Osteochondritis dissecans development after bone contusion of the knee in the skeletally immature: a case series

Background: Capitellar osteochondritis dissecans (OCD) in skeletally immature athletes has often been seen in baseball players and gymnasts. The choice of surgical procedure for unstable lesions in skeletally immature athletes remains controversial. Purpose: To investigate functional outcomes and radiographic changes in the midterm to long-term postoperative period after arthroscopic (AS) resection for small to large capitellar OCD lesions in skeletally immature athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 elbows in 38 patients (33 boys, 5 girls; mean age, 14 years [range, 13-15 years]) with skeletally immature elbows underwent AS resection for capitellar OCD. Patients were observed for at least 5 years (mean, 8 years [range, 5-12 years]). Elbows with a lesion width that did not exceed one-half of the radial head diameter were assigned to group 1 (n = 17 elbows), and larger lesions were assigned to group 2 (n = 21 elbows). Functional scores, patient satisfaction, range of motion (ROM), and osteoarthritis (OA) grades were evaluated between the groups. Results: All patients returned to sports activity. Functional scores at the final follow-up were not significantly different between the groups. Patient satisfaction scores were significantly higher in group 1 than in group 2. There was significant improvement in flexion ROM at the final follow-up compared with preoperative values in group 1 ( P = .017), and there was a significant between-group difference (group 1: 141°; group 2: 133°; P = .002). Extension ROM showed significant improvement in both groups (group 1: from –8° to 3°; group 2: from –17° to –1°; P < .001 for both). Group 1 tended to have better extension than group 2, but the difference was not significant. There were no elbows with severe OA in either group, but the OA grade progressed in 5 elbows (29%) in group 1 and 9 elbows (43%) in group 2, and this rate of OA progression was statistically significant between groups ( P = .005). Conclusion: Both functional outcomes and radiological findings after AS fragment resection were excellent in elbows with small lesions. Although overall outcomes were acceptable in elbows with larger lesions, flexion ROM and patient satisfaction scores were significantly inferior to those in elbows with smaller lesions.

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Autologous Osteochondral Mosaicplasty for Centrally and Laterally Located, Advanced Capitellar Osteochondritis Dissecans in Teenage Athletes: Clinical Outcomes, Radiography, and Magnetic Resonance Imaging Findings

The American Journal of Sports Medicine ◽

10.1177/0363546518768279 ◽

2018 ◽

Vol 46 (8) ◽

pp. 1943-1951 ◽

Cited By ~ 9

Author(s):

Tadanao Funakoshi ◽

Daisuke Momma ◽

Yuki Matsui ◽

Tamotsu Kamishima ◽

Yuichiro Matsui ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Outcomes ◽

Osteochondritis Dissecans ◽

Case Series ◽

Return To Play ◽

Joint Surface ◽

Resonance Imaging ◽

Level Of Evidence

Background: Autologous osteochondral mosaicplasty (ie, mosaicplasty) results in satisfactory clinical outcomes and reliable return to play for patients with large or unstable lesions due to osteochondritis dissecans (OCD) of the humeral capitellum. However, the association between the healing of the reconstructed cartilage and clinical outcomes remains unclear. Purpose: To evaluate the efficacy of mosaicplasty in teenage athletes through use of clinical scores and imaging. The secondary purpose was to compare the clinical outcomes with images of centrally and laterally located lesions. Study Design: Case series; Level of evidence, 4. Methods: This study analyzed 22 elbows (all male patients; mean age, 13.5 ± 1.2 years) with capitellar OCD managed with mosaicplasty. Patients were divided into 2 groups according to the location of the lesions: central (10 patients) and lateral (12 patients). Evaluation was performed through use of the clinical rating system of Timmerman and Andrews, plain radiographs, and magnetic resonance imaging (MRI; the cartilage repair monitoring system of Roberts). The mean follow-up period was 27.5 months (range, 24-48 months). Results: Lateral lesions were significantly larger than central lesions (147.1 ± 51.9 mm2 vs 95.5 ± 27.4 mm2, P = .01). No other significant differences were found between central and lateral lesions. Timmerman and Andrews scores for both central and lateral lesions improved significantly from 125.0 ± 30.1 points and 138.3 ± 34.5 points preoperatively to 193.5 ± 11.3 points and 186.7 ± 18.1 points, respectively, at final follow-up ( P < .0001, P < .0001). Radiography identified complete graft incorporation in all cases and the absence of severe osteoarthritic changes or displaced osteochondral fragments. In the lateral group, the radial head ratio at final follow-up (1.83 ± 0.23) was significantly larger than the preoperative findings (1.75 ± 0.14, P = .049). The quality of joint surface reconstruction was found to be acceptable for central and lateral lesions on MRI evaluation. Conclusion: Mosaicplasty resulted in satisfactory clinical outcomes and smooth cartilage surface integrity in teenage athletes with OCD on their return to competition-level sports activities irrespective of lesion location.

