Decreased Defect Size and Partial Restoration of Subchondral Bone on Computed Tomography After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum

2018 ◽  
Vol 46 (12) ◽  
pp. 2954-2959 ◽  
Author(s):  
Rens Bexkens ◽  
Christiaan J.A. van Bergen ◽  
Michel P.J. van den Bekerom ◽  
Gino M.M.J. Kerkhoffs ◽  
Denise Eygendaal
Keyword(s):  
Computed Tomography ◽  
Subchondral Bone ◽  
Osteochondritis Dissecans ◽  
Sagittal Plane ◽  
Case Series ◽  
Defect Size ◽  
Arthroscopic Debridement ◽  
Osseous Union ◽  
Anterior Posterior

Background: Arthroscopic debridement and microfracture are considered the primary surgical treatment for capitellar osteochondritis dissecans (OCD). Healing of the subchondral bone plays an essential role in cartilage repair, while lack of healing is related to the development of osteoarthritis. To date, it is unknown to what extent healing of the subchondral bone occurs after this technique in the elbow. Purpose: To analyze defect size changes and subchondral bone healing with computed tomography (CT) after arthroscopic debridement and microfracture for advanced capitellar OCD. Study Design: Case series; Level of evidence, 4. Methods: Between 2009 and 2016, 67 patients underwent arthroscopic debridement and microfracture for advanced capitellar OCD. Fifty-four patients (81% follow-up rate) with CT scans were included (mean ± SD: preoperative, 4.0 ± 1.7 months; postoperative, 29 ± 9.0 months). OCD defect size was assessed by measuring the largest diameter in 3 directions: medial-lateral direction (coronal plane) and anterior-posterior direction and depth (both in sagittal plane). Healing of the OCD was divided into 3 categories: good—complete osseous union or ossification; fair—incomplete osseous union or ossification but improved; poor—no changes between pre- and postoperative scans. Postoperative clinical outcome was assessed with the Oxford Elbow Score (OES) at the same time as the postoperative CT scan. Results: There were 30 female and 24 male patients (age, 15.7 ± 3.2 years). Defect size decreased ( P < .001) in all 3 directions (medial-lateral × anterior-posterior × depth) at 29 ± 9.0 months: preoperatively, 7.9 ± 2.8 × 8.0 ± 3.2 × 4.1 ± 1.5 mm; postoperatively, 3.5 ± 3.3 × 4.0 ± 3.5 × 1.6 ± 1.4 mm. Healing of the subchondral bone was graded as good in 19 defects (35%), fair in 27 (50%), and poor in 8 (15%). The mean postoperative OES score was 40 ± 8.4. Neither postoperative defect size nor healing grade correlated with the OES ( P > .05). Conclusion: Arthroscopic debridement and microfracture for advanced capitellar OCD result in improved (ie, decreased) defect size at a mean follow-up of 29 months, both in width and in depth. Healing of the subchondral bone was either good or fair in 85%. Interestingly, CT findings did not correlate with clinical outcomes.

Clinical Outcome After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum

2017 ◽  
Vol 45 (10) ◽  
pp. 2312-2318 ◽  
Author(s):  
Rens Bexkens ◽  
Kim I.M. van den Ende ◽  
Paul T. Ogink ◽  
Christiaan J.A. van Bergen ◽  
Michel P.J. van den Bekerom ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Linear Regression Analysis ◽  
Case Series ◽  
Loose Body ◽  
Return To Sports ◽  
Arthroscopic Debridement ◽  
Duration Of Symptoms ◽  
Point Increase ◽  
The Mean

