outcomes of extra-articular, intra-epiphyseal drilling for ocd lesions of the knee with intact...
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![Page 1: Outcomes of extra-articular, intra-epiphyseal drilling for OCD lesions of the knee with intact articular cartilage Eric W Edmonds, MD Jay Albright, MD](https://reader036.vdocuments.us/reader036/viewer/2022081504/56649d095503460f949db643/html5/thumbnails/1.jpg)
Outcomes of extra-articular,intra-epiphyseal drilling for OCD
lesions of the knee with intact articular cartilage
Eric W Edmonds, MDJay Albright, MD
Scott J Mubarak, MDTracey Bastrom, MA
Henry G Chambers, MD
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Introduction• Juvenile Osteochondritis
dissecans (JOCD)– Subchondral lesion with
degrees of osseous resorption, collapse, and sequestrum formation, possible delamination of articular cartilage in the skeletally immature
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Guhl Classification
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Management• Non-operative
management:– Activity modification, PT,
casting– 50% heal in 10 to 18
months (Cahill, 1989)• Operative techniques:
– Intra-articular drilling– Four outcome studies: 82%
to 95% successful union
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Outcomes of Intra-articular Drilling
• Multiple perforations in the previously intact cartilage.
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Outcomes of Intra-articular Drilling
• Less perpendicular perforations in the sclerotic rim of the lesion.
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Purpose
• Evaluate:– Extra-articular, intra-epiphyseal drilling– Does not damage intact articular cartilage– Increased fenestration of sclerotic rim
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Methods• Retrospective review• Years 1997 to 2005• 68 children, 75 knees (76 OCD lesions)• Inclusion criteria
– Open growth plates, failed six months conservative management, arthroscopically confirmed intact articular cartilage
• Exclusion criteria– Arthroscopic drilling through cartilage, detached
cartilage, or closed growth plates.
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Technique1. Diagnostic arthroscopy to confirm
Guhl grade2. A 0.062 inch K-wire, percutaneous,
intra-epiphyseal to center of lesion
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Technique
1.This center-center “guide” wire is then preserved as a guide for further wire placement.
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Technique• A parallel wire
guide is used to direct a subsequent “drilling” K-wire
• 15 to 20 holes are drilled through the sclerotic rim
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Outcome Determination• Radiographic
outcomes– Success: complete
resolution of OCD lesion
• Clincial outcomes– Failure: further
intervention
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Results
• 59 lesions with complete data–17 lateral condyles and 42
medial condyles
• Mean age 13.4 years (8 to 18.6)
• 15 girls and 36 boys
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Results• 52 lesions with
successful healing (87%)
• 7 lesions requiring further intervention (13%)
Pre-drilling
Post-drilling
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Duration to complete healing
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
0 10 20 30 40 50 60 70 80
Each lesion
Results• Mean duration to healing:
– 11.8 months (1.3 to 47.3)• Mean follow-up:
– 23.7 months (1.3 to 72)
Each Lesion in Study
Duration to Complete Healing
Time (months)
1263
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Failures• 2nd operation, mean 18 months
after index operation:–4 required repeat drillings–2 required repeat drilling with
bone graft–1 required trans-articular drilling
with osteochondral tack
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Failures• 3rd operation: requiring
matchstick bone graft and chondroplasty– 39 months after the index
procedure (15 months after the second procedure of repeat drilling)
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Complications• No other complications
resulted from this procedure
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Comparing Our Results
• Our rate of 87% complete radiographic healing represents comparable outcomes to previous intra-articular drilling reports of 82% to 95% successful union
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Discussion• Extra-articular, intra-epiphyseal drilling of
OCD lesions
– Similar rate of healing compared to intra-articular drilling
– Improved fenestration of subchondral rim
– Nullifies damage to the overlying articular cartilage
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Conclusion• Less iatrogenic
damage
• A safe and effective technique
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Thank You