Osteochondral autograft transfer for the treatment of osteochondritis dissecans of the medial femoral condyle in dogs

SummaryObjective: To describe the clinical application of osteochondral autograft transfer procedure for the treatment of osteochondritis dissecans (OCD) of the canine medial femoral condyle and to report clinical and force plate outcomes.Methods: Osteochondral autograft transfer (OATS™; Arthrex, Naples FL, USA) instrumentation was employed in six stifle joints of five dogs. Clinical examination was performed preoperatively and at two to three weeks, six to eight weeks, 12–18 weeks and at >22 months postoperatively. Radiography and arthroscopy were performed preoperatively and 12–18 weeks postoperatively. The followup examinations performed at 22 to 56 months included radiography, questionnaire completion with the owner, and force plate gait evaluation.Results: Articular surface reconstruction was radiographically (for 6 stifle joints) and arthroscopically (for 5 stifle joints) maintained at 12–18 weeks. Subjectively-assessed lameness resolved in five out of six stifles by the 12 to 18 week reassessment. Morbidity included lateral patellar luxation at seven weeks and cranial cruciate ligament rupture at 11 months postoperatively. At the >22 month re-evaluation examination, subjectively-assessed lameness and signs of discomfort were minimal. Owner perceptions of outcome were positive; force plate assessment of gait indicated that weight bearing on three out of six OAT implanted limbs was less than the contralateral limb, but these comparisons were not evaluated statistically. A progression in the development of osteophytes was radiographically evident.Clinical significance: The OAT procedure can reconstruct medial femoral condyle OCD defects in dogs. Long-term lameness and progressive osteophytosis may occur but can be associated with other pathology such as cruciate ligament insufficiency.

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Trans-articular versus Retro-articular Drilling of Stable Osteochondritis Dissecans of the Knee: A Prospective Randomized Controlled Trial by the ROCK Multicenter Study Group

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00249 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0024

Author(s):

Kevin Shea ◽

Elizabeth Liotta ◽

Katelyn Hergott ◽

Eric Wall ◽

Greg Myer ◽

...

Keyword(s):

Osteochondritis Dissecans ◽

Articular Surface ◽

Absolute Risk ◽

Controlled Trial ◽

Femoral Condyle ◽

Weight Bearing ◽

Relative Effectiveness ◽

Healing Time ◽

Return To Sports ◽

Patient Reported

Objectives: The most common presentation of knee osteochondritis dissecans (OCD) is a stable lesion on the lateral aspect of the medial femoral condyle (MFC) in an adolescent or pre-adolescent athlete. The standard of care for primary treatment is non-operative, and includes rest/activity modification and often weight bearing protection or bracing. Failed conservative management often leads arthroscopy and drilling of the lesion. Two different primary drilling techniques have been utilized, but no prospective studies have compared their relative effectiveness. The study hypothesis was that retro-articular drilling (RAD), the slightly newer technique, would not be inferior to trans-articular (TAD), with regard to rate of healing, time to return to sports (RTS), and patient-reported outcome scores (PROs). Methods: Skeletally immature (n=113) patients presenting with MRI-confirmed stable OCD of the MFC who did not demonstrate substantial healing after a minimum of 3 months of non-operative treatment were prospectively enrolled by one of seventeen surgeon-investigators (at 14 centers, representing all major geographic regions in the U.S.) and randomized to TAD or RAD. Post-operatively, serial radiographs were obtained every 6 weeks to assess healing, and PROs were obtained at 6 months, 12 months, and 24 months. Twelve patients were closed out at time of surgery due to lesion instability detected during arthroscopy. Power analysis determined that in order to detect a difference in 2-year IKDC score between RA and TA groups with 80% power, sample sizes of 37 subjects per group would be required if the true standard deviation were 15. This analysis was based on conducting an independent samples Student’s t-test with alpha set to 5%. Results: Ninety-one study subjects were included, consisting of 51 TAD and 40 RAD patients, respectively, with the two groups being similar in age (12.6 years vs. 11.9 years), sex distribution (45% vs. 27% female, p=0.081), and 2-year PRO response rate (both 90%). No significant differences between TAD and RAD were detected in follow-up Pedi-IKDC, Lysholm, Marx knee activity score, or KOOS QOL scores (Table 1). Revision/additional OCD surgery occurred in 10% of patients in RAD and 4% in TAD (p=0.40). 73% of TAD patients reached a ‘healed’ status at a mean of 1.15 years, compared with 60% RAD patients at a mean of 1.21 years. Conclusions: While both primary forms of OCD drilling (TAD and RAD) showed consistent post-operative healing, achieving a completely ‘healed’ status was often a more prolonged process, taking approximately 1 year, despite clinical improvement and RTS being achieved much sooner. PROs were similar between drilling techniques. Significantly higher powered studies are needed to better elucidate the greater revision surgery rates in RAD compared with TAD, but overall risk is low and absolute risk only 6%. The current data support either drilling technique, which may be technically simpler, without the need for fluoroscopy, with TAD, and may be more protective of the chondral articular surface with RAD.