Background: Various surgical treatment techniques have been developed to treat capitellar osteochondritis dissecans; however, the optimal technique remains the subject of ongoing debate. Purpose: To evaluate clinical outcomes after arthroscopic debridement and microfracture for advanced capitellar osteochondritis dissecans. Study Design: Case series; Level of evidence, 4. Methods: Between 2008 and 2015, the authors followed 77 consecutive patients (81 elbows) who underwent arthroscopic debridement and microfracture, and loose body removal if needed, for advanced capitellar osteochondritis dissecans. Seventy-one patients (75 elbows) with a minimum follow-up of 1 year were included. The mean age was 16 years (SD, ±3.3 years; range, 11-26 years) and the mean follow-up length was 3.5 years (SD, ±1.9 years; range, 1-8.2 years). Based on CT and/or MRI results, 71 lesions were classified as unstable and 4 as stable. Clinical elbow outcome (pain, function, and social-psychological effect) was assessed using the Oxford Elbow Score (OES) at final follow-up (OES range, 0-48). Range of motion and return to sports were recorded. Multivariable linear regression analysis was performed to determine predictors of postoperative OES. Results: Intraoperatively, there were 3 grade 1 lesions, 2 grade 2 lesions, 10 grade 3 lesions, 1 grade 4 lesion, and 59 grade 5 lesions. The mean postoperative OES was 40.8 (SD, ±8.0). An open capitellar physis was a predictor of better elbow outcome (5.8-point increase; P = .025), as well as loose body removal/grade 4-5 lesions (6.9-point increase; P = .0020) and shorter duration of preoperative symptoms (1.4-point increase per year; P = .029). Flexion slightly improved from 134° to 139° ( P < .001); extension deficit slightly improved from 8° to 3° ( P < .001). Pronation ( P = .47) and supination did not improve ( P = .065). Thirty-seven patients (55%) returned to their primary sport at the same level, and 5 patients (7%) returned to a lower level. Seventeen patients (25%) did not return to sport due to elbow-related symptoms, and 10 patients (13%) did not return due to non–elbow-related reasons. No complications were recorded. Conclusion: Arthroscopic debridement and microfracture for advanced capitellar osteochondritis dissecans provide good clinical results, especially in patients with open growth plate, loose body removal, and shorter duration of symptoms. However, only 62% of patients in this study returned to sports.

scholarly journals Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098187
Author(s):  
Justus Gille ◽  
Ellen Reiss ◽  
Moritz Freitag ◽  
Jan Schagemann ◽  
Matthias Steinwachs ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Demographic Data ◽  
Case Series ◽  
Defect Size ◽  
Lysholm Score ◽  
Outcome Analysis ◽  
Cartilage Defects ◽  
Chondral Defects ◽  
The Mean

Background: Autologous matrix-induced chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. Purpose: To evaluate the long-term clinical outcomes of AMIC for the treatment of chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: A multisite prospective registry recorded demographic data and outcomes for patients who underwent repair of chondral defects. In total, 131 patients were included in the study. Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) score for pain were used for outcome analysis. Across all patients, the mean ± SD age of patients was 36.6 ± 11.7 years. The mean body weight was 80.0 ± 16.8 kg, mean height was 176.3 ± 7.9 cm, and mean defect size was 3.3 ± 1.8 cm2. Defects were classified as Outerbridge grade III or IV. A repeated-measures analysis of variance was used to compare outcomes across all time points. Results: The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement ( P < .001) in all scores was observed at 1 to 2 years after AMIC, and improved values were noted up to 7 years postoperatively. Among all patients, the mean preoperative Lysholm score was 46.9 ± 19.6. At the 1-year follow-up, a significantly higher mean Lysholm score was noted, with maintenance of the favorable outcomes at 7-year follow-up. The KOOS also showed a significant improvement of postoperative values compared with preoperative data. The mean VAS had significantly decreased during the 7-year follow-up. Age, sex, and defect size did not have a significant effect on the outcomes. Conclusion: AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years postoperatively.

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

2018 ◽  
Vol 46 (8) ◽  
pp. 1943-1951 ◽  
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.

scholarly journals Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988426 ◽  
Author(s):  
John T. Stranix ◽  
Merisa L. Piper ◽  
Said C. Azoury ◽  
Geoffrey Kozak ◽  
Oded Ben-Amotz ◽  
...  
Keyword(s):  
Free Flap ◽  
Femoral Condyle ◽  
Donor Site ◽  
Case Series ◽  
Medial Femoral Condyle ◽  
Flap Reconstruction ◽  
Foot And Ankle ◽  
Osseous Union ◽  
Vascularized Bone

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.

