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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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Unal P, Samargandi R, Olejnik R, Lakhal W, Odent T. Efficacy of the pridie drilling technique in knee osteochondritis dissecans among children and young adults: follow-up of 41 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1065-1071. [PMID: 37930425 DOI: 10.1007/s00590-023-03769-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This study aims to examine whether Pridie drilling, a form of bone marrow stimulation, can expedite the healing process and enable a faster return to sports activity in patients with knee Osteochondritis dissecans (OCD). The primary objective is to assess the effectiveness of Pridie drilling in stable OCD lesions that do not respond to non-operative treatment, by evaluating the absence of painful symptoms 6 months after the procedure. Secondary objectives include evaluating radiographic reconstruction 6 months post-surgery and determining the time it takes to resume sports participation. MATERIALS AND METHODS This single-center retrospective study included all cases of stable OCD in the knee that underwent anterograde chondral drilling between 2008 and 2020. Diagnosis of OCD was established using knee radiographs, and the surgical technique involved multiple multidirectional subchondral drilling. Treatment efficacy was defined by the absence of painful symptoms for 6 months postoperatively. RESULTS A total of 41 knees were included in the study, and no complications were observed before or after surgery. At 6 months postoperatively, 32 knees (78%) showed complete resolution of symptoms. Complete radiographic reconstruction was observed in 66% of cases. Asymptomatic patients at 6 months returned to sports activity of similar intensity to that practiced previously in an average time of 7.9 months; while, patients who were symptomatic at 6 months returned in an average time of 16.5 months. CONCLUSION This study provides evidence supporting the short-term efficacy of anterograde chondral drilling in stable lesion of OCD in children and adolescents after failed functional treatment. LEVEL OF EVIDENCE Level III (retrospective cohort study).
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Affiliation(s)
- Pauline Unal
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Trousseau, CHRU de Tours, Avenue de la République, Chambray-lès-Tours, 37044, Tours cedex 9, France
| | - Ramy Samargandi
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Trousseau, CHRU de Tours, Avenue de la République, Chambray-lès-Tours, 37044, Tours cedex 9, France.
- Orthopedic Surgery Department, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
- Faculté de Médecine, Université de Tours, Tours, France.
| | - Romain Olejnik
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Trousseau, CHRU de Tours, Avenue de la République, Chambray-lès-Tours, 37044, Tours cedex 9, France
| | - Walid Lakhal
- Nouvelle Clinique Bordeaux Tondu, Avenue Jean Alfonséa, Floirac, France
| | - Thierry Odent
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Trousseau, CHRU de Tours, Avenue de la République, Chambray-lès-Tours, 37044, Tours cedex 9, France
- Faculté de Médecine, Université de Tours, Tours, France
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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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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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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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