2015 ISAKOS Biennial Congress ePoster #1511

Osteochondritis Dissecans of the Knee of Football Players Repaired with Bio Absorbable Implants

Alkiviadis Kalliakmanis, MD, PhD, Athens GREECE
Pantelis Vasilios Nikolaou, MD, PhD, Athens GREECE
Sarantos Zourntos, MD, Athens GREECE
Dimitrios Bousgas, MD, Athens GREECE
Despoina Danassi - Afentaki, MD, PhD, Athens GREECE
Athens Medical Centre, Athens, GREECE

FDA Status Not Applicable

Summary: The treatment of osteochondral defects in Osteochondritis dissecans of the knee is a challenging problem. Considerable interest has been developed over the past years in osteochondral reconstruction with arthroscopic fixation of the fragments using bioabsorbable implants

Abstract:

Introduction

The treatment of osteochondral defects in Osteochondritis dissecans of the knee is a challenging problem. Considerable interest has been developed over the past years in osteochondral reconstruction with arthroscopic fixation of the fragments using bioabsorbable implants.

Purpose

The purpose of this study was to evaluate the functional and radiographic outcome of arthroscopic fixation of lesions of osteochondritis dissecans in the knee using poly-L-lactic acid bioabsorbable fixation device.

Methods

A retrospective clinical and radiographic evaluation of 44 amateur and professional football players (28 male and 16 female) with a mean age of 13.3 years treated with arthroscopic repair of Osteochondritis dissecans using bioabsorbable nails, was carried out. Preoperative magnetic resonance imaging was performed in all patients. Patients were evaluated at mean follow-up of 32 months with a clinical examination, International Knee Documentation Committee form, and Lysholm questionnaire. Postoperative radiographic evaluation of plain x-rays, high resolution morphologic and compositional Magnetic Resonance Imaging was performed at the patients.

Results

At surgery, a mean of 4 nails (range, 2 to 6) were used to fix 20 lesions classified as stage II and 24 lesions classified as stage III on the basis of Guhl arthroscopic classification system. The mean lesion size was 3.2 cm2 (range 1.1 cm2 to 4.8 cm2). The mean postoperative Lysholm score was 93 (range 80 to 100) and the IKDC objectives were A in 40 patients and B in 4 patients. All athletes but four returned to the same level of sports activities at a mean of 6 months after surgery. Postoperative MRI evaluation revealed evidence of fragment union in 43 patients and of questionable healing in 1. One patient underwent second look arthroscopy to remove the head of one nail. Compositional imaging with MRI showed that the quality of the cartilage of the fixed fragment was equivalent to the quality of the native hyaline cartilage regarding the collagen network and the proteoglycan content.

Conclusion

Our experience of arthroscopic fixation of osteochondritis dissecans using bioabsorbable nails gave satisfactory results. It supports the use of MRI techniques for the preoperative staging and postoperative assessment of the structural integrity and the quality of the fixed lesion cartilage.
Key terms: Osteochondritis dissecans-Bioabsorbable nail-Fixation –Knee
What is known about the subject: Evolving technology and new knowledge regarding osteochondral pathophysiology have led to numerous procedures for surgical treatment of osteochondritis dissecans lesions. Bioabsorbable implants have been used in the recent past with excellent results. MRI evaluation has been advocated as an accurate way to stage the lesions preoperatively and assess the surgical outcome