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Erschienen in: Clinical Orthopaedics and Related Research® 4/2013

01.04.2013 | Symposium: Osteochondritis Dissecans

Drilling Juvenile Osteochondritis Dissecans: Retro- or Transarticular?

verfasst von: Matthew J. Gunton, MD, James L. Carey, MD, MPH, Colin R. Shaw, BSc (Hons), MSc, M. Lucas Murnaghan, MD, MEd, FRCSC

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 4/2013

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Abstract

Background

Early diagnosis and successful treatment of juvenile osteochondritis dissecans (JOCD) is essential in preventing articular degeneration at a young age. Surgical treatment of stable JOCD lesions failing nonoperative treatment involves retroarticular or transarticular drilling to induce revascularization and healing. Multiple case series report high healing rates and infrequent complications for both retroarticular and transarticular drilling modalities; however, it is unclear from these individual reports whether one mode of drilling provides higher healing rates.

Questions/purposes

We asked whether transarticular or retroarticular drilling of stable JOCD lesions results in differing patient-oriented outcomes, rates of radiographic healing, time to radiographic healing, and complication rates.

Methods

We systematically reviewed the short-term clinical outcomes of retroarticular and transarticular drilling of stable OCD lesions. PubMed and additional sources identified 65 studies; 12 studies met inclusion criteria.

Results

Heterogeneity and quality of studies limited review to qualitative analysis. No clear differences were seen in patient-oriented outcomes after treatment with either drilling modality. Radiographic healing for JOCD lesions drilled retroarticularly occurred in 96 of 111 (86%) lesions in an average of 5.6 months. Transarticular drilling of JOCD lesions resulted in 86 of 94 (91%) lesions healing by radiography in an average of 4.5 months. No complications were reported for either drilling modality.

