhabra B, Todd R. Lawrence J, Polousky JD, Saper M, Uquillas C, Nissen CW, Kostyun RO, Albright J, Bae D, Bohn D, Chan C, Crepeau A, Edmonds E, Fabricant P, Ganley T, Little K, Lee Pace J, Pacicca D, Pennock A, Saluan P, Shea K, Wall E, Wilson P, Nissen CW. MRI Features That Contribute to Decision-Making for Treatment of Capitellar OCD Lesions: An Expert Consensus Using the Delphi Method. Orthop J Sports Med 2024; 12:23259671241252813. [PMID: 38845610 PMCID: PMC11155329 DOI: 10.1177/23259671241252813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 06/09/2024] Open
Abstract
Background Most healthcare providers utilize magnetic resonance imaging (MRI) to assist in diagnosing and treating osteochondritis dissecans (OCD) of the capitellum. However, consensus on imaging features that portend clinically relevant information in the care of these lesions has not been determined. Purpose To conduct a survey on the MRI features of a capitellar OCD that are salient for clinical decision-making using a classic Delphi protocol. Study Design A consensus statement. Methods Invitations to participate were sent to 33 healthcare providers identified as capitellar OCD experts. A classic 3-round survey method was used to gather agreement and consensus on the level of importance for clinical decision-making on 33 MRI features. A concise list of features that guide decision-making on the stability of an OCD lesion and the ability of an OCD lesion to heal with nonoperative care was also identified. Agreement and consensus were determined a priori as ≥66%. Results Of the 33 identified experts, 20 agreed to participate, and 17 (52%) completed all 3 rounds. Of the 33 MRI features evaluated, 17 reached agreement as important for clinical decision-making by the experts. Consensus was reached for a concise list of MRI features that were significant to decision-making (94%), suggestive of a stable lesion (100%), had the potential to heal with nonoperative treatment (94%), were suggestive of an unstable lesion (100%), and had low potential to heal with nonoperative treatment (88%). Conclusion This 3-round Delphi process produced consensus on clinically relevant MRI features that contribute to clinical decision-making for capitellar OCD. The results of this study will be used as the basis for an interrater reliability assessment of the identified salient features, creating the foundation for developing a reliable MRI assessment tool rooted in clinical experiences. The development of a standardized assessment of capitellar OCD is intended to improve clinical practice and patient outcomes.
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Affiliation(s)
- Regina O. Kostyun
- Bone and Joint Institute, Hartford HealthCare, Hartford, Connecticut, USA
| | - Jie C. Nguyen
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bobby Chhabra
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Michael Saper
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Carl W. Nissen
- PRISM Sports Medicine, Bone and Joint Institute, Hartford HealthCare, Hartford, Connecticut, USA
| | | | - Regina O. Kostyun
- Bone and Joint Institute, Hartford HealthCare, Hartford, Connecticut, USA
| | - Jay Albright
- Children’s Hospital of Colorado, Aurora, Colorado, USA
| | - Donald Bae
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Deb Bohn
- TRIA, Minneapolis, Minnesota, USA
| | - Charles Chan
- Stanford Medicine Children's Health, Sunnyvale, California, USA
| | - Allison Crepeau
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Eric Edmonds
- Rady Children's Hospital, San Diego, California, USA
| | | | - Theodore Ganley
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Donna Pacicca
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | | | | | - Kevin Shea
- Stanford Medicine Children's Health, Sunnyvale, California, USA
| | - Eric Wall
- Cincinnati Children's, Cincinnati, Ohio, USA
| | | | - Carl W. Nissen
- PRISM Sports Medicine; University of Connecticut, Bone and Joint Institute, Hartford HealthCare, Hartford, Connecticut, USA
- Investigation performed at the Bone and Joint Institute, Hartford HealthCare, Hartford, Connecticut, USA
