Skip to main content

Advertisement

SpringerLink
Log in

The “hump” a new arthroscopic phenomenon guiding for reliable therapy of osteochondritis dissecans of variable stability status

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Despite 150 years of research, there are currently no reliable morphological characteristics that can be used to differentiate between stable and unstable juvenile osteochondritis dissecans (JOCD) lesions in the knee joint. Arthroscopic probing is still the gold standard. In arthroscopic evaluation, a previously undescribed pattern of a cartilaginous convex elevation (“hump”) was identified as a new feature and potential sign of JOCD in transition to instability. The aim of the study was to evaluate the clinical outcomes after surgical intervention (drilling) on the “hump”.

Materials and methods

In a retrospective case series of sixteen patients with an arthroscopically detectable “hump”, the analysis of clinical function scores (Lysholm, Tegner) and morphological MRI monitoring of radiological healing were performed. The assessment of lesion healing was based on pre- and postoperative MRI examinations. The “hump” was defined as an arthroscopically impressive protrusion of the femoral articular surface with a minimally softened, discolored, but intact cartilage margin that, is not mobile upon in the arthroscopic palpation hook test. The primary therapy of choice was drilling of all “humps”.

Results

The “hump” could be detected arthroscopically in 16 of 59 JOCD lesions. Specific MRI correlations with the “hump” or arthroscopic unstable lesions could not be detected. Not all “humps” showed signs of MRI-based healing after the drilling, and in some a dissection of the osteochondral flap occurred within the first postoperative year. As a result, secondary refixation became necessary.

Conclusion

In the present study, the “hump” was identified as an important differential diagnostic arthroscopic feature of an arthroscopically primarily stable JOCD lesion, potentially placing the lesion at risk of secondary loosening over time. Therefore, drilling alone may not be appropriate in the event of arthroscopic “hump” discovery, but additional fixation may be required to achieve the healing of the lesion.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abouassaly M, Peterson D, Salci L, Farrokhyar F, D’Souza J, Bhandari M et al (2014) Surgical management of osteochondritis dissecans of the knee in the paediatric population: a systematic review addressing surgical techniques. Knee Surg Sports Traumatol Arthrosc 22:1216–1224. https://doi.org/10.1007/s00167-013-2531-y

    Article  CAS  PubMed  Google Scholar 

  2. Accadbled F, Vial J, Sales de Gauzy J (2018) Osteochondritis dissecans of the knee. Orthop Traumatol Surg Res 104:S97–S105. https://doi.org/10.1016/j.otsr.2017.02.016

    Article  CAS  PubMed  Google Scholar 

  3. Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M (2009) Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy 25:145–152. https://doi.org/10.1016/j.arthro.2008.09.008

    Article  PubMed  Google Scholar 

  4. Adachi N, Deie M, Nakamae A, Okuhara A, Kamei G, Ochi M (2015) Functional and radiographic outcomes of unstable juvenile osteochondritis dissecans of the knee treated with lesion fixation using bioabsorbable pins. J Pediatr Orthop 35:82–88. https://doi.org/10.1097/Bpo.0000000000000226

    Article  PubMed  Google Scholar 

  5. Aglietti P, Buzzi R, Bassi PB, Fioriti M (1994) Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy 10:286–291. https://doi.org/10.1016/s0749-8063(05)80113-6

    Article  CAS  PubMed  Google Scholar 

  6. Anderson AF, Pagnani MJ (1997) Osteochondritis dissecans of the femoral condyles. Long-term results of excision of the fragment. Am J Sports Med 25:830–834. https://doi.org/10.1177/036354659702500617

    Article  CAS  PubMed  Google Scholar 

  7. Andriolo L, Crawford DC, Reale D, Zaffagnini S, Candrian C, Cavicchioli A et al (2020) Osteochondritis dissecans of the knee: etiology and pathogenetic mechanisms. A systematic review. Cartilage 11:273–290. https://doi.org/10.1177/1947603518786557

    Article  PubMed  Google Scholar 

  8. Bohndorf K (1998) Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification. Eur Radiol 8:103–112. https://doi.org/10.1007/s003300050348