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Arthroscopic autologous osteochondral mosaicplasty for the treatment of subchondral cystic lesion in the medial femoral condyle in a horse

Acta Veterinaria Hungarica ◽

10.1556/avet.48.2000.3.11 ◽

2000 ◽

Vol 48 (3) ◽

pp. 343-354 ◽

Cited By ~ 41

Author(s):

D. Girtler ◽

G. Bodó ◽

L. Hangody ◽

Zsuzsa Szabó ◽

Ch. Peham ◽

...

Keyword(s):

Cystic Lesion ◽

Femoral Condyle ◽

Weight Bearing ◽

Bone Cyst ◽

Clinical Signs ◽

Medial Femoral Condyle ◽

Femoral Trochlea ◽

Osteochondral Autograft ◽

Osteochondral Autograft Transplantation ◽

Successful Transplantation

An 11-year-old, Hungarian half-bred stallion was presented with a history of mixed left hindlimb lameness of 6 months duration. Subchondral bone cyst of the medial femoral condyle and injury of the medial meniscus were diagnosed. Osteochondral autograft transplantation (mosaic arthroplasty) was performed, taking grafts from the less weight-bearing medial border of the medial femoral trochlea of the affected limb, and transplanting them into the cyst during arthroscopy. The lameness was evaluated prior to and one year after the operation with a motion analysis system during treadmill exercise. Considerable improvement of the lameness and the clinical signs as well as successful transplantation of the grafts, and a new hard joint cartilage surface of the medial femoral condyle could be detected during follow-up arthroscopy. Osteochondral autograft transplantation seems to bee a possible alternative for treating subchondral cystic lesions of the medial femoral condyle in horses. A new technique for the surgical treatment of a subchondral cystic lesion of the medial femoral condyle in the horse is described.

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Abnormal Femoral Origin of the Anterior Cruciate Ligament Associated with Osteochondritis Dissecans of the Medial Femoral Condyle

Surgical Science ◽

10.4236/ss.2013.410093 ◽

2013 ◽

Vol 04 (10) ◽

pp. 474-476

Author(s):

Massimiliano Salvi ◽

Francesco Caputo ◽

Giuseppe Piu ◽

Marco Sanna ◽

Cristina Sanna

Keyword(s):

Anterior Cruciate Ligament ◽

Osteochondritis Dissecans ◽

Femoral Condyle ◽

Cruciate Ligament ◽

Medial Femoral Condyle ◽

Anterior Cruciate

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Osteochondritis dissecans of the medial femoral condyle associated with congenital hypoplasia of the lateral meniscus and anterior cruciate ligament

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/s0749-8063(98)70063-5 ◽

1998 ◽

Vol 14 (6) ◽

pp. 630-633 ◽

Cited By ~ 19

Author(s):

T Mitsuoka ◽

S Horibe ◽

M Hamada

Keyword(s):

Anterior Cruciate Ligament ◽

Osteochondritis Dissecans ◽

Femoral Condyle ◽

Cruciate Ligament ◽

Lateral Meniscus ◽

Medial Femoral Condyle ◽

Anterior Cruciate

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Osteochondritis dissecans of the weight-bearing surface of the medial femoral condyle in adults