Conclusions

Retroarticular and transarticular drilling of stable lesions results in comparable short-term patient-oriented outcomes and radiographic healing. Further high-quality comparative studies are required to adequately compare drilling modalities, clearly define radiographic healing, and patient-oriented outcomes after nonoperative treatment.
Literatur
1.
Zurück zum Zitat Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M. Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy. 2009;25:145–152.PubMedCrossRef Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M. Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy. 2009;25:145–152.PubMedCrossRef
2.
Zurück zum Zitat Aglietti P, Buzzi R, Bassi P, Fioriti M. Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy. 1994;10:286–291.PubMedCrossRef Aglietti P, Buzzi R, Bassi P, Fioriti M. Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy. 1994;10:286–291.PubMedCrossRef
3.
Zurück zum Zitat Aichroth P. Osteochondritis dissecans of the knee. A clinical survey. J Bone Joint Surg Br. 1971;53:440–447.PubMed Aichroth P. Osteochondritis dissecans of the knee. A clinical survey. J Bone Joint Surg Br. 1971;53:440–447.PubMed
4.
Zurück zum Zitat Anderson A, Richards D, Pagnani M, Hovis D. Antegrade drilling for osteochondritis dissecans of the knee. Arthroscopy. 1997;13:319–324.PubMedCrossRef Anderson A, Richards D, Pagnani M, Hovis D. Antegrade drilling for osteochondritis dissecans of the knee. Arthroscopy. 1997;13:319–324.PubMedCrossRef
5.
Zurück zum Zitat Bradley J, Dandy D. Results of drilling osteochondritis dissecans before skeletal maturity. J Bone Joint Surg Br. 1989;71:642–644.PubMed Bradley J, Dandy D. Results of drilling osteochondritis dissecans before skeletal maturity. J Bone Joint Surg Br. 1989;71:642–644.PubMed
6.
Zurück zum Zitat Cahill BR, Phillips MR, Navarro R. The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy: a prospective study. Am J Sports Med. 1989;17:601–606.PubMedCrossRef Cahill BR, Phillips MR, Navarro R. The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy: a prospective study. Am J Sports Med. 1989;17:601–606.PubMedCrossRef
7.
Zurück zum Zitat Cepero S, Ullot R, Sastre S. Osteochondritis of the femoral condyles in children and adolescents: our experience over the last 28 years. J Pediatr Orthop B. 2005;14:24–29.PubMedCrossRef Cepero S, Ullot R, Sastre S. Osteochondritis of the femoral condyles in children and adolescents: our experience over the last 28 years. J Pediatr Orthop B. 2005;14:24–29.PubMedCrossRef
8.
Zurück zum Zitat Chambers HG, Shea KG, Anderson AF, Brunelle TJ, Carey JL, Ganley TJ, Paterno MV, Weiss JM, Sanders JO, Watters WC 3rd, Goldberg MJ, Keith MW, Turkelson CM, Wies JL, Raymond L, Boyer KM, Hitchock K, Anderson S, Sluka P, Boone C, Patel N; American Academy of Orthopedic Surgeons. Diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg. 2011;19:297–306.PubMed Chambers HG, Shea KG, Anderson AF, Brunelle TJ, Carey JL, Ganley TJ, Paterno MV, Weiss JM, Sanders JO, Watters WC 3rd, Goldberg MJ, Keith MW, Turkelson CM, Wies JL, Raymond L, Boyer KM, Hitchock K, Anderson S, Sluka P, Boone C, Patel N; American Academy of Orthopedic Surgeons. Diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg. 2011;19:297–306.PubMed
9.
Zurück zum Zitat Donaldson L, Wojtys E. Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee. J Pediatr Orthop. 2008;28:831–835.PubMedCrossRef Donaldson L, Wojtys E. Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee. J Pediatr Orthop. 2008;28:831–835.PubMedCrossRef
10.
Zurück zum Zitat Edmonds E, Albright J, Bastrom T, Chambers H. Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr Orthop. 2010;30:870–878.PubMedCrossRef Edmonds E, Albright J, Bastrom T, Chambers H. Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr Orthop. 2010;30:870–878.PubMedCrossRef
11.
Zurück zum Zitat Flynn JM, Kocher MS, Ganley TJ. Osteochondritis dissecans of the knee. J Pediatr Orthop. 2004;24:434–443.PubMedCrossRef Flynn JM, Kocher MS, Ganley TJ. Osteochondritis dissecans of the knee. J Pediatr Orthop. 2004;24:434–443.PubMedCrossRef
12.