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Konarski W, Poboży T, Konarska K, Derczyński M, Kotela I. Understanding Osteochondritis Dissecans: A Narrative Review of the Disease Commonly Affecting Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:498. [PMID: 38671714 PMCID: PMC11049496 DOI: 10.3390/children11040498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) is a joint disorder predominantly affecting the knee, elbow, and ankle of children and adolescents. This comprehensive review delves into the epidemiology, etiology, clinical manifestations, diagnostic approaches, and treatment of OCD. RESULTS The most common cause of OCD is repetitive microtrauma, typically associated with sports activities, alongside other significant factors such as genetic predisposition, ischemia, and obesity. In early stages or when lesions are small, OCD often presents as non-specific, vaguely localized pain during physical activity. As the condition progresses, patients may experience an escalation in symptoms, including increased stiffness and occasional swelling, either during or following activity. These symptom patterns are crucial for early recognition and timely intervention. Diagnosis in most cases is based on radiographic imaging and magnetic resonance imaging. Nonsurgical treatment of OCD in young patients with open growth plates and mild symptoms involves activity restriction, immobilization methods, and muscle strengthening exercises, with a return to sports only after symptoms are fully resolved and at least six months have passed. Surgical treatment of OCD includes subchondral drilling in mild cases. Unstable lesions involve methods like restoring the joint surface, stabilizing fractures, and enhancing blood flow, using techniques such as screws, anchors, and pins, along with the removal of fibrous tissue and creation of vascular channels. The specifics of OCD treatment largely depend on the affected site. CONCLUSIONS This synthesis of current research and clinical practices provides a nuanced understanding of OCD, guiding future research directions and enhancing therapeutic strategies.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland; (T.P.); (M.D.)
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland; (T.P.); (M.D.)
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland;
| | - Michał Derczyński
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland; (T.P.); (M.D.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
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Shimizu T, Murata Y, Nakashima H, Nishimura H, Suzuki H, Kawasaki M, Tsukamoto M, Sakai A, Uchida S. Clinical Outcomes and Return-to-Sport Rates following Fragment Fixation Using Hydroxyapatite/Poly-L-Lactate Acid Threaded Pins for Knee Osteochondritis Dissecans: A Case Series. Biomimetics (Basel) 2024; 9:232. [PMID: 38667242 PMCID: PMC11048533 DOI: 10.3390/biomimetics9040232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Osteochondritis dissecans (OCD) of the knee is an uncommon injury in young active patients. There is currently a lack of knowledge regarding clinical outcomes and return-to-sport rates after fragment fixation surgery using hydroxy appetite poly-L-lactic acid (HA/PLLA) threaded pins for knee OCD among athletes. Our purpose was to investigate the clinical outcomes and return-to-sport rates following osteochondral fragment fixation using HA/PLLA pins for the treatment of knee OCD lesions among athletes. A total of 45 patients were retrospectively reviewed. In total, 31 patients were excluded, and 14 patients were included. Pre- and postoperative patient-reported outcome scores (PROSs), including the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcome Scale (KOOS), were compared. In addition, patients were categorized into four groups according to postoperative sports status: higher, same, lower than preinjury, or unable to return to sports. The mean age was 14.4 years (SD 1.67). All patients were male. All PROSs significantly improved at 6, 12, and 24 months postsurgery compared to presurgery. 50% of the patients returned to sports at the same or higher level after surgery. Fragment fixation using HA/PLLA pins leads to favorable clinical outcome scores and high return-to-sport rates in the treatment of athletes with knee OCD.
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Affiliation(s)
- Taichi Shimizu
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu 807-0804, Fukuoka, Japan; (T.S.); (H.S.); (M.K.); (M.T.); (A.S.)