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

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.

scholarly journals Arthroscopic Meniscopexy for the Treatment of Nontraumatic Osteochondritis Dissecans in the Knee Joint of Adult Patients

Cartilage ◽  
2018 ◽  
Vol 11 (4) ◽  
pp. 441-446
Author(s):  
Fabian Blanke ◽  
Andreas Feitenhansl ◽  
Maximilian Haenle ◽  
Stephan Vogt
Keyword(s):  
Knee Joint ◽  
Osteochondritis Dissecans ◽  
Case Series ◽  
Complete Healing ◽  
Lysholm Score ◽  
Anterior Horn ◽  
Grade Ii ◽  
Magnetic Resonance Imaging Mri ◽  
Knee Pathology

Objective The etiology of osteochondritis dissecans (OCD) is still uncertain. Recently, it has been hypothesized that instability of the anterior horn of the meniscus is an important cause for the development of a nontraumatic OCD in adolescents with good results after surgical stabilization. This case series aims to evaluate the treatment results after meniscus stabilization in adults with nontraumatic OCD. Design Ten patients with magnetic resonance imaging (MRI)-confirmed OCD of the knee joint, meniscal instability, and closed epiphyseal plates were enrolled in this study. The instable meniscus was stabilized by direct suturing of the anterior horn of the meniscus. MRI examinations were performed preoperative and 6 and 12 months postoperative. The OCD was classified arthroscopically according to Guhl and according to Hughes in the MRI. The overall knee function was evaluated by the Lysholm score before treatment and 12 months postoperative. Results Four women and 6 men with a mean age of 20.6 ± 1.9 years were included in this study. Preoperatively 60% of the patients showed a grade II or III lesion arthroscopically and 70% a grade III or IVa lesion in the MRI examination. After arthroscopic meniscus stabilization the Lysholm score increased in average from 48.1 ± 14.12 before treatment to 97.5 ± 3.1 postoperative. At final follow-up after 12 months, an improvement of the OCD in the MRI could be demonstrated in all patients (100%). In 80% of the patients a complete healing of the OCD could be noted. Conclusion The clinical concept of an instable anterior horn of the meniscus as a cause for the development of a nontraumatic OCD seems to be transferable to adults and arthroscopic stabilization can lead to a sufficient healing of this knee pathology.

Multilevel Pedicle Subtraction Osteotomy for Correction of Severe Rigid Adult Spinal Deformities: A Case Series, Indications, Considerations, and Literature Review

2020 ◽  
Author(s):  
Darryl Lau ◽  
Alexander F Haddad ◽  
Marissa T Fury ◽  
Vedat Deviren ◽  
Christopher P Ames
Keyword(s):  
Pain Relief ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Pedicle Subtraction Osteotomy ◽  
Spinal Deformities ◽  
Spinal Region ◽  
Spinal Imbalance

Abstract BACKGROUND Rigid and ankylosed thoracolumbar spinal deformities require three-column osteotomy (3CO) to achieve adequate correction. For severe and multiregional deformities, multilevel 3CO is required but its use and outcomes are rarely reported. OBJECTIVE To describe the use of multilevel pedicle subtraction osteotomy (PSO) in adult spinal deformity (ASD) patients with severe, rigid, and ankylosed multiregional deformity. METHODS Retrospective review of 5 ASD patients who underwent multilevel PSO for the correction of severe fixed deformity and review the literature regarding the use of multilevel PSO. RESULTS Five patients presented with spinal imbalance secondary to regional and multiregional spinal deformities involving the thoracolumbar spine. All patients underwent a single-stage two-level noncontiguous PSO, and 2 of the patients underwent a staged third PSO to treat deformity involving a separate spinal region. Significant radiographic correction was achieved with normalization of spinal alignment and parameters. Two-level PSO was able to provide greater than 80 degrees of sagittal plane correction in both the lumbar and thoracic spine. Two patients experienced new postoperative weakness which recovered to preoperative baseline at 3 to 6 mo follow-up. At most recent follow-up, 4 of the 5 patients gained significant pain relief and had improved functionality. CONCLUSION Noncontiguous multilevel PSO is a formidable surgical technique. Additional risk (compared to single-level 3CO) comes in the form of greater blood loss and higher risk for postoperative weakness. Nonetheless, multilevel PSO is feasible and effective for correcting severe multiplanar and multiregional ASD, and patients gain significant benefits in increased functionality and pain relief.