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Early Clinical Results of Arthroscopically Assisted Drilling via the Radius in a Distal-to-Proximal Direction for Osteochondritis Dissecans of the Elbow

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119868937 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711986893

Author(s):

Yuji Arai ◽

Kunio Hara ◽

Hiroaki Inoue ◽

Ginjiro Minami ◽

Yoshikazu Kida ◽

...

Keyword(s):

Range Of Motion ◽

Osteochondritis Dissecans ◽

Japanese Orthopaedic Association ◽

Case Series ◽

Return To Sport ◽

Functional Scores ◽

Arthroscopically Assisted ◽

The Mean ◽

Flexion And Extension

Background: We have previously reported the technique of arthroscopically assisted drilling of osteochondritis dissecans (OCD) lesions of the elbow via the radius in a distal-to-proximal direction. With this technique, the entire OCD lesion can be drilled vertically under arthroscopic guidance with pronation and supination of the forearm and flexion and extension of the elbow joint. Purpose: To retrospectively evaluate return to sport, range of motion, and the Japanese Orthopaedic Association–Japan Elbow Society Elbow Function Score (JOA-JES score) after treatment of an elbow OCD lesion by drilling through the radius. Study Design: Case series; Level of evidence, 4. Methods: From November 2003 to January 2006, a total of 7 male adolescent baseball players with OCD lesions of the elbow were treated through use of arthroscopically assisted drilling via the radius. The stage of the OCD lesion was evaluated based on preoperative plain radiographs. Patients were observed for a minimum of 36 months, and clinical analysis included time for return to sport, elbow range of motion, and the JOA-JES score before intervention and at final follow-up. Results: We evaluated all 7 patients at a mean follow-up time of 36.1 months (range, 24-68 months). The stage of the OCD lesion on plain radiography was “translucent” in 1 patient, “sclerotic” in 5 patients, and “loosening” in 1 patient. The mean range of motion before surgery was 131.2° and –4.7° in flexion and extension, respectively, and this improved to 138.6° and 1.1° at final follow-up. The improvement in extension was statistically significant ( P = .04). The mean JOA-JES score of 83.0 before surgery significantly improved to 94.0 at final follow-up ( P < .001). One patient required excision of a free body at 51 months postoperatively, but all patients returned to sports early and without pain at an average of 4.6 months postoperatively. No feature of osteoarthrosis was noted on radiography on the final examination in any patient. Conclusion: The findings of this study demonstrate that arthroscopically assisted drilling of an elbow OCD lesion through the radial head allows for early return to sporting activities as well as improved motion and functional scores.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120941380 ◽

2020 ◽

Vol 8 (8) ◽

pp. 232596712094138

Author(s):

Millicent Croman ◽

Dennis E. Kramer ◽

Benton E. Heyworth ◽

Mininder S. Kocher ◽

Lyle J. Micheli ◽

...

Keyword(s):

Osteochondritis Dissecans ◽

Tibial Plateau ◽

Femoral Condyle ◽

Young Patients ◽

Case Series ◽

Lateral Compartment ◽

Nonoperative Treatment ◽

Lateral Side ◽

Level Of Evidence ◽

Presenting Symptoms

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.

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The 3-in-1 Procedure for Recurrent Dislocation of the Patella in Skeletally Immature Children and Adolescents

The American Journal of Sports Medicine ◽

10.1177/0363546509333480 ◽

2009 ◽

Vol 37 (9) ◽

pp. 1814-1820 ◽

Cited By ~ 48

Author(s):

Francesco Oliva ◽

Mario Ronga ◽

Umile Giuseppe Longo ◽

Vittorino Testa ◽

Giovanni Capasso ◽

...