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital for University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu, Kitakyushu 807-0024, Fukuoka, Japan; (Y.M.); (H.N.); (H.N.)
| | - Hirotaka Nakashima
- Department of Orthopaedic Surgery, Wakamatsu Hospital for University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu, Kitakyushu 807-0024, Fukuoka, Japan; (Y.M.); (H.N.); (H.N.)
| | - Haruki Nishimura
- Department of Orthopaedic Surgery, Wakamatsu Hospital for University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu, Kitakyushu 807-0024, Fukuoka, Japan; (Y.M.); (H.N.); (H.N.)
| | - Hitoshi Suzuki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu 807-0804, Fukuoka, Japan; (T.S.); (H.S.); (M.K.); (M.T.); (A.S.)
| | - Makoto Kawasaki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu 807-0804, Fukuoka, Japan; (T.S.); (H.S.); (M.K.); (M.T.); (A.S.)
| | - Manabu Tsukamoto
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu 807-0804, Fukuoka, Japan; (T.S.); (H.S.); (M.K.); (M.T.); (A.S.)
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu 807-0804, Fukuoka, Japan; (T.S.); (H.S.); (M.K.); (M.T.); (A.S.)
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu, Kitakyushu 807-0024, Fukuoka, Japan; (Y.M.); (H.N.); (H.N.)
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Quigley R, Allahabadi S, Yazdi AA, Frazier LP, McMorrow KJ, Meeker ZD, Wagner KR, Chan J, Cole BJ. Bioabsorbable Screw Fixation Provides Good Results With Low Failure Rates at Mid-term Follow-up of Stable Osteochondritis Dissecans Lesions That Do Not Improve With Initial Conservative Treatment. Arthrosc Sports Med Rehabil 2024; 6:100863. [PMID: 38362480 PMCID: PMC10867764 DOI: 10.1016/j.asmr.2023.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/10/2023] [Indexed: 02/17/2024] Open
Abstract
Purpose To evaluate the clinical and radiographic outcomes of patients who have undergone bioabsorbable screw fixation for intact, stable grade I and II osteochondritis dissecans (OCD) lesions for which at least 6 months of conservative management has failed. Methods A retrospective review of prospectively collected data from a single institution was performed to identify patients who underwent internal fixation of stable grade I and II OCD lesions (according to the Guhl classification) between January 2010 and January 2020. Patients were included regardless of the presence of concomitant procedures. The inclusion criteria consisted of (1) primary surgery, (2) failure of at least 6 months of conservative management, (3) the use of a bioabsorbable screw (or screws), and (4) minimum 2-year clinical follow-up. Radiographs were obtained at a minimum of 1 year postoperatively. Patient demographic characteristics, clinical patient-reported outcomes, complications, and failure rates were noted. Results Twenty-four knees among 23 patients (96% follow-up) were analyzed and followed up for 6.36 ± 3.42 years (range, 2.0-12.7 years). Patients showed statistically significant postoperative improvements in all patient-reported outcomes including the Lysholm score, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score subscales (P < .05). In 3 knees (12%), a reoperation was required due to failure at an average of 3.64 years after the index procedure. No specific complications were attributed to the use of bioabsorbable screws. Patients in whom primary surgical treatment failed did not differ in demographic characteristics, arthroscopic findings, or surgical treatment from those who had successful treatment. Conclusions Internal fixation of stable grade I and II OCD lesions with bioabsorbable screws produces reliable results with a 12% rate of failure in appropriately indicated patients in whom at least 6 months of conservative management has failed. Clinical outcomes improved significantly during the mid-term follow-up period. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Ryan Quigley
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sachin Allahabadi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Allen A. Yazdi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Landon P. Frazier
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Katie J. McMorrow
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zachary D. Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kyle R. Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jimmy Chan
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J. Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
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Vivekanantha P, Sritharan P, Hemstock R, Johnson J, de Sa D. High rates of return to sport following management of osteochondritis dissecans of the femoral trochlea: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:389-404. [PMID: 38270223 DOI: 10.1002/ksa.12040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To summarize management strategies and associated clinical outcomes in patients with osteochondritis dissecans (OCD) of the femoral trochlea. METHODS Three databases were searched from inception to 2 October 2023, for studies describing outcomes posttreatment for femoral trochlear OCD. The authors adhered to the preferred reporting items for systematic reviews and meta-analyses and revised assessment of multiple systematic reviews guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, injury characteristics, and operative details were extracted. Outcomes