Autologous Chondrocyte Implantation as Treatment for Unsalvageable Osteochondritis Dissecans: 10- to 25-Year Follow-up

2020 ◽  
Vol 48 (5) ◽  
pp. 1134-1140 ◽  
Author(s):  
James L. Carey ◽  
Kevin G. Shea ◽  
Anders Lindahl ◽  
Haris S. Vasiliadis ◽  
Carl Lindahl ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Open Surgery ◽  
Autologous Chondrocyte Implantation ◽  
Case Series ◽  
Activity Level ◽  
Osteochondral Allograft ◽  
Level Of Evidence ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI). Hypothesis: Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty. Study Design: Case series; Level of evidence, 4. Methods: All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires to assess the Knee injury and Osteoarthritis Outcome Score, Tegner-Wallgren activity score, and Lysholm score. In addition, patients were asked whether they had to undergo further surgery, including knee replacement, of the knee that underwent ACI. They were asked whether they would have the surgery again if in the same situation. Results: A total of 55 patients (93%) with 61 OCD lesions (91%) responded. The median follow-up duration was 19 years (range, 10-26 years) and the median age at follow-up was 43 years (range, 28-69 years). Subsequent arthroscopy was performed in the majority of cases, although many of these were scheduled “second looks” as part of a study. With respect to other subsequent surgery, 12 knees (20%) underwent any additional open surgery, but only 2 knees (3%) underwent arthroplasty. Eight knees (13%) underwent revision ACI. Most patients reached their preinjury activity level (62%) and would undergo ACI again if in the same situation (85%). If failure is defined as revision of the graft or conversion to arthroplasty, then survivorship after ACI for OCD in the current study would be 87% at 10 years, 85% at 15 years, and 82% at 20 years. Conclusion: ACI for OCD provides a durable treatment option. At a median follow-up of 19 years, there was a very low (~3%) conversion to total knee arthroplasty.

The Horizon Sign and Frontal Bar: Two Topographic Landmarks to Confirm Endoscopic Frontal Sinusotomy

2019 ◽  
Vol 160 (4) ◽  
pp. 740-743
Author(s):  
Evan S. Walgama ◽  
Andrew Thamboo ◽  
Navarat Tangbumrungtham ◽  
Noel Ayoub ◽  
Zara M. Patel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Frontal Sinus ◽  
Case Series ◽  
Acute Angle ◽  
Sinus Surgery ◽  
Consecutive Case ◽  
Landmark Identification ◽  
Frontal Sinuses ◽  
Anterior Posterior

Confirming a thorough dissection of the frontal sinus during endoscopic sinus surgery can be challenging, and some surgeons would benefit from reliable topographic landmark identification to ensure completion of this sinus dissection. We defined (1) the “horizon sign” as the curvilinear shadow of the posterior table cast superiorly upon the anterior table of the frontal sinus at the acute angle of their meeting point and (2) the “frontal bar” as a sagittal septation at the union of the anterior/posterior tables. A cadaveric study, followed by an intraoperative consecutive case series, was performed to evaluate these 2 landmarks as indicators of complete dissection. The horizon sign was extremely reliable, identified in 100% of cadaveric frontal sinuses and intraoperative frontal sinuses. The frontal bar was present in only 67% of frontal sinuses by computed tomography. In live patients, the sensitivity and specificity of the frontal bar were 62% and 95%, respectively.

Sign in / Sign up

Export Citation Format

Share Document