The Knee ◽

10.1016/s0968-0160(02)00020-0 ◽

2002 ◽

Vol 9 (3) ◽

pp. 201-207 ◽

Cited By ~ 11

Author(s):

F.M. Jaberi

Keyword(s):

Osteochondritis Dissecans ◽

Femoral Condyle ◽

Weight Bearing ◽

Medial Femoral Condyle ◽

Bearing Surface

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An in vitro Comparison of Two Replacement Techniques Utilizing Fascia Lata after Cranial Cruciate Ligament Transection in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633025 ◽

1993 ◽

Vol 06 (02) ◽

pp. 85-92 ◽

Cited By ~ 3

Author(s):

G. L. Coetzee

Keyword(s):

Femoral Condyle ◽

Cruciate Ligament ◽

Maximum Load ◽

Fascia Lata ◽

Patellar Ligament ◽

Cross Sectional ◽

Cranial Cruciate Ligament ◽

Replacement Technique ◽

Over The Top

SummaryThe immediate postoperative biomechanical properties of an “underand-over” cranial cruciate ligament (CCL) replacement technique consisting of fascia lata and the lateral onethird of the patellar ligament, were compared with that of a modified intra- and extracapsular “under-and-over-the-top” (UOTT) method. The right CCL in twelve adult dogs was dissected out and replaced with an autograft. The contralateral, intact CCL served as the control. In group A, the graft was secured to the lateral femoral condyle with a spiked washer and screw. In group B the intracapsular graft was secured to the lateral femoro-fabellar ligament, and the remainder to the patellar tendon. Both CCL replacement techniques exhibited a 2.0 ± 0.5 mm anterior drawer immediately after the operation. After skeletonization of the stifles, the length and cross-sectional area of the intact CCL and CCL substitutes were determined. Each bone-ligament unit was tested in linear tension to failure at a fixed distraction rate of 15 mm/s with the stifle in 120° flexion. Data was processed to obtain the corresponding material parameters (modulus, stress and strain in the linear loading region, and energy absorption to maximum load).The immediate postoperative structural and material properties of the “under-and-over” cranial cruciate ligament replacement technique with autogenous fascia lata, were compared to that of a modified intra- and extracapsular “under-and-over-the-top” (UOTT) method. The combined UOT T technique was slightly stronger (6%), but allowed 2.8 ± 0.9 mm more cranial tibial displacement at maximum linear force.

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Evaluation of Positive Contrast Arthrography in Canine Cranial Cruciate Ligament Disease

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632495 ◽

1996 ◽

Vol 09 (01) ◽

pp. 10-3 ◽

Cited By ~ 2

Author(s):

D.N. Aron ◽

R. Roberts ◽

J. Stallings ◽

J. Brown ◽

C.W. Hay

Keyword(s):

Articular Surface ◽

Cruciate Ligament ◽

Positive Contrast ◽

Joint Effusion ◽

Radiographic Evaluation ◽

Cranial Cruciate Ligament ◽

Joint Pathology ◽

Meniscal Pathology ◽

Cranial Cruciate Ligament Disease ◽

Better Than

SummaryArthrographic and intraoperative evaluations of stifles affected with cranial cruciate disease were compared. Arthrography did not appear to be helpful in predicting cranial cruciate ligament pathology. The caudal cruciate ligament was consistently not visualized in the arthrograms and was normal at surgery. The menisci were visualized consistently in the arthrograms, but conclusions could not be made as to the benefit of arthrography in predicting meniscal pathology. Arthrography was not helpful in predicting joint capsule and femoral articular surface pathology. Survey radiographic evaluation was better than arthrography in evaluating joint pathology. When cruciate injury is suspected, after history and physical examination, survey radiographs are better than positive contrast arthrograms at supporting the diagnosis.Positive contrast arthrography was evaluated as a diagnostic aid in canine cranial cruciate ligament disease. It did not appear to be useful in predicting joint pathology. With arthrography, both menisci could be visualized and evaluated for abnormalities. Joint effusion and presence of osteophytes evaluated on survey radiographs was better than arthrography in evaluating joint pathology.

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