included patient reported outcome measures (PROMs), complications, and revision and return to sport (RTS) rates. RESULTS Twenty studies comprising 105 patients (119 knees) were included. Females comprised 10.1% (range: 0%-100%) of patients and the mean age of patients was 14.5 (range: 11-28) years. A total of 89 (74.7%) of knees received operative management, with 28 of 34 (82.4%) known open procedures being open reduction internal fixation (ORIF), and nine of 29 (31%) known arthroscopic procedures receiving arthroscopic reduction internal fixation (ARIF) or drilling. Lysholm and International Knee Documentation Committee scores in 20 patients each ranged from 93.4 to 100 and 74.7 to 96.6, respectively. The revision rate for operative procedures was 9.0%, and the overall RTS rate was 93.3%. CONCLUSION There is very little high quality evidence investigating patients with femoral trochlear OCD lesions. Drilling, ARIF, and ORIF were the most common surgical options for this patient population. Patients treated with either nonoperative or operative management returned to sport at a high rate, and those requiring operative management had a low revision rate. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | - Praveen Sritharan
- Michael deGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Riley Hemstock
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, Canada
| | - Jansen Johnson
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Darren de Sa
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
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Kiani SN, Yellin JL, Huffman WH, Guzek RH, Shea KG, Nguyen JC, Ganley TJ. Patella and Trochlea Osteochondritis Dissecans: Demographics and Treatment Paradigms. J Pediatr Orthop 2024; 44:e138-e143. [PMID: 38108383 DOI: 10.1097/bpo.0000000000002588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Previous research on patellar and trochlear groove osteochondritis dissecans (OCD) is limited by small sample sizes. This study aims to describe the presentation of patients with OCD lesions of the patella and trochlea and characterize the outcomes of operative and nonoperative treatments. METHODS This retrospective cohort study identified all patients from a single institution from 2008 to 2021 with patellar and/or trochlear OCD lesions. Patients were excluded from the study if surgical records were unavailable or if the patient had knee surgery for a different injury at index surgery or in the 12 months postoperative. Minimum follow-up was 12 months. Outcomes included a return to sports (RTS), pain resolution, radiographic healing, and treatment "success" (defined as full RTS, complete pain resolution, and full healing on imaging). RESULTS A total of 68 patients (75 knees) were included-45 (60%) with patellar OCD and 30 (40%) with trochlear. Of the patients, 69% were males. The median age at knee OCD diagnosis was 14 years. At the final follow-up, 62% of knees (n = 44) recovered sufficiently to allow a full RTS and 54% of knees (n = 39) had full pain resolution. Of the 46 knees with radiographic imaging at least 1 year apart, 63% had full healing of the lesion. There was no significant difference in RTS, pain resolution, radiographic healing, or overall success when comparing treatments. CONCLUSIONS This study provides valuable epidemiologic demographic and outcome data regarding the scarcely reported patellar and trochlear OCD. While over half of patients fully returned to sports and reported full pain resolution, a large proportion continued to experience symptoms over a year after presentation. Future research should aim to better define the treatment algorithms for these OCD subtypes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sara N Kiani
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joseph L Yellin
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - William H Huffman
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ryan H Guzek
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Theodore J Ganley
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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7
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Konarski W, Poboży T, Konarska K, Śliwczyński A, Kotela I, Krakowiak J. A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review. J Clin Med 2024; 13:287. [PMID: 38202294 PMCID: PMC10780049 DOI: 10.3390/jcm13010287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Musculoskeletal disorders, standing as the fifth leading cause of disability-adjusted life years globally, present significant challenges in orthopedics. Osteochondritis dissecans (OCD) and avascular necrosis (AVN) are distinct but closely related conditions within this spectrum, impacting patients' quality of life with pain, limited mobility, and dysfunction. OCD, involving cartilage and bone detachment in joints, predominantly affects young athletes, but its exact etiology and optimal management remain subjects of ongoing research. Conversely, AVN, marked by bone tissue death due to compromised blood supply, is linked to systemic factors like corticosteroid use and traumatic injuries. Diagnosis for both conditions relies on radiography and magnetic resonance imaging. Conservative treatment for AVN includes the use of a cane or crutches, pharmacological therapy, or physical therapy. On the other hand, in OCD, the primary approach is activity/sports restriction. Surgical treatment options for AVN patients encompass core decompression, bone grafting, or, in the most advanced cases, total hip arthroplasty. OCD may be surgically treated through subchondral drilling or fixation of unstable lesions. Advanced cases of OCD involve cartilage salvage with resurfacing techniques. The presentation of differences between these conditions enhances our understanding, facilitating improved diagnosis and management strategies.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland;
