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Surgical management of osteochondritis dissecans of the knee in the paediatric population: a systematic review addressing surgical techniques

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Several case series have been published exploring a variety of surgical treatments for osteochondritis dissecans (OCD) in patients 18 years and younger, but a systematic review is currently lacking. This systemic review identifies the various surgical techniques reported in the literature for treating OCD and assesses the effectiveness of these treatments based on functional outcomes and radiographic healing.

Methods

A search of the EMBASE and MEDLINE databases was performed to identify clinical studies reporting outcomes of surgical management of OCD in the knee. A quality assessment of the included articles was conducted independently by 2 reviewers using a quality assessment tool developed by Yang et al.

Results

A total of 25 papers including 470 patients aged ≤18 years (516 lesions) met the eligibility criteria and were reviewed. Surgical techniques for stable lesions included (arthroscopic and open) transarticular drilling, either alone (41 %) or with bioabsorbable pin fixation (3 %), extra-articular drilling (29 %) and fixation with bioabsorbable screws (4 %) or bone pegs (4 %). For unstable lesions, surgical techniques included (arthroscopic and open) fixation with bioabsorbable pins (9 %), metal screws (4 %), bone pegs (4 %), osteochondral plugs (3 %) or bioabsorbable screws (2 %), as well as transarticular drilling with bioabsorbable pin fixation (3 %) and drilling with metal screw fixation (2 %).

Conclusion

The most common techniques were transarticular drilling for stable lesions and bioabsorbable pin fixation for unstable lesions. The key findings were that the vast majority of lesions healed postoperatively, regardless of technique, and that high-quality trials are required to more appropriately compare the effectiveness of techniques.

Level of evidence

Systematic review, Level IV.

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Acknowledgments

Dr. Bhandari is funded in part by a Canada Research Chair. No funding was received for the completion of this manuscript.

Conflict of interest

There are no possible conflicts of interest associated with this manuscript.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St. West, Room 4E17, Hamilton, ON, L8N 3Z5, Canada

    M. Abouassaly, D. Peterson, L. Salci, M. Bhandari & O. R. Ayeni

  2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    F. Farrokhyar, J. D’Souza & M. Bhandari

Authors
  1. M. Abouassaly
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  2. D. Peterson
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  3. L. Salci
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  4. F. Farrokhyar
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  5. J. D’Souza
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  6. M. Bhandari
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  7. O. R. Ayeni
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Corresponding author

Correspondence to O. R. Ayeni.

Appendix: Search strategy

Appendix: Search strategy

(Osteochondritis or osteochondriti*.mp or ocd.mp or Joint Loose Bodies or loose bod*.mp) and (Knee or knee*.mp Knee Injuries or knee injur*.mp or Knee Joint patellofemoral.mp femoropatellar.mp or tibiofemoral.mp or femorotibial.mp or Femur or femur*.mp or Patella or patella*.mp)—limiting to [English language and humans and year = “2000–Current” and “all child (0–18 years)”] and excluding review articles. EMBASE was searched for (osteochondritis or osteochondritis dissecans or osteochondriti*.mp or ocd.mp or joint destruction or loose bod*.mp) and (knee or knee injury or knee*.mp or patellofemoral.mp or femoropatellar.mp or tibiofemoral.mp or femorotibial.mp or femur*.mp or femur or patella or patella*.mp)—limiting to [human and English language and year = “2000–Current” and (infant or child or preschool child < 1–6 years > or school child < 7–12 years > or adolescent < 13–17 years >)] and excluding review articles.

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Abouassaly, M., Peterson, D., Salci, L. et al. 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 (2014). https://doi.org/10.1007/s00167-013-2531-y

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  • DOI: https://doi.org/10.1007/s00167-013-2531-y

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