Zurück zum Zitat Guhl J. Arthroscopic treatment of osteochondritis dissecans: a preliminary report. Orthop Clin North Am. 1979;10:671–683.PubMed Guhl J. Arthroscopic treatment of osteochondritis dissecans: a preliminary report. Orthop Clin North Am. 1979;10:671–683.PubMed
13.
Zurück zum Zitat Guhl J. Arthroscopic treatment of osteochondritis dissecans. Clin Orthop Relat Res. 1982;167:65–74.PubMed Guhl J. Arthroscopic treatment of osteochondritis dissecans. Clin Orthop Relat Res. 1982;167:65–74.PubMed
14.
Zurück zum Zitat Hartman JM, Forsen JW Jr, Wallace MS, Neely JG. Tutorials in clinical research: part IV: recognizing and controlling bias. Laryngoscope. 2002;112:23–31.PubMedCrossRef Hartman JM, Forsen JW Jr, Wallace MS, Neely JG. Tutorials in clinical research: part IV: recognizing and controlling bias. Laryngoscope. 2002;112:23–31.PubMedCrossRef
15.
Zurück zum Zitat Hayan R, Phillipe G, Ludovic S, Claude K, Jean-Michel C. Juvenile osteochondritis of femoral condyles: treatment with transchondral drilling. Analysis of 40 cases. J Child Orthop. 2009 Dec 18 [Epub ahead of print]. Hayan R, Phillipe G, Ludovic S, Claude K, Jean-Michel C. Juvenile osteochondritis of femoral condyles: treatment with transchondral drilling. Analysis of 40 cases. J Child Orthop. 2009 Dec 18 [Epub ahead of print].
16.
Zurück zum Zitat Hefti F, Berguiristain J, Krauspe R, Möller-Madsen B, Riccio V, Tschauner C, Wetzel R, Zeller R. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B. 1999;8:231–245.PubMed Hefti F, Berguiristain J, Krauspe R, Möller-Madsen B, Riccio V, Tschauner C, Wetzel R, Zeller R. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B. 1999;8:231–245.PubMed
17.
Zurück zum Zitat Hughston JC, Hergenroeder PT, Courtenay BG. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am. 1984;66:1340–1348.PubMed Hughston JC, Hergenroeder PT, Courtenay BG. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am. 1984;66:1340–1348.PubMed
18.
Zurück zum Zitat Kawasaki K, Uchio Y, Adachi N, Iwasa J, Ochi M. Drilling from the intercondylar area for treatment of osteochondritis dissecans of the knee joint. Knee. 2003;10:257–263.PubMedCrossRef Kawasaki K, Uchio Y, Adachi N, Iwasa J, Ochi M. Drilling from the intercondylar area for treatment of osteochondritis dissecans of the knee joint. Knee. 2003;10:257–263.PubMedCrossRef
19.
Zurück zum Zitat Kocher M, Micheli L, Yaniv M, Zurakowski D, Ames A, Adrignolo A. Functional and Radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med. 2001;29:562–566.PubMed Kocher M, Micheli L, Yaniv M, Zurakowski D, Ames A, Adrignolo A. Functional and Radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med. 2001;29:562–566.PubMed
20.
Zurück zum Zitat Kocher MS, Smith JT, Iversen MD, Brustowicz K, Ogunwole O, Andersen J, Yoo WJ, McFeely ED, Anderson AF, Zurakowski D. Reliability, validity, and responsiveness of a modified International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC) in children with knee disorders. Am J Sports Med. 2011;39:933–939.PubMedCrossRef Kocher MS, Smith JT, Iversen MD, Brustowicz K, Ogunwole O, Andersen J, Yoo WJ, McFeely ED, Anderson AF, Zurakowski D. Reliability, validity, and responsiveness of a modified International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC) in children with knee disorders. Am J Sports Med. 2011;39:933–939.PubMedCrossRef
21.
Zurück zum Zitat Konig F. [Regarding free bodies in joints] [in German]. Dtsch Z Chir. 1887–1888;27:90–109. Konig F. [Regarding free bodies in joints] [in German]. Dtsch Z Chir. 1887–1888;27:90–109.
22.
Zurück zum Zitat Lee C, Mercurio C. Operative treatment of osteochondritis dissecans in situ by retrograde drilling and cancellous bone graft: a preliminary report. Clin Orthop Relat Res. 1981;158:129–136.PubMed Lee C, Mercurio C. Operative treatment of osteochondritis dissecans in situ by retrograde drilling and cancellous bone graft: a preliminary report. Clin Orthop Relat Res. 1981;158:129–136.PubMed
23.
Zurück zum Zitat Linden B. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am. 1977;59:769–776.PubMed Linden B. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am. 1977;59:769–776.PubMed
24.
Zurück zum Zitat Lindholm TS, Osterman K. Treatment of juvenile osteochondritis dissecans in the knee. Acta Orthop Belg. 1979;45:633–640.PubMed Lindholm TS, Osterman K. Treatment of juvenile osteochondritis dissecans in the knee. Acta Orthop Belg. 1979;45:633–640.PubMed