| | - Andrzej Śliwczyński
- Social Medicine Institute, Department of Social and Preventive Medicine, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Social Medicine Institute, Department of Social and Preventive Medicine, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
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Bast N, Zimmerman R, Schlechter J. An Overview of Pediatric Knee Arthroscopy With Use of the NeedleScope. Arthrosc Tech 2024; 13:102813. [PMID: 38312861 PMCID: PMC10837811 DOI: 10.1016/j.eats.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/26/2023] [Indexed: 02/06/2024] Open
Abstract
As sports-related injuries are becoming more common among children, there has been an increased need for knee arthroscopies in the pediatric population. Nevertheless, pediatric knee arthroscopy exposure is varied among orthopaedic surgeons, especially during residency training. There is a considerable difference in knee arthroscopy case volume between the adult and the pediatric population among orthopaedic residents. Although the fundamentals of adult knee arthroscopy have been well delineated, there is a paucity of literature surrounding basic pediatric knee arthroscopy. Our goal is to further explain the fundamentals needed to perform successful arthroscopic surgery in the pediatric knee. Through discussing proper patient positioning, instrumentation, including the utility of the 1.9-mm small-bore needle arthroscope (NanoScope; Arthrex, Naples, FL), subtle tips and tricks, as well as advantages and disadvantages of arthroscopy in children, this Technical Note along with the corresponding video are designed to help elucidate the intricacies of the pediatric knee. It will serve as educational material targeted to the resident trainee or any orthopaedic practitioner interested in gaining an introductory foundation to pediatric knee arthroscopy.
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Affiliation(s)
- Nicholas Bast
- Department of Orthopaedic Surgery, Riverside University Health System—Medical Center, Moreno Valley, California, U.S.A
| | | | - John Schlechter
- Department of Orthopaedic Surgery, Riverside University Health System—Medical Center, Moreno Valley, California, U.S.A
- CHOC Children’s Hospital, Orange, California, U.S.A
- Pediatric Orthopedic Specialists of Orange County, Orange, California, U.S.A
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9
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Kemmeren LAM, van Bergen CJA, Reijman M, Piscaer TM. Physician preferences in diagnostics and treatment of juvenile osteochondritis dissecans are diverse across the knee, ankle and elbow: an ESSKA survey. Knee Surg Sports Traumatol Arthrosc 2023; 31:5228-5237. [PMID: 37787862 PMCID: PMC10598091 DOI: 10.1007/s00167-023-07563-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To investigate the current preferences regarding the work-up and treatment choices of juvenile osteochondritis dissecans (JOCD) of the knee, ankle and elbow among orthopaedic surgeons. METHODS An international survey was set up for all European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members, which assessed various questions on diagnosis and treatment of JOCD of different joints. Respondents answered questions for one or more joints, based on their expertise. Proportions of answers were calculated and compared between joints. Consensus was defined as more than 75% agreement on an item; disagreement was defined as less than 25% agreement. RESULTS Fifty physicians responded to the survey, of whom forty-two filled out the questions on the knee, fourteen on the ankle and nine on the elbow. Plain radiography and MRI were the most used imaging modalities for the assessment and follow-up of JOCD in the knee and ankle, but not for the elbow. MRI was also the preferred method to assess the stability of a lesion in the knee and ankle. There was universal agreement on activity and/or sports restriction as the non-operative treatment of choice for JOCD. Size, stability and physeal closure were the most important prognostic factors in determining the operative technique for the elbow. For the knee, these factors were size and stability and for the ankle, these were size and location. CONCLUSION Activity and/or sports restriction was the non-operative treatment of choice. Furthermore, plain radiography and MRI were the preferred imaging modalities for the knee and ankle, but not for the elbow. For determining the operative technique, physicians agreed that the size of the lesion is an important prognostic factor in all joints. These findings help us understand how juvenile osteochondritis dissecans is treated in current practice and may provide opportunities for improvement. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Laura A M Kemmeren
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands.
