Download PDF
J Knee Surg 2018; 31(03): 206-211
DOI: 10.1055/s-0037-1607199
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Internal Fixation of Osteochondritis Dissecans Lesions in the Patellofemoral Joint

Clayton W. Nuelle
1   The San Antonio Orthopaedic Group, San Antonio, Texas
,
Jack Farr
2   Cartilage Restoration Center, OrthoIndy, Greenwood, Indiana
› Author Affiliations
Further Information

Publication History

03 March 2017

25 August 2017

Publication Date:
04 October 2017 (online)

    Permissions and Reprints

Abstract

Osteochondritis dissecans (OCD) lesions of the patellofemoral joint can be difficult to identify and treat. Asymptomatic or stable lesions in skeletally immature patients may be treated nonoperatively, but symptomatic lesions often require surgical intervention. Evidence of instability should be carefully evaluated with preoperative magnetic resonance imaging or computed tomography arthrogram. Careful preoperative planning is necessary to ensure the appropriate surgical approach and implants are selected for surgical management. Multiple techniques have been described, but internal fixation of both “classic” and cartilage-only OCD lesions has been shown to have strong outcomes in managing these difficult cases.

Keywords

osteochondritis dissecans - internal fixation - patellofemoral
 

  • References

  • 1 Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg 1995; 3 (04) 237-247
    CrossrefPubMedGoogle Scholar
  • 2 Hughston JC, Hergenroeder PT, Courtenay BG. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 1984; 66 (09) 1340-1348
    CrossrefPubMedGoogle Scholar
  • 3 Flynn JM, Kocher MS, Ganley TJ. Osteochondritis dissecans of the knee. J Pediatr Orthop 2004; 24 (04) 434-443
    CrossrefPubMedGoogle Scholar
  • 4 Peters TA, McLean ID. Osteochondritis dissecans of the patellofemoral joint. Am J Sports Med 2000; 28 (01) 63-67
    CrossrefPubMedGoogle Scholar
  • 5 Smith JB. Osteochondritis dissecans of the trochlea of the femur. Arthroscopy 1990; 6 (01) 11-17
    CrossrefPubMedGoogle Scholar
  • 6 Kramer DE, Yen YM, Simoni MK. , et al. Surgical management of osteochondritis dissecans lesions of the patella and trochlea in the pediatric and adolescent population. Am J Sports Med 2015; 43 (03) 654-662
    CrossrefPubMedGoogle Scholar
  • 7 Chun KC, Kim KM, Jeong KJ, Lee YC, Kim JW, Chun CH. Arthroscopic bioabsorbable screw fixation of unstable osteochondritis dissecans in adolescents: clinical results, magnetic resonance imaging, and second-look arthroscopic findings. Clin Orthop Surg 2016; 8 (01) 57-64
    CrossrefPubMedGoogle Scholar
  • 8 Schwarz C, Blazina ME, Sisto DJ, Hirsh LC. The results of operative treatment of osteochondritis dissecans of the patella. Am J Sports Med 1988; 16 (05) 522-529
    CrossrefPubMedGoogle Scholar
  • 9 Chambers HG, Shea KG, Carey JL. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg 2011; 19 (05) 307-309
    CrossrefPubMedGoogle Scholar
  • 10 Dellamaggiora R, Vaishnav S, Vangsness Jr CT. Osteochondritis dissecans of the adult knee. Oper Tech Sports Med 2008; 16: 65-69
    CrossrefPubMedGoogle Scholar
  • 11 Makino A, Muscolo DL, Puigdevall M, Costa-Paz M, Ayerza M. Arthroscopic fixation of osteochondritis dissecans of the knee: clinical, magnetic resonance imaging, and arthroscopic follow-up. Am J Sports Med 2005; 33 (10) 1499-1504
    CrossrefPubMedGoogle Scholar
  • 12 Kocher MS, Micheli LJ, Yaniv M, Zurakowski D, Ames A, Adrignolo AA. Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med 2001; 29 (05) 562-566
    CrossrefPubMedGoogle Scholar
  • 13 Bradley J, Dandy DJ. Results of drilling osteochondritis dissecans before skeletal maturity. J Bone Joint Surg Br 1989; 71 (04) 642-644
    PubMedGoogle Scholar
  • 14 Dines JS, Fealy S, Potter HG, Warren RF. Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device. Arthroscopy 2008; 24 (01) 62-68
    CrossrefPubMedGoogle Scholar
  • 15 Kocher MS, Czarnecki JJ, Andersen JS, Micheli LJ. Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med 2007; 35 (05) 712-718
    CrossrefPubMedGoogle Scholar
