Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleOutcomes of Osteochondral Lesions of the Knee Repaired With a Bioabsorbable Device
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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Cited by (55)
Unstable Knee OCD Lesion Fixation with Bioabsorbable Fixation
2023, Operative Techniques in Sports MedicineBiomechanical Analysis of Unstable Osteochondral Fragment Fixation Using Three Different Techniques: Osteochondral Plug, Bioabsorbable Pin, and Suture Anchor with Tape
2022, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :Regarding bioabsorbable internal fixation for unstable knee OCD, Chun et al.12 reported favorable outcomes after bioabsorbable screw fixation in adolescents without complications due to fixation failure. In previous reports,13,14 although the number of patients was relatively small and there were some differences in the union rate depending on the age of patients, good clinical results have been reported. In contrast, low rates of clinical healing and high complication rates after bioabsorbable fixation among skeletally mature patients were suggested.15
Knotless Suture Anchor Fixation of a Traumatic Osteochondral Lesion of the Lateral Femoral Condyle
2021, Arthroscopy TechniquesCitation Excerpt :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.
Does Internal Fixation for Unstable Osteochondritis Dissecans of the Skeletally Mature Knee Work? A Systematic Review
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :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.