| | - Christiaan J A van Bergen
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
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10
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Kelly SR, Mustafa L, Al-Kharabsheh Y, DeFroda SF, Nuelle CW. All-Arthroscopic Bone Grafting and Primary Fixation of a Medial Femoral Condyle Osteochondritis Dissecans Lesion. Arthrosc Tech 2023; 12:e1721-e1725. [PMID: 37942112 PMCID: PMC10627890 DOI: 10.1016/j.eats.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/28/2023] [Indexed: 11/10/2023] Open
Abstract
Treatment of osteochondritis dissecans (OCD) lesions poses a significant challenge for orthopaedic surgeons and can cause debilitating limitations on the activity of patients. Timing of intervention, surgical technique, and selection of graft when needed are all key elements of treatment that need to be considered carefully and discussed with patients. Primary fixation of an OCD fragment with intact subchondral bone has been shown to be beneficial in some cases. There is limited literature, however, on how to approach large chondral lesions in young patients without a large subchondral base attached to the fragment. Treatment of large OCD lesions of the knee with an all-arthroscopic approach provides several benefits, including limited dissection for exposure, improved ability to assess the stability of the OCD lesion during articulation after fixation, and an expedited recovery compared to an open approach. The purpose of this technical note is to detail a technique of performing an all-arthroscopic bone grafting and primary fixation of a medial femoral condyle OCD lesion.
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Affiliation(s)
- Shayne R. Kelly
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Luai Mustafa
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | | | - Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
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11
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Bangert Y, Zarembowicz P, Engelleiter K, Gkarilas E, Schmitt H, Renkawitz T, Jaber A. Long-Term Outcome and Athletic Level following Operative Treatment for Osteochondritis Dissecans of the Knee in Pediatric and Adolescent Patients. J Clin Med 2023; 12:4140. [PMID: 37373833 DOI: 10.3390/jcm12124140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Research on the long-term outcomes following surgical therapy for osteochondritis dissecans (OCD) of the knee is scarce. A single-center retrospective cohort study was conducted to investigate surgically treated patients for knee OCD between 1993 and 2007. A total of 37 patients with an average follow-up duration of 14 years (range 8-18) were in the final cohort. IKDC and Lysholm scores were assessed. The duration and types of sport activity were reported. Long-term results were compared with existing midterm data. Knee scores showed a very good outcome with a mean of 91.3 in the IKDC score and 91.7 in the Lysholm score. Compared to midterm outcomes, both IKDC (p = 0.028) and Lysholm scores (p = 0.01) improved on final follow-up. Patients with open physes showed a significantly better Lysholm score compared to patients with closed physes (p = 0.034). Defect localization and size did not influence the outcome, but a defect depth of <0.8 cm2 achieved significantly better scores than ≥0.8 cm2. Of all surgical interventions, refixation achieved the best outcome. Long-term results significantly improved compared to midterm results with a follow-up of 40 months (p = 0.01). Thirty-six out of 37 patients were physically active, with 56% of sports being knee-straining activities. Long-term results following surgically treated OCD fragments show excellent function and a good athletic level. Patients with open physes potentially have better knee outcomes. Midterm results are sustainable and could improve further in the long term.
