Meniscal Suturing Versus Screw Fixation for Treatment of Osteochondritis Dissecans: Clinical and Magnetic Resonance Imaging Results

doi:10.1016/j.arthro.2014.05.010

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 30, Issue 10, October 2014, Pages 1269-1279

https://doi.org/10.1016/j.arthro.2014.05.010 Get rights and content

Purpose

The purpose of this study was to compare meniscal stabilization alone with screw fixation in restoring subjective and objective knee function and structural cartilage integrity in skeletally immature patients with osteochondritis dissecans (OCD) of the knee.

Methods

This study comprised 28 patients (32 knees) with magnetic resonance imaging (MRI)–confirmed OCD. Unstable menisci were treated with either stabilization (15 patients, 16 knees) or screw fixation (13 patients, 16 knees; control group). Patients were assessed by functional scoring (Hughston, International Knee Documentation Committee [IKDC]) and MRI for a minimum follow-up period of 2.5 years.

Results

In the meniscus stabilization group, the Hughston score improved from 1.4 to 3.8 (P < .01). There was improvement in the IKDC grade, from grade C preoperatively to grade A in 14 knees and grade B in 2 (P < .01). Of 16 knees, 15 had complete defect resolution on MRI by 1 year. There were 3 complications: 1 wound infection, 1 case of trauma requiring reoperation, and 1 revision because of treatment failure at 6 months. In the screw fixation group, the Hughston score improved from 1.4 to 3.6 (P < .01). There was a significant improvement in IKDC grade, from grade C preoperatively to grade A in 11 knees and grade B in 5 (P < .01). At 2 years postoperatively, no differences in these variables were found between the groups.

Conclusions

Meniscal suturing alone for the treatment of an OCD of the knee shows good or excellent results in terms of clinical scoring and MRI assessment at almost 3 years' follow-up. The results are comparable with those of screw fixation but with a faster recovery in the postoperative course.

Level of Evidence

Level III, retrospective comparative study.

Section snippets

Methods

This study was designed as a cohort study, approved by the responsible authorities (Ethical Committee Basel, No. 12.072; German Clinical Trials Register, No. DRKS00003532), and conducted at a tertiary-care pediatric orthopaedic hospital with a caseload of roughly 30 to 40 OCD patients annually. All included patients (28 patients, 32 knees) had an MRI-confirmed OCD with clinical symptoms. All patients underwent a course of conservative treatment, consisting of initial immobilization, followed by

Results

In group A the mean preoperative Hughston score of 1.4 improved to 3.1 at 6 weeks and 3.8 after a minimum of 24 months postoperatively, which was a statistically significant improvement compared with the preoperative score (P < .0001). In group B a statistically significant difference was not noted until 6 months postoperatively. At 6 months after surgery, no significant differences were found between the groups (group A v group B after 6 weeks, 3.1 v 2.3 [P < .01]; after 3 months, 3.8 v 2.8 [P

Discussion

Meniscal suturing alone shows comparable clinical and MRI results to screw fixation in OCD after a follow-up of almost 3 years. Both groups showed comparable, good clinical and radiologic results, including a high OCD healing rate at 1 year postoperatively. All patients returned to high-level activities up to 1 year after surgery.

To date, most treatment methods have targeted the OCD lesion itself.²⁵ We hypothesized that addressing the likely causative factor, namely an unstable meniscus that

Conclusions

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These environments had a higher healing potential for the OCD, even when treating only the symptomatic DLM. In OCD of the medial femoral condyle with non-DLM, Camathias et al. reported that meniscal suturing alone for juvenile OCD showed good or excellent results in clinical scoring and MRI assessment [16]. They emphasized that meniscal stabilization was effective in the treatment of OCD.
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We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.
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Osteochondritis dissecans (OCD) is a focal pathological lesion involving the subchondral bone. It most commonly involves the knee and can result in significant damage to the overlying articular cartilage, leading to loose bodies, accelerated joint degeneration and pain. It is classically categorised into juvenile and adult forms, with many juvenile patients having favourable outcomes with nonoperative management, whereas adult patients predominantly require operative treatments. There are multiple proposed theories regarding the aetiology of the disease; however, there is no agreed-on cause. Imaging studies, specifically magnetic resonance imaging (MRI), play an important role in diagnosing and characterising OCD lesions. In addition to a patient’s skeletal maturity, characteristics including the lesion size, location and stability are among the most important prognostic factors used to guide treatment decisions. OCD lesions that require operative management can be treated by reparative or restorative techniques. Reparative techniques are generally first attempted and include drilling, loose body excision and internal fixation. Restorative treatments are reserved for patients with lesions that have failed reparative attempts or are deemed not amenable to repair. These operative treatments include microfracture, osteochondral autograft transplantation, osteochondral allograft and autologous chondrocyte implantation techniques. Ultimately the majority of patients have favourable outcomes with these treatment strategies; however, further comparative studies are essential for establishing ideal guidelines for the appropriate management of this complex pathological condition of the knee.
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: The authors report that they have no conflicts of interest in the authorship and publication of this article.

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Original Article With Video IllustrationMeniscal Suturing Versus Screw Fixation for Treatment of Osteochondritis Dissecans: Clinical and Magnetic Resonance Imaging Results

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

Orthop Clin North Am

Arthroscopy

Arthroscopy

Current concepts review. Osteochondritis dissecans

J Bone Joint Surg Am

Natural course of osteochondritis dissecans in children

J Pediatr Orthop B

Osteochondritis dissecans of the knee: Treatment of juvenile and adult forms

J Am Acad Orthop Surg

Bioabsorbable lag screw fixation of knee osteochondritis dissecans in the skeletally immature

J Pediatr Orthop B

Osteochondritis dissecans in children

J Bone Joint Surg Am

Juvenile osteochondritis dissecans: A 5-year review of the natural history using clinical and MRI evaluation

Pediatr Radiol

A review of knowledge in osteochondritis dissecans: 123 Years of minimal evolution from König to the ROCK study group

Clin Orthop Relat Res

Osteochondritis dissecans knee histology studies have variable findings and theories of etiology

Clin Orthop Relat Res

Osteochondritis dissecans: A multicenter study of the European Pediatric Orthopedic Society

J Pediatr Orthop B

Aetiology of osteochondritis dissecans. Failure to establish a familial background

J Bone Joint Surg Br

Osteochondritis dissecans. History, pathophysiology and current treatment concepts

Clin Orthop Relat Res

Original Article With Video Illustration
Meniscal Suturing Versus Screw Fixation for Treatment of Osteochondritis Dissecans: Clinical and Magnetic Resonance Imaging Results