  • 16 Anderson CN, Magnussen RA, Block JJ, Anderson AF, Spindler KP. Operative fixation of chondral loose bodies in osteochondritis dissecans in the knee: a report of 5 cases. Orthop J Sports Med 2013; 1 (02) DOI: 10.1177/2325967113496546.
    PubMedGoogle Scholar
  • 17 Cain EL, Clancy WG. Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med 2001; 20 (02) 321-342
    CrossrefPubMedGoogle Scholar
  • 18 Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 58-69
    PubMedGoogle Scholar
  • 19 Polousky JD, Albright J. Salvage techniques in osteochondritis dissecans. Clin Sports Med 2014; 33 (02) 321-333
    CrossrefPubMedGoogle Scholar
  • 20 Gomoll AH, Minas T, Farr J, Cole BJ. Treatment of chondral defects in the patellofemoral joint. J Knee Surg 2006; 19 (04) 285-295
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Wittstein JR, O'Brien SD, Vinson EN, Garrett Jr WE. MRI evaluation of anterior knee pain: predicting response to nonoperative treatment. Skeletal Radiol 2009; 38 (09) 895-901
    CrossrefPubMedGoogle Scholar
  • 22 Winalski CS, Gupta KB. Magnetic resonance imaging of focal articular cartilage lesions. Top Magn Reson Imaging 2003; 14 (02) 131-144
    CrossrefPubMedGoogle Scholar
  • 23 Teo BJ, Buhary K, Tai BC, Hui JH. Cell-based therapy improves function in adolescents and young adults with patellar osteochondritis dissecans. Clin Orthop Relat Res 2013; 471 (04) 1152-1158
    CrossrefPubMedGoogle Scholar
  • 24 Chadli L, Cottalorda J, Delpont M, Mazeau P, Thouvenin Y, Louahem D. Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents. Int Orthop 2017; 41 (01) 197-202
    CrossrefPubMedGoogle Scholar
  • 25 Matava MJ, Brown CD. Osteochondritis dissecans of the patella: arthroscopic fixation with bioabsorbable pins. Arthroscopy 1997; 13 (01) 124-128
    CrossrefPubMedGoogle Scholar
  • 26 Barrett I, King AH, Riester S. , et al. Internal fixation of unstable osteochondritis dissecans in the skeletally mature knee with metal screws. Cartilage 2016; 7 (02) 157-162
    CrossrefPubMedGoogle Scholar
  • 27 Millington KL, Shah JP, Dahm DL, Levy BA, Stuart MJ. Bioabsorbable fixation of unstable osteochondritis dissecans lesions. Am J Sports Med 2010; 38 (10) 2065-2070
    CrossrefPubMedGoogle Scholar
  • 28 Friederichs MG, Greis PE, Burks RT. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. Arthroscopy 2001; 17 (05) 542-545
    Google Scholar
  • 29 Kocher MS, Tucker R, Ganley TJ, Flynn JM. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 2006; 34 (07) 1181-1191
    CrossrefPubMedGoogle Scholar
  • 30 Chambers HG, Shea KG, Anderson AF. , et al; American Academy of Orthopedic Surgeons. Diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg 2011; 19 (05) 297-306
    CrossrefPubMedGoogle Scholar
  • 31 Madry H, Gao L, Eichler H, Orth P, Cucchiarini M. Bone marrow aspirate concentrate-enhanced marrow stimulation of chondral defects. Stem Cells Int 2017; DOI: 10.1155/2017/1609685.
    PubMedGoogle Scholar
  • 32 Hoffman JK, Geraghty S, Protzman NM. Articular cartilage repair using marrow stimulation augmented with a viable chondral allograft: 9-month postoperative histological evaluation. Case Rep Orthop 2015; 2015: 617365
    PubMedGoogle Scholar
  • 33 Delaney R, Barrett C, Stevens P. ProChondrix® cartilage restoration matrix contains growth factors necessary for hyaline cartilage regeneration. Available at: http://www.prochondrix.org/wp-content/uploads/2016/03/M8S0106.001_Basic-Sci-Vol-1-ProCh-Growth-Factor-FINAL.pdf . Accessed March 1, 2017
    PubMedGoogle Scholar
  • 34 Bardos T, Farkas B, Mezes B. , et al. Osteochondral integration of multiply incised pure cartilage allograft: repair method of focal chondral defects in a porcine model. Am J Sports Med 2009; 37 (Suppl. 01) 50S-57S
    CrossrefPubMedGoogle Scholar
  • 35 Bardos T, Vancsodi J, Farkas B. , et al. Pilot study of cartilage repair in the knee joint with multiply incised chondral allograft. Cartilage 2015; 6 (02) 73-81
    CrossrefPubMedGoogle Scholar
  • 36 Visonà E, Chouteau J, Aldegheri R, Fessy MH, Moyen B. Patella osteochondritis dissecans end stage: The osteochondral mosaicplasty option. Orthop Traumatol Surg Res 2010; 96 (05) 543-548
    CrossrefPubMedGoogle Scholar