    Article  CAS  PubMed  Google Scholar 

  9. Braun S, Vogt S, Imhoff AB (2007) Stage oriented surgical cartilage therapy. Current situation. Orthopade 36:589–599. https://doi.org/10.1007/s00132-007-1095-2 (Quiz 600)

    Article  CAS  PubMed  Google Scholar 

  10. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37:890–897. https://doi.org/10.1177/0363546508330143

    Article  PubMed  Google Scholar 

  11. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Jt Surg Am 85-A(Suppl 2):58–69. https://doi.org/10.2106/00004623-200300002-00008

    Article  Google Scholar 

  12. Cahill BR (1995) Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg 3:237–247. https://doi.org/10.5435/00124635-199507000-00006

    Article  CAS  PubMed  Google Scholar 

  13. Cahill BR, Phillips MR, Navarro R (1989) The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy—a prospective-study. Am J Sports Med 17:601–606. https://doi.org/10.1177/036354658901700502

    Article  CAS  PubMed  Google Scholar 

  14. Carey JL, Wall EJ, Grimm NL, Ganley TJ, Edmonds EW, Anderson AF et al (2016) Novel arthroscopic classification of osteochondritis dissecans of the knee: a multicenter reliability study. Am J Sports Med 44:1694–1698. https://doi.org/10.1177/0363546516637175

    Article  PubMed  Google Scholar 

  15. Chambers HG, Shea KG, Carey JL (2011) AAOS clinical practice guideline: diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg 19:307–309. https://doi.org/10.5435/00124635-201105000-00008

    Article  PubMed  Google Scholar 

  16. Chan C, Richmond C, Shea KG, Frick SL (2018) Management of osteochondritis dissecans of the femoral condyle: a critical analysis review. JBJS Rev 6:e5. https://doi.org/10.2106/JBJS.RVW.17.00005

    Article  PubMed  Google Scholar 

  17. De Smet AA, Fisher DR, Graf BK, Lange RH (1990) Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR Am J Roentgenol 155:549–553. https://doi.org/10.2214/ajr.155.3.2117355

    Article  PubMed  Google Scholar 

  18. Detterline AJ, Goldstein JL, Rue JP, Bach BR Jr (2008) Evaluation and treatment of osteochondritis dissecans lesions of the knee. J Knee Surg 21:106–115. https://doi.org/10.1055/s-0030-1247804

    Article  PubMed  Google Scholar 

  19. Din R, Annear P, Scaddan J (2006) Internal fixation of undisplaced lesions of osteochondritis dissecans in the knee. J Bone Jt Surg Br 88:900–904. https://doi.org/10.1302/0301-620X.88B7.17210

    Article  CAS  Google Scholar 

  20. Dipaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7:101–104. https://doi.org/10.1016/0749-8063(91)90087-e

    Article  CAS  PubMed  Google Scholar 

  21. Dunoski B (2018) Imaging the pediatric athlete: acute and stress skeletal injuries. Mo Med 115:349–353

    PubMed  PubMed Central  Google Scholar 

  22. Edmonds EW, Albright J, Bastrom T, Chambers HG (2010) Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr Orthop 30:870–878. https://doi.org/10.1097/BPO.0b013e3181f5a216

    Article  PubMed  Google Scholar 

  23. Edmonds EW, Polousky J (2013) A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from Konig to the ROCK study group. Clin Orthop Relat Res 471:1118–1126. https://doi.org/10.1007/s11999-012-2290-y

    Article  PubMed  Google Scholar 

  24. Ellermann JM, Donald B, Rohr S, Takahashi T, Tompkins M, Nelson B et al (2016) Magnetic resonance imaging of osteochondritis dissecans: validation study for the ICRS classification system. Acad Radiol 23:724–729. https://doi.org/10.1016/j.acra.2016.01.015

