1
|
Deichsel A, Palma Kries LK, Raschke MJ, Peez C, Briese T, Glasbrenner J, Herbst E, Kittl C. Refixation of a Large Osteochondral Fragment with Magnesium Compression Screws-A Case Report. Life (Basel) 2023; 13:life13051179. [PMID: 37240824 DOI: 10.3390/life13051179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Osteochondrosis dissecans (OCD) is a disease affecting the subchondral bone and the overlying articular cartilage. The etiology is most likely a combination of biological and mechanical factors. The incidence is highest in children >12 years old and it predominantly affects the knee. In high-grade OCD lesions, free osteochondral fragments usually are refixed via titanium screws or biodegradable screws or pins. In this case, headless compression screws made from magnesium were used for refixation. CASE REPORT A thirteen-year-old female patient with a two-year history of knee pain was diagnosed with an OCD lesion of the medial femoral condyle. After initial conservative treatment, displacement of the osteochondral fragment occurred. Refixation was performed using two headless magnesium compression screws. At the 6 months follow up, the patient was pain free, and the fragment showed progressive healing while the implants were biodegrading. DISCUSSION Existing implants for refixation of OCD lesions either require subsequent removal or show less stability and possible inflammatory reactions. The new generation of magnesium screws used in this case did not lead to a gas release, as described for previous magnesium implants, while maintaining stability during continuous biodegradation. CONCLUSIONS The data available to date on magnesium implants for the treatment of OCD are promising. However, the evidence on the magnesium implants in refixation surgery of OCD lesions is still limited. Further research needs to be conducted to provide data on outcomes and possible complications.
Collapse
Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Lucas Klaus Palma Kries
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| |
Collapse
|
2
|
Felus J, Kowalczyk B, Starmach M, Wyrobek L. Osteochondral Fractures in Acute Patellar Dislocations in Adolescents: Midterm Results of Surgical Treatment. Orthop J Sports Med 2022; 10:23259671221107608. [PMID: 35859644 PMCID: PMC9289920 DOI: 10.1177/23259671221107608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Osteochondral fractures (OCFs) are common injuries during acute patellar
dislocation (APD), carrying a high risk of early joint deterioration if left
untreated. The recommended approach is reduction and stable fixation;
however, data on the results of such treatment are limited. Purpose: To evaluate midterm results of fixation of APD-related OCFs in adolescents
and to identify predictive factors for poor outcomes. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective analysis of adolescent patients who underwent
internal fixation of APD-related OCFs between 2004 and 2015 at a single
tertiary pediatric trauma center. The primary outcome variables included
Knee injury and Osteoarthritis Outcome Score (KOOS), patient satisfaction
(0-10 scale), and sports participation compared with preoperative level.
Secondary outcome variables included relationship between final results and
OCF location (patellofemoral vs tibiofemoral), surgical delay (>6 weeks),
and patellar instability after OCF fixation. OCF healing was evaluated using
magnetic resonance imaging (MRI). Results: Included were 40 patients (19 female, 21 male) with 42 OCFs (29 patellar
OCFs, 13 lateral femoral condyle OCFs). The median patient age at surgery
was 14.5 years (interquartile range [IQR], 13-15.5 years), and median
follow-up was 76 months (IQR, 52.5-95 months). Recurrence of patellar
instability occurred in 27.5% of patients. Median overall KOOS was 93.8
(IQR, 90.8-97.6); KOOS–Symptoms, 92.9 (IQR, 85.7-96.4); KOOS–Pain, 97.2
(IQR, 91.7-100); KOOS–Activities of Daily Living, 100 (IQR, 97.1-100);
KOOS–Sports, 90 (IQR, 80-100); and KOOS–Quality of Life, 78.1 (IQR,
56.2-87.5). Median satisfaction score was 8 (IQR, 8-9), and 16 patients
(40%) returned to sports participation at their preinjury level. MRI scans
revealed a 100% rate of bone healing. Abnormalities exceeding the fracture
area were evident on MRI scans in 86.5% of patients. Recurrence of patellar
instability (even after surgical fixation) and unstable patella at final
follow-up were independent predictors of worse results after OCF
fixation. Conclusion: In the current study, reduction and internal fixation for APD-related OCF in
adolescents yielded favorable midterm outcomes. Recurrence of dislocation
and persistent patellar instability jeopardized clinical results.
Collapse
Affiliation(s)
- Jaroslaw Felus
- Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland
| | - Bart Kowalczyk
- Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland
| | - Michal Starmach
- Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland
| | - Lukasz Wyrobek
- Pediatric Orthopedics and Trauma Surgery Department, University Children's Hospital, Krakow, Poland
| |
Collapse
|
3
|
Kristinsson J, Elsoe R, Jensen HP, Larsen P. Satisfactory outcome following arthroscopic fixation of tibial intercondylar eminence fractures in children and adolescents using bioabsorbable nails. Arch Orthop Trauma Surg 2021; 141:1945-1951. [PMID: 33715062 DOI: 10.1007/s00402-021-03860-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Tibial intercondylar eminence fracture is a rare fracture and is commonly treated with suture, screw or bio-absorbable nail. Current literature includes little information regarding outcome of surgically treatment with bio-absorbable nails. The purpose of this study was to report the clinical and functional outcomes in patients with tibial intercondylar eminence fractures arthroscopically treated with bio-absorbable nails. METHODS The study design was retrospective follow-up. Sixteen patients, age 11-16 years, were surgically treated with bio-absorbable nail following an intercondylar eminence fracture. Thirteen patients participate in the present follow-up study. The median follow-up time was 6.5 years. The main outcome measurement was the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measurements consisted of: Eq5d-5L questionnaire, knee pain, knee laxity, range of motion (ROM), muscle strength, gait analyses, radiological outcomes, activity and level. RESULTS The median KOOS scores for the five subscales were: pain 98.5 (19-100), symptoms 90.5 (54-100), ADL 100 (22-100), sport 87.5, (0-100) and QOL 88.0 (13-100), indication satisfactory outcome. Low level of gait asymmetry was observed. Almost balanced muscle strength between the injured and non-injured leg for knee extension and knee flexion strength was observed. Measurement of anterior knee laxity showed 12 patients with a knee laxity between - 1 and 2 mm. The examination of intercondylar eminence displacement at the time of follow-up showed that 12 patients had a displacement of 2 mm or less. CONCLUSION This case series demonstrates satisfactory patient-reported and functional outcomes in the treatment of intercondylar eminence fractures in children and adolescents with bio-absorbable nails.
Collapse
Affiliation(s)
- Jens Kristinsson
- Department of Orthopedic Trauma Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Rasmus Elsoe
- Department of Orthopedic Trauma Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Hans Peter Jensen
- Department of Orthopedic Trauma Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Peter Larsen
- Department of Orthopedic Trauma Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
- Department of Physiotherapy, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| |
Collapse
|
4
|
Samitier G, Vinagre G, Cugat R, Seijas R, Barastegui D. One-Stage Osteochondral Fracture Repair Technique With Knotless Anchors and