25.
Zurück zum Zitat Louisia S, Beaufils P, Katabi M, Robert H. Transchondral drilling for osteochondritis dissecans of the medial condyle of the knee. Knee Surg Sports Traumatol Arthrosc. 2003;11:33–39.PubMed Louisia S, Beaufils P, Katabi M, Robert H. Transchondral drilling for osteochondritis dissecans of the medial condyle of the knee. Knee Surg Sports Traumatol Arthrosc. 2003;11:33–39.PubMed
26.
Zurück zum Zitat Mitsuoka T, Shino K, Hamada M, Horibe S. Osteochondritis dissecans of the lateral femoral condyle of the knee joint. Arthroscopy. 1999;15:20–26.PubMedCrossRef Mitsuoka T, Shino K, Hamada M, Horibe S. Osteochondritis dissecans of the lateral femoral condyle of the knee joint. Arthroscopy. 1999;15:20–26.PubMedCrossRef
27.
Zurück zum Zitat Ojala R, Kerimaa P, Lakovaara M, Hyvönen P, Lehenkari P, Tervonen O, Blanco-Segueiros R. MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the knee. Skeletal Radiol. 2011;40:765–770.PubMedCrossRef Ojala R, Kerimaa P, Lakovaara M, Hyvönen P, Lehenkari P, Tervonen O, Blanco-Segueiros R. MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the knee. Skeletal Radiol. 2011;40:765–770.PubMedCrossRef
28.
Zurück zum Zitat Paget J. On the production of some of the loose bodies and joints. St Bartholomew’s Hosp Rep. 1870;6:1–4. Paget J. On the production of some of the loose bodies and joints. St Bartholomew’s Hosp Rep. 1870;6:1–4.
29.
Zurück zum Zitat Pascual-Garrido C, Friel NA, Kirk SS, McNickle AG, Bach BR Jr, Bush-Joseph CA, Verma NN, Cole BJ. Midterm results of surgical treatment for adult osteochondritis dissecans of the knee. Am J Sports Med. 2009;37(Suppl 1):125S–130S.PubMedCrossRef Pascual-Garrido C, Friel NA, Kirk SS, McNickle AG, Bach BR Jr, Bush-Joseph CA, Verma NN, Cole BJ. Midterm results of surgical treatment for adult osteochondritis dissecans of the knee. Am J Sports Med. 2009;37(Suppl 1):125S–130S.PubMedCrossRef
30.
Zurück zum Zitat Pill SG, Ganley TJ, Milam RA, Lou JE, Meyer JS, Flynn JM. Role of magnetic resonance imaging and clinical criteria in predicting successful nonoperative treatment of osteochondritis dissecans in children. J Pediatr Orthop. 2003;23:102–108.PubMed Pill SG, Ganley TJ, Milam RA, Lou JE, Meyer JS, Flynn JM. Role of magnetic resonance imaging and clinical criteria in predicting successful nonoperative treatment of osteochondritis dissecans in children. J Pediatr Orthop. 2003;23:102–108.PubMed
32.
Zurück zum Zitat Sales de Gauzy J, Mansat C, Darodes PH, Cahuzac JP. Natural course of osteochondritis dissecans in children. J Pediatr Orthop B. 1999;8:26–28.PubMed Sales de Gauzy J, Mansat C, Darodes PH, Cahuzac JP. Natural course of osteochondritis dissecans in children. J Pediatr Orthop B. 1999;8:26–28.PubMed
33.
Zurück zum Zitat Smillie I. Treatment of osteochondritis dissecans. J Bone Joint Surg Br. 1957;39:248–260.PubMed Smillie I. Treatment of osteochondritis dissecans. J Bone Joint Surg Br. 1957;39:248–260.PubMed
34.
Zurück zum Zitat Wall E, Von Stein D. Juvenile osteochondritis dissecans. Orthop Clin North Am. 2003;34:341–353.PubMedCrossRef Wall E, Von Stein D. Juvenile osteochondritis dissecans. Orthop Clin North Am. 2003;34:341–353.PubMedCrossRef
35.
Zurück zum Zitat Wall EJ, Vourazeris J, Myer GD, Emery KH, Divine JG, Nick TG, Hewett TE. The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am. 2008;90:2655–2664.PubMedCrossRef Wall EJ, Vourazeris J, Myer GD, Emery KH, Divine JG, Nick TG, Hewett TE. The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am. 2008;90:2655–2664.PubMedCrossRef
36.
Zurück zum Zitat Wright RW. Knee injury outcomes measures. J Am Acad Orthop Surg. 2009;17:31–39.PubMed Wright RW. Knee injury outcomes measures. J Am Acad Orthop Surg. 2009;17:31–39.PubMed
Metadaten
Titel
Drilling Juvenile Osteochondritis Dissecans: Retro- or Transarticular?
verfasst von
Matthew J. Gunton, MD
James L. Carey, MD, MPH
Colin R. Shaw, BSc (Hons), MSc
M. Lucas Murnaghan, MD, MEd, FRCSC
Publikationsdatum
01.04.2013
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 4/2013
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-011-2237-8

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