Tags

Type your tag names separated by a space and hit enter

Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work? A Systematic Review.
Arthroscopy. 2019 08; 35(8):2512-2522.A

Abstract

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.

Authors+Show Affiliations

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan.Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.. Electronic address: Krych.Aaron@mayo.edu.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

31395194

Citation

Leland, Devin P., et al. "Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work? a Systematic Review." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 35, no. 8, 2019, pp. 2512-2522.
Leland DP, Bernard CD, Camp CL, et al. Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work? A Systematic Review. Arthroscopy. 2019;35(8):2512-2522.
Leland, D. P., Bernard, C. D., Camp, C. L., Nakamura, N., Saris, D. B. F., & Krych, A. J. (2019). Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work? A Systematic Review. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 35(8), 2512-2522. https://doi.org/10.1016/j.arthro.2019.03.020
Leland DP, et al. Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work? a Systematic Review. Arthroscopy. 2019;35(8):2512-2522. PubMed PMID: 31395194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work? 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, PY - 2018/12/11/received PY - 2019/03/01/revised PY - 2019/03/04/accepted PY - 2019/8/10/entrez PY - 2019/8/10/pubmed PY - 2020/4/21/medline SP - 2512 EP - 2522 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 35 IS - 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. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/31395194/Does_Internal_Fixation_for_Unstable_Osteochondritis_Dissecans_of_the_Skeletally_Mature_Knee_Work_A_Systematic_Review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(19)30252-X DB - PRIME DP - Unbound Medicine ER -