TY - JOUR
T1 - Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work?
T2 - A Systematic Review
AU - Leland, Devin P
AU - Bernard, Christopher D
AU - Camp, Christopher L
AU - Nakamura, Norimasa
AU - Saris, Daniel B F
AU - Krych, Aaron J
N1 - Funding Information:
The authors report the following potential conflicts of interest or sources of funding: C.C. reports nonfinancial support from Arthrex, Inc. D.S. reports other from Cartilage, other from International Cartilage Repair Society, Dutch Orthopedic Society, other from Knee Surgery, Sports Traumatology, Arthroscopy, personal fees from Smith & Nephew, Genzyme, Tigenix. A.K. reports grants from Aesculp/B.Braun, other from American Journal of Sports Medicine, grants, personal fees, and other from Arthrex, Inc., grants from Arthritis Foundation, grants from Ceterix, grants from Histogenics, other from International Cartilage Repair Society, other from International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine, other from Minnesota Orthopedic Society, personal fees and other from Musculoskeletal Transplantation Foundation, personal fees from Vericel, personal fees from DePuy, personal fees from JRF Ortho. Full ICMJE author disclosure forms are available for this article online, as supplementary material. The authors report the following potential conflicts of interest or sources of funding: C.C. reports nonfinancial support from Arthrex, Inc. D.S. reports other from Cartilage, other from International Cartilage Repair Society, Dutch Orthopedic Society, other from Knee Surgery, Sports Traumatology, Arthroscopy, personal fees from Smith & Nephew, Genzyme, Tigenix. A.K. reports grants from Aesculp/B.Braun, other from American Journal of Sports Medicine, grants, personal fees, and other from Arthrex, Inc., grants from Arthritis Foundation, grants from Ceterix, grants from Histogenics, other from International Cartilage Repair Society, other from International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine, other from Minnesota Orthopedic Society, personal fees and other from Musculoskeletal Transplantation Foundation, personal fees from Vericel, personal fees from DePuy, personal fees from JRF Ortho. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Publisher Copyright:
© 2019 Arthroscopy Association of North America
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/8
Y1 - 2019/8
N2 - PURPOSE: To report the rate of radiographic union, patient-reported outcomes, complications, and reoperations after internal fixation of unstable osteochondritis dissecans (OCD) in the skeletally mature knee.METHODS: A literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they were skeletally mature and underwent internal fixation of an unstable OCD lesion of the knee. Risk of bias assessment was performed using the Methodological Index for Non-randomized Studies scoring system. Surgical technique, rate of union, patient-reported outcomes, complications, and reoperations were collected.RESULTS: Thirteen studies resulted in 148 patients (150 knees) for inclusion. Patient age ranged from 14 to 45 years. Numerous fixation procedures were used, including biodegradable devices (rods, pins, nails, and screws), metal screws, Kirschner wire, and autologous bone sticks. Overall, reported outcome measures were heterogeneous in nature. The rate of radiographic healing ranged from 67% to 100% across 6 studies. Improved subjective results and Hughston criteria on final follow-up ranged from 83% to 100% across 4 studies each. Mean postoperative Lysholm scores ranged from 42 to 98 in studies that reported them. Both complication and reoperation rates ranged from 0% to 44%. The most commonly performed reoperations were loose body excision and cartilage resurfacing procedures.CONCLUSIONS: A variety of surgical techniques are available for treatment of unstable OCD lesions in the skeletally mature knee. In this systematic review, internal fixation of the native fragment showed acceptable rates of radiographic union and improved patient-reported outcomes relative to other techniques.LEVEL OF EVIDENCE: Level IV, systematic review of level III-IV studies.
AB - PURPOSE: To report the rate of radiographic union, patient-reported outcomes, complications, and reoperations after internal fixation of unstable osteochondritis dissecans (OCD) in the skeletally mature knee.METHODS: A literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they were skeletally mature and underwent internal fixation of an unstable OCD lesion of the knee. Risk of bias assessment was performed using the Methodological Index for Non-randomized Studies scoring system. Surgical technique, rate of union, patient-reported outcomes, complications, and reoperations were collected.RESULTS: Thirteen studies resulted in 148 patients (150 knees) for inclusion. Patient age ranged from 14 to 45 years. Numerous fixation procedures were used, including biodegradable devices (rods, pins, nails, and screws), metal screws, Kirschner wire, and autologous bone sticks. Overall, reported outcome measures were heterogeneous in nature. The rate of radiographic healing ranged from 67% to 100% across 6 studies. Improved subjective results and Hughston criteria on final follow-up ranged from 83% to 100% across 4 studies each. Mean postoperative Lysholm scores ranged from 42 to 98 in studies that reported them. Both complication and reoperation rates ranged from 0% to 44%. The most commonly performed reoperations were loose body excision and cartilage resurfacing procedures.CONCLUSIONS: A variety of surgical techniques are available for treatment of unstable OCD lesions in the skeletally mature knee. In this systematic review, internal fixation of the native fragment showed acceptable rates of radiographic union and improved patient-reported outcomes relative to other techniques.LEVEL OF EVIDENCE: Level IV, systematic review of level III-IV studies.
KW - Bone Nails
KW - Cartilage/transplantation
KW - Humans
KW - Knee Joint/surgery
KW - Orthopedic Procedures/methods
KW - Osteochondritis Dissecans/surgery
KW - Patient Reported Outcome Measures
KW - Postoperative Period
KW - Second-Look Surgery
UR - http://www.scopus.com/inward/record.url?scp=85071281954&partnerID=8YFLogxK
U2 - 10.1016/j.arthro.2019.03.020
DO - 10.1016/j.arthro.2019.03.020
M3 - Review article
C2 - 31395194
SN - 0749-8063
VL - 35
SP - 2512
EP - 2522
JO - Arthroscopy
JF - Arthroscopy
IS - 8
ER -