    Article  PubMed  Google Scholar 

  25. Erickson BJ, Chalmers PN, Yanke AB, Cole BJ (2013) Surgical management of osteochondritis dissecans of the knee. Curr Rev Musculoskelet Med 6:102–114. https://doi.org/10.1007/s12178-013-9156-0

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fabricant PD, Milewski MD, Kostyun RO, Wall EJ, Zbojniewicz AM, Research in Osteochondritis of the Knee Study Group et al (2020) Osteochondritis dissecans of the knee: an interrater reliability study of magnetic resonance imaging characteristics. Am J Sports Med 48:2221–2229. https://doi.org/10.1177/0363546520930427

    Article  PubMed  Google Scholar 

  27. Fleiss JL, Levin B, Paik MC (1981) The measurement of interrater agreement. Statistical methods for rates and proportions, vol 2. Wiley, pp 22–23

    Google Scholar 

  28. Gunton MJ, Carey JL, Shaw CR, Murnaghan ML (2013) Drilling juvenile osteochondritis dissecans: retro-or transarticular? Clin Orthop Relat Res 471:1144–1151. https://doi.org/10.1007/s11999-011-2237-8

    Article  PubMed  Google Scholar 

  29. Han Q-x, Tong Y, Zhang L, Sun J, Ma J, Liu X et al (2021) Comparative efficacy of osteochondral autologous transplantation and microfracture in the knee: an updated meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-04075-9

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hayan R, Phillipe G, Ludovic S, Claude K, Jean-Michel C (2010) Juvenile osteochondritis of femoral condyles: treatment with transchondral drilling. Analysis of 40 cases. J Child Orthop 4:39–44. https://doi.org/10.1007/s11832-009-0225-2

    Article  PubMed  Google Scholar 

  31. Imhoff A, König U (2003) Arthroskopie—qualifizierte stadieneinteilung der osteochondralen läsion (OCL) am knie. Arthroskopie 16:23–28. https://doi.org/10.1007/s00142-003-0209-z

    Article  Google Scholar 

  32. Ishikawa M, Nakamae A, Nakasa T, Ikuta Y, Hayashi S, Ochi M et al (2018) Limitation of in-situ arthroscopic fixation for stable juvenile osteochondritis dissecans in the knee. J Pediatr Orthop B 27:516–521. https://doi.org/10.1097/BPB.0000000000000531

    Article  PubMed  Google Scholar 

  33. Jones MH, Williams AM (2016) Osteochondritis dissecans of the knee: a practical guide for surgeons. Bone Jt J 98-B:723–729. https://doi.org/10.1302/0301-620X.98B6.36816

    Article  CAS  Google Scholar 

  34. Kaiser N, Jakob RP, Pagenstert G, Tannast M, Petek D (2021) Stable clinical long term results after AMIC in the aligned knee. Arch Orthop Trauma Surg 141:1845–1854. https://doi.org/10.1007/s00402-020-03564-7

    Article  PubMed  Google Scholar 

  35. Kocher MS, Tucker R, Ganley TJ, Flynn JM (2006) Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 34:1181–1191. https://doi.org/10.1177/0363546506290127

    Article  PubMed  Google Scholar 

  36. Komnos G, Iosifidis M, Papageorgiou F, Melas I, Metaxiotis D, Hantes M (2021) Juvenile osteochondritis dissecans of the knee joint: midterm clinical and MRI outcomes of arthroscopic retrograde drilling and internal fixation with bioabsorbable pins. Cartilage 13:19476035211003324. https://doi.org/10.1177/19476035211003325

    Article  CAS  Google Scholar 

  37. Krause M, Hapfelmeier A, Moller M, Amling M, Bohndorf K, Meenen NM (2013) Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment. Am J Sports Med 41:2384–2391. https://doi.org/10.1177/0363546513496049

    Article  PubMed  Google Scholar 

  38. Krause M, Lehmann D, Amling M, Rolvien T, Frosch KH, Puschel K et al (2015) Intact bone vitality and increased accumulation of nonmineralized bone matrix in biopsy specimens of juvenile osteochondritis dissecans: a histological analysis. Am J Sports Med 43:1337–1347. https://doi.org/10.1177/0363546515572579

