Summary

Arthroscopic fixation of juvenile knee OCD lesions using bioabsorbable implants has been shown to produce satisfactory long term results.

Abstract

Purpose

The aim of this study was to assess the long term results of operative management of osteochondritis dissecans (OCD) lesions in skeletally immature knees by arthroscopic internal fixation using bioabsorbable implants.

Materials & Methods
A series of 22 patients (24 knees) with juvenile OCD of the knee who were followed for a minimum of five years after surgical treatment by arthroscopic fixation with bioabsorbable implants were included in the study. All subjects were skeletally immature at the time of surgery and had MRI-confirmed knee OCD lesions which either were found to be unstable or had failed conservative treatment for at least six months. Each lesion was fixed in situ with commercially available bioabsorbable (96L/4D PLA copolymer) implants during knee arthroscopy. Postoperatively, protective weight bearing was maintained for the first six weeks with free mobilisation thereafter. All patients were reviewed at 1.5, 3, and 6 months after the intervention and subsequently were followed at 6-monthly intervals over a period of no less than five years.
Outcome evaluation was based on the statistical analysis of the differences between the pre- and postoperative values (at the last follow-up visit) in the Hughston rating scale and pedi-IKDC subjective form.

Results

The mean Hughston score increased from 1.3±0.5 preoperatively to 3.6±0.6 at the time of the last follow-up, whereas the mean pedi-IKDC score raised from 66.6±4.9 to 85.8±6.3 correspondingly. In both cases the differences were found to be statistically significant (p<0.001). Furthermore, there was a negative correlation between the amount of change in the Hughston score and the age of the patient (r=-0.518), as well as between the amount of change in the pedi-IKDC score and the size of the lesion (r=-0.407).

Conclusions

This study has demonstrated satisfactory long term results of arthroscopic fixation of OCD lesions in skeletally immature knees with use of bioabsorbable implants. The aforementioned technique appears to be a safe and effective means of managing juvenile OCD of the knee.

Key words: Osteochondrtitis, fixation