Document Title: Makino-AJSM-Oct05.shtml
Article Title: Arthroscopic Fixation of Osteochondritis Dissecans of the Knee Clinical, Magnetic Resonance Imaging, and Arthroscopic Follow-up
Authors: Arturo Makino, MD, D. Luis Muscolo, MD, Miguel Puigdevall, MD, Matias Costa-Paz, MD and Miguel Ayerza, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date:
Volume 33, pages 1499-1504
Keywords: osteochondritis dissecans, Herbert-screw fixation, magnetic resonance imaging (MRI), second-look, long-term effects.

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Comments: Osteochondritis dissecans, a separation (delamination) of the articular-cartilage layer from the underlying bone, is troubling in that can bring degeneration and eventual osteoarthritis in the long term. These Argentinian authors found that using a titantium screw to anchor the loose portion brings viable results. One concern that arises with this approach is that even though the screw is countersunk, loss of thickness of the articular cartilage in the area could eventually result in mechanical abrasion (by the screw head) of the mating articular cartilage surface (i.e. on the other bone in the articulation). Also of concern is the fact that the area represented by the screw's presence translates into a reduction (albeit a small one) of load-bearing surface area. Even though the Herbert screw can be removed later on, the space it occupied can, at best, fill with biomechanically suboptimal fibrocartilage (instead of the high-quality hyaline articular cartilage that normally defines a bone's uninjured load-bearing surface).

ABSTRACT

Background: Optimal treatment of osteochondritis dissecans of the knee is still controversial.

Purpose: To review a group of patients with osteochondritis dissecans of the knee who were treated with arthroscopic compressive screw fixation and who were evaluated with magnetic resonance imaging studies and a second-look arthroscopic procedure at follow-up.

Study Design: Case series; level of evidence, 4.

Methods: A total of 14 patients (15 knees) with osteochondritis dissecans of the knee were treated with arthroscopic titanium Herbert screw fixation of the osteochondral fragment. A second-look arthroscopic procedure was performed to remove hardware and to evaluate fragment stability. At final follow-up, magnetic resonance imaging studies were used to evaluate potential healing of the subchondral bone. Outcomes were clinically evaluated at a mean follow-up of 50 months (range, 25–104 months) by the Lysholm score and by the International Knee Documentation Committee score.

Results: At second-look arthroscopy, 14 of 15 knees showed evidence of a stable fragment with an intact smooth surface. According to magnetic resonance imaging parameters, 14 knees showed evidence of a healing process of the osteochondral fragment. The average Lysholm score improved 18 points from a mean of 79 preoperatively to 97 postoperatively, and according to the International Knee Documentation Committee score, 13 of 15 knees showed a normal result.

Conclusion: This study suggests that magnetic resonance imaging parameters of a healed osteochondral fragment and patients with satisfactory functional results correspond with arthroscopic evidence of fragment stability. According to this study, arthroscopic fixation with compressive screws is an effective method of repair for osteochondritis dissecans of the knee.

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