    Article  PubMed  Google Scholar 

  39. Kubota M, Ishijima M, Ikeda H, Takazawa Y, Saita Y, Kaneko H et al (2018) Mid and long term outcomes after fixation of osteochondritis dissecans. J Orthop 15:536–539. https://doi.org/10.1016/j.jor.2018.01.002

    Article  PubMed  PubMed Central  Google Scholar 

  40. Linden B (1976) The incidence of osteochondritis dissecans in the condyles of the femur. Acta Orthop Scand 47:664–667. https://doi.org/10.3109/17453677608988756

    Article  CAS  PubMed  Google Scholar 

  41. Magnussen RA, Carey JL, Spindler KP (2009) Does operative fixation of an osteochondritis dissecans loose body result in healing and long-term maintenance of knee function? Am J Sports Med 37:754–759. https://doi.org/10.1177/0363546508328119

    Article  PubMed  PubMed Central  Google Scholar 

  42. Masquijo J, Kothari A (2019) Juvenile osteochondritis dissecans (JOCD) of the knee: current concepts review. EFORT Open Rev 4:201–212. https://doi.org/10.1302/2058-5241.4.180079

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pareek A, Sanders TL, Wu IT, Larson DR, Saris DBF, Krych AJ (2017) Incidence of symptomatic osteochondritis dissecans lesions of the knee: a population-based study in Olmsted County. Osteoarthr Cartil 25:1663–1671. https://doi.org/10.1016/j.joca.2017.07.005

    Article  CAS  Google Scholar 

  44. Pascual-Garrido C, McNickle AG, Cole BJ (2009) Surgical treatment options for osteochondritis dissecans of the knee. Sports Health 1:326–334. https://doi.org/10.1177/1941738109334216

    Article  PubMed  PubMed Central  Google Scholar 

  45. Pennock AT, Bomar JD, Chambers HG (2013) Extra-articular, intraepiphyseal drilling for osteochondritis dissecans of the knee. Arthrosc Tech 2:e231-235. https://doi.org/10.1016/j.eats.2013.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  46. Perelli S, Romoli ARM, Costa-Paz M, Erquicia JI, Gelber PE, Monllau JC (2019) Internal fixation of osteochondritis dissecans of the knee leads to good long-term outcomes and high degree of healing without differences between fixation devices. J Clin Med 8:1934. https://doi.org/10.3390/jcm8111934

    Article  PubMed  PubMed Central  Google Scholar 

  47. Peterson L, Minas T, Brittberg M, Lindahl A (2003) Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation—results at two to ten years. J Bone Jt Surg 85a:17–24. https://doi.org/10.2106/00004623-200300002-00003

    Article  Google Scholar 

  48. Quatman CE, Quatman-Yates CC, Schmitt LC, Paterno MV (2012) The clinical utility and diagnostic performance of MRI for identification and classification of knee osteochondritis dissecans. J Bone Jt Surg Am 94:1036–1044. https://doi.org/10.2106/JBJS.K.00275

    Article  Google Scholar 

  49. Roßbach BP, Paulus AC, Niethammer TR, Wegener V, Gülecyüz MF, Jansson V et al (2016) Discrepancy between morphological findings in juvenile osteochondritis dissecans (OCD): a comparison of magnetic resonance imaging (MRI) and arthroscopy. Knee Surg Sports Traumatol Arthrosc 24:1259–1264. https://doi.org/10.1007/s00167-015-3724-3

    Article  PubMed  Google Scholar 

  50. Salci L, Ayeni O, Abouassaly M, Farrokhyar F, D’Souza JA, Bhandari M et al (2014) Indications for surgical management of osteochondritis dissecans of the knee in the pediatric population: a systematic review. J Knee Surg 27:147–155. https://doi.org/10.1055/s-0033-1360653

    Article  PubMed  Google Scholar 

  51. Samora WP, Chevillet J, Adler B, Young GS, Klingele KE (2012) Juvenile osteochondritis dissecans of the knee: predictors of lesion stability. J Pediatr Orthop 32:1–4. https://doi.org/10.1097/BPO.0b013e31823d8312