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Affiliation(s)
- Yannic Bangert
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Patrick Zarembowicz
- Department for Orthopaedic and Trauma Surgery, BG Klinik Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany
| | - Karoly Engelleiter
- Department for Orthopaedic and Trauma Surgery, Helios Clinic, 75175 Pforzheim, Germany
| | - Evangelos Gkarilas
- Department for Orthopaedics, Trauma and Spinal Surgery, Neckar-Odenwald Clinics, 74821 Mosbach, Germany
| | - Holger Schmitt
- German Joint Center, ATOS Clinic Heidelberg, 69115 Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Ayham Jaber
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
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12
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Armstrong AR, Zbýň Š, Kajabi AW, Metzger GJ, Ellermann JM, Carlson CS, Tóth F. Naturally occurring osteochondrosis latens lesions identified by quantitative and morphological 10.5 T MRI in pigs. J Orthop Res 2023; 41:663-673. [PMID: 35716161 PMCID: PMC9759621 DOI: 10.1002/jor.25401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Juvenile osteochondritis dissecans (JOCD) is a pediatric orthopedic disorder that involves the articular-epiphyseal cartilage complex and underlying bone. Clinical disease is often characterized by the presence of radiographically apparent osteochondral flaps and fragments. The existence of early JOCD lesions (osteochondrosis latens [OCL] and osteochondrosis manifesta [OCM]) that precede the development of osteochondral flaps and fragments is also well recognized. However, identification of naturally occurring OCL lesions (confined to cartilage) using noninvasive imaging techniques has not yet been accomplished. We hypothesized that 10.5 T magnetic resonance imaging (MRI) can identify naturally occurring OCL lesions at predilection sites in intact joints of juvenile pigs. Unilateral elbows and knees (stifles) were harvested from three pigs aged 4, 8, and 12 weeks, and scanned in a 10.5 T MRI to obtain morphological 3D DESS images, and quantitative T2 and T1ρ relaxation time maps. Areas with increased T2 and T1ρ relaxation times in the articular-epiphyseal cartilage complex were identified in 1/3 distal femora and 3/3 distal humeri and were considered suspicious for OCL or OCM lesions. Histological assessment confirmed the presence of OCL or OCM lesions at each of these sites and failed to identify additional lesions. Histological findings included necrotic vascular profiles associated with areas of chondronecrosis either confined to the epiphyseal cartilage (OCL, 4- and 8-week-old specimens) or resulting in a delay in endochondral ossification (OCM, 12-week-old specimen). Future studies with clinical MR systems (≤7 T) are needed to determine whether these MRI methods are suitable for the in vivo diagnosis of early JOCD lesions in humans.
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Affiliation(s)
- Alexandra R. Armstrong
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Štefan Zbýň
- Center for Magnetic Resonance Research, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Abdul Wahed Kajabi
- Center for Magnetic Resonance Research, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Gregory J. Metzger
- Center for Magnetic Resonance Research, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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13
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Cabral J, Duart J. Osteochondritis dissecans of the knee in adolescents: How to treat them? J Child Orthop 2023; 17:54-62. [PMID: 36755556 PMCID: PMC9900018 DOI: 10.1177/18632521231152269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 02/10/2023] Open
Abstract
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.
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Affiliation(s)
- Joao Cabral
- Serviço de Ortopedia Pediátrica, Hospital Pediátrico—Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Julio Duart
- Complejo Hospitalario de Navarra, Pamplona, Spain
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14
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Turati M, Anghilieri FM, Bigoni M, Rigamonti L, Tercier S, Nicolaou N, Accadbled F. Osteochondritis dissecans of the knee: Epidemiology, etiology, and natural history. J Child Orthop 2023; 17:40-46. [PMID: 36755551 PMCID: PMC9900014 DOI: 10.1177/18632521221149063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/14/2022] [Indexed: 01/29/2023] Open
Abstract
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.
