Original Article
Outcomes of Osteochondral Lesions of the Knee Repaired With a Bioabsorbable Device

https://doi.org/10.1016/j.arthro.2007.07.025Get rights and content

Purpose: We sought to evaluate the functional and radiographic outcome of osteochondral lesions involving the femoral condyle that were arthroscopically repaired via a bioabsorbable fixation device made of self-reinforced poly-L-lactic acid. Methods: A retrospective clinical and radiographic evaluation of 9 patients (8 male and 1 female) with a mean age of 18 years at the time of surgery was carried out. Of these patients, 8 were diagnosed with osteochondritis dissecans and 1 had a traumatic chondral fracture. All patients underwent arthroscopic repair of a discrete osteochondral lesion involving the femoral condyle with a bioabsorbable fixation implant. All patients were evaluated at a mean of 33 months postoperatively. All patients had preoperative magnetic resonance imaging (MRI) documenting the integrity and location of the fragment. Patients were evaluated at follow-up with a physical examination, Lysholm questionnaire, and repeated MRI with specific cartilage pulse sequencing. Results: At surgery, the mean size of the fragment was 2 × 2 cm. A mean of 4 nails was used in each case (range, 2 to 10). All patients were treated with a postoperative rehabilitation protocol of non–weight-bearing for a minimum of 6 weeks. The mean postoperative Lysholm score was 94 (range, 78 to 100). The outcomes were excellent in 7 patients, good in 1, and fair in 1. After surgery, MRI evaluation of the osteochondral lesion and overlying cartilage was graded as healed in 7 patients and of questionable integrity in 2. Conclusions: This report documents the efficacy of a bioabsorbable nail to internally fix osteochondral lesions. It supports the use of MRI for both preoperative planning and postoperative assessment of fragment healing. Level of Evidence: Level IV, therapeutic case series.

Section snippets

Methods

We treated 9 consecutive patients (8 male and 1 female) with femoral osteochondral defects of either the medial or lateral condyle (OCD in 8 and osteochondral fracture in 1) with a bioabsorbable nail composed of SR-PLLA (SmartNail; ConMed Linvatec, Largo, FL) (Fig 1). Each device used for the procedures measured 1.5 mm in diameter and 16, 20, or 25 mm in length depending on the length needed.

Preoperative MRI with fast spin-echo images in 3 planes to assess articular cartilage via validated

Results

Preoperative MRI findings were interpreted as being consistent with OCD in 8 patients and an osteochondral fracture in the other patient. On the basis of the Dipaola MRI staging classification (Table 1), 5 lesions were classified as stage II (breach of the articular cartilage and decreased signal consistent with fibrous tissue surrounding the osteochondritic lesion) and 4 were consistent with stage III lesions (separation of the articular cartilage and increased signal on T2 behind the fragment

Discussion

OCD represents a spectrum of pathology that responds well to different treatment options based on the age of the patient and stage of the lesion.2, 3, 4, 5 For patients in whom nonoperative management fails or who have unstable lesions, internal fixation of the fragment can provide good results. This report documents the efficacy of an arthroscopically inserted bioabsorbable nail to treat OCD lesions of the femoral condyle. By proceeding arthroscopically, the clinician subjects the patient to a

Conclusions

This report documents the efficacy of a bioabsorbable nail to internally fix osteochondral lesions. It supports the use of MRI for both preoperative planning and postoperative assessment of fragment healing.

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      Treatment options include fragment excision, which can lead to early degenerative arthritis, and osteochondral fragment fixation.17,18 There are a number of successful techniques for fixation of osteochondral fractures, including metal screws, bioabsorbable pins and screws, and suture-only techniques.9-13,15,16 Metal screws provide excellent fixation strength and compression across the fracture fragment, but they often require a second surgery for screw removal.

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      Millington et al.7 reported a healing rate of 67% (12 of 18) after fixation with various bioabsorbable devices. In 3 additional studies, the rate of radiographic healing was found to be 88%-100%.8,17,19 On second-look arthroscopy, healing was characterized by union of the OCD progeny fragment with stability when probed.

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    R.F.W. received support exceeding $500 from ConMed Linvatec, Largo, Florida, related to this research.

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