    Article  PubMed  Google Scholar 

  52. Shea KG, Richmond CG, Ganley TJ (2018) Osteochondritis dissecans in the skeletally immature knee. Instr Course Lect 67:403–412

    PubMed  Google Scholar 

  53. Sofu H, Gumussuyu G, Guler O, Ucpunar H, Duman S, Camurcu Y (2021) Lesion size and varus malalignment are the major determinants leading to poorer clinical outcomes after combined microfracture treatment for focal cartilage lesions during anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-04138-x

    Article  PubMed  Google Scholar 

  54. Tabaddor RR, Banffy MB, Andersen JS, McFeely E, Ogunwole O, Micheli LJ et al (2010) Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop 30:14–20. https://doi.org/10.1097/BPO.0b013e3181c6318c

    Article  PubMed  Google Scholar 

  55. Uppstrom TJ, Gausden EB, Green DW (2016) Classification and assessment of juvenile osteochondritis dissecans knee lesions. Curr Opin Pediatr 28:60–67. https://doi.org/10.1097/MOP.0000000000000308

    Article  PubMed  Google Scholar 

  56. Wall EJ, Vourazeris J, Myer GD, Emery KH, Divine JG, Nick TG et al (2008) The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am 90:2655–2664. https://doi.org/10.2106/JBJS.G.01103

    Article  PubMed  PubMed Central  Google Scholar 

  57. Wu IT, Custers RJ, Desai VS, Pareek A, Stuart MJ, Saris DB et al (2018) Internal fixation of unstable osteochondritis dissecans: do open growth plates improve healing rate? Am J Sports Med 46:2394–2401. https://doi.org/10.1177/0363546518783737

    Article  PubMed  Google Scholar 

  58. Yonetani Y, Matsuo T, Nakamura N, Natsuume T, Tanaka Y, Shiozaki Y et al (2010) Fixation of detached osteochondritis dissecans lesions with bioabsorbable pins: clinical and histologic evaluation. Arthroscopy 26:782–789. https://doi.org/10.1016/j.arthro.2009.10.009

    Article  PubMed  Google Scholar 

  59. Yonetani Y, Nakamura N, Natsuume T, Shiozaki Y, Tanaka Y, Horibe S (2010) Histological evaluation of juvenile osteochondritis dissecans of the knee: a case series. Knee Surg Sports Traumatol Arthrosc 18:723–730. https://doi.org/10.1007/s00167-009-0898-6

    Article  PubMed  Google Scholar 

  60. Yonetani Y, Tanaka Y, Shiozaki Y, Kanamoto T, Kusano M, Tsujii A et al (2012) Transarticular drilling for stable juvenile osteochondritis dissecans of the medial femoral condyle. Knee Surg Sports Traumatol Arthrosc 20:1528–1532. https://doi.org/10.1007/s00167-011-1736-1

    Article  PubMed  Google Scholar 

Download references

Funding

No external source of funding was used.

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    A. Korthaus & M. Krause

  2. Pediatric Sports Medicine, Sports Traumatology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany

    N. M. Meenen

  3. CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058, Basel, Switzerland

    G. Pagenstert

Authors
  1. A. Korthaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. M. Meenen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Pagenstert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Krause
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NMM, AK, MK conceived the project, the main conceptual ideas and the proof sketch. NMM, MK, GP, AK wrote the manuscript. AK performed the data analysis. All authors discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to N. M. Meenen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

A positive ethics vote of the ethics committee of the Hamburg Medical Chamber is available (PV 3795).

Informed consent

For this type of study informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Korthaus, A., Meenen, N.M., Pagenstert, G. et al. The “hump” a new arthroscopic phenomenon guiding for reliable therapy of osteochondritis dissecans of variable stability status. Arch Orthop Trauma Surg 143, 1513–1521 (2023). https://doi.org/10.1007/s00402-022-04409-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-022-04409-1

Keywords

Search

Navigation