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Affiliation(s)
- Marco Turati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | | | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Luca Rigamonti
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Stephane Tercier
- Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Nicolaou
- Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Franck Accadbled
- Department of Orthopedics, Children’s Hospital, Toulouse University Hospital, Toulouse, France
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15
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Poboży T, Konarski W, Piotrowska-Lis K, Domańska J, Poboży K, Kielar M. Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review. Healthcare (Basel) 2022; 10:healthcare10102010. [PMID: 36292459 PMCID: PMC9602487 DOI: 10.3390/healthcare10102010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
We present basic differences in the musculoskeletal ultrasound examinations between adults and children. Examiners who deal with adults on a daily basis have shared concerns about examining children. Such concerns may arise from the different approach to child ultrasounds, but they also come from differences in anatomical characteristics according to developmental age. We discuss the presence of growth plates, as well as non-mineralized parts of the bones. We also refer to the pathologies most often found in ultrasounds in early developmental stages. In the PubMed database, the set of keywords: "msk ultrasound in children", "pediatric msk sonoanatomy", "coxitis fugax", "pediatric Baker's cyst", "Baker's cyst ultrasonography", "bone septic necrosis in ultrasonography", "ultrasonography in juvenile idiopathic arthritis", and "ultrasonography in juvenile spondyloarthropathies", was used to identify a total of 1657 results, from which 54 was selected to be included in the article. We discuss the problem of osteochondritis dissecans, Osgood-Schlatter disease, examples of ligament injuries (especially in relation to the knee and ankle joints), exfoliation of growth cartilages, osteochondroma, exudates and inflammations affecting joints, and Baker's cysts. In this way, we have collected useful information about the most common diseases of the musculoskeletal system in children.
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Affiliation(s)
- Tomasz Poboży
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
- Correspondence:
| | - Wojciech Konarski
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | | | - Julia Domańska
- Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Kamil Poboży
- Faculty of Medicine, Medical University of Warsaw, 01-938 Warsaw, Poland
| | - Maciej Kielar
- Surgery Clinic of Medical Department, Lazarski High School, 02-662 Warsaw, Poland
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16
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Pearl MC, Mont MA, Scuderi GR. Osteonecrosis of the Knee: Not all Bone Edema is the Same. Orthop Clin North Am 2022; 53:377-392. [PMID: 36208881 DOI: 10.1016/j.ocl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Knee pain is among the most common complaints that an orthopedic surgeon may see in practice. It is often worked up with X-rays and MRI, leading to a myriad of potential diagnoses ranging from minimal edema patterns to various types of osteonecrosis. Similarities in certain causes can pose diagnostic challenges. The purpose of this review was to present the 3 types of osteonecrosis observed in the knee as well as additional causes to consider to help aid in the diagnosis and treatment..
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Affiliation(s)
- Matthew C Pearl
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA; Northwell Orthopedic Institute, 130 East 77th Street, 11th Floor, Black Hall, New York, NY 10075, USA.
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA; Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore, MD, USA
| | - Giles R Scuderi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA; Northwell Orthopedic Institute, 210 East 64th Street, New York, NY 10065, USA
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17
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Ganley TJ. Top 5 AJSM Papers in Pediatric Sports Medicine Over the Past 50 Years. Am J Sports Med 2022; 50:1775-1778. [PMID: 35648626 DOI: 10.1177/03635465221100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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18
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Hsu JC, Tran DH. Arthroscopic Fixation of Knee Osteochondritis Dissecans With Interlinked Knotless All-Suture Anchors. Arthrosc Tech 2022; 11:e1013-e1019. [PMID: 35782848 PMCID: PMC9245000 DOI: 10.1016/j.eats.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/05/2022] [Indexed: 02/03/2023] Open
Abstract
Unstable, displaced, and persistently symptomatic osteochondritis dissecans of the knee typically requires surgical treatment. An arthroscopic, knotless fixation method using interlinked all-suture anchors is presented, with potential advantages over other current techniques in fixation over a broad zone, treatment versatility for a wide range of fragment types, retensioning ability after stressing, decreased risk of implant-breakage complications, and avoidance of additional surgery for implant removal.
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Affiliation(s)
- Jim C. Hsu
- Address correspondence to Jim C. Hsu, M.D., The Polyclinic, 904 Seventh Ave., 4th Floor, Seattle, WA, 98104, U.S.A.
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