Keyword(s):

Children And Adolescents ◽

Patellar Dislocation ◽

Case Series ◽

Skeletal Maturation ◽

Isokinetic Strength ◽

Skeletally Immature ◽

Recurrent Patellar Dislocation ◽

Level Of Evidence ◽

The Mean

Background Recurrent patellar dislocations are common injuries in children and adolescents. The subjective and functional results of soft tissue surgical management in a population that was skeletally immature at the time of surgery have not been reported. Hypothesis The 3-in-1 procedure is an effective treatment for recurrent patellar dislocation in skeletally immature patients. Study Design Case series; Level of evidence, 4. Methods Twenty-five skeletally immature patients (age at operation, 13.5 ± 3.8 years) who were practicing sports and suffering from recurrent unilateral patellar dislocation were included in the study and followed until skeletal maturation. Clinical evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry. Results The average follow-up was 3.8 years (range, 2.5-6 years). The mean modified Cincinnati score increased from 51.7 ± 12.6 preoperatively to 94.3 ± 10.8 (P < .02), while the mean Kujala scores increased from 52.4 ± 12.7 preoperatively to 93.8 ± 14.2 (P < .02). The Insall-Salvati index remained essentially unchanged, being 1.04 ± 0.2 preoperatively and 1.02 ± 0.3 at latest follow-up. Significant differences were found between the operated and the contralateral limb in the various isokinetic strength variables at all angular velocities measured at the latest follow-up (.05 < P < .0042). Conclusion The 3-in-1 procedure is a safe, reliable management option for recurrent patellar dislocation in skeletally immature patients. Side-to-side differences in isokinetic strength and in anthropometric indices persist despite subjective success of the procedure.

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Bioabsorbable lag screw fixation of knee osteochondritis dissecans in the skeletally immature

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0b013e328341dfb4 ◽

2011 ◽

Vol 20 (2) ◽

pp. 74-80 ◽

Cited By ~ 17

Author(s):

Carlo Camathias ◽

Jan D. Festring ◽

Mark S. Gaston

Keyword(s):

Osteochondritis Dissecans ◽

Screw Fixation ◽

Skeletally Immature ◽

Lag Screw

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Management Strategies for Osteochondritis Dissecans of the Knee in the Skeletally Immature Athlete

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2014.5140 ◽

2014 ◽

Vol 44 (9) ◽

pp. 665-679 ◽

Cited By ~ 11

Author(s):

Emily A. Eismann ◽

Robert J. Pettit ◽

Eric J. Wall ◽

Gregory D. Myer

Keyword(s):

Osteochondritis Dissecans ◽

Management Strategies ◽

Skeletally Immature

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Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117693604 ◽

2017 ◽

Vol 5 (3) ◽

pp. 232596711769360 ◽

Cited By ~ 21

Author(s):

Eric J. Wall ◽

Paul J. Ghattas ◽

Emily A. Eismann ◽

Gregory D. Myer ◽

Preston Carr

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Case Series ◽

Reconstruction Technique ◽

Skeletally Immature ◽

Patient Reported ◽

Ikdc Score ◽

Anterior Cruciate ◽

Bone Tunnels

Background: The safest and most effective technique for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is currently unknown. Purpose: To evaluate the functional and patient-reported outcomes of a specific all-epiphyseal ACL reconstruction technique in which the graft, bone tunnels, and fixation do not cross the knee growth plates. Study Design: Case series; Level of evidence, 4. Methods: Twenty-seven patients (23 boys, 4 girls; mean age, 11 years; range, 8-15 years) underwent an all-epiphyseal ACL reconstruction with a single femoral transverse epiphyseal tunnel and primarily split tibial epiphyseal tunnels. Outcomes were evaluated in terms of the manual Lachman test, range of motion, pain, return to activity, angular or leg-length deformity on imaging, and International Knee Documentation Committee (IKDC) or Pedi-IKDC score an average of 3.8 years postoperatively, with a minimum 2-year follow-up. Results: The mean IKDC score was 94 ± 11. There were no growth arrests, but 3 patients had knee overgrowth, and 2 required a subsequent guided growth procedure. The ACL graft failed in 4 patients (15%), and 2 patients had contralateral ACL tears (7%). There were 5 subsequent ipsilateral meniscal tears, 4 of which were retears of a repaired meniscus. Ipsilateral knee reinjury significantly correlated with the number of associated injuries at the time of index surgery ( P = .040) and the number of sports played ( P = .029). Conclusion: All-epiphyseal ACL reconstruction resulted in excellent long-term functional outcomes, despite a high rate of complications (48%) and secondary procedures (37%) in this highly active cohort. The incidence of graft failure was similar to other standard ACL reconstruction techniques for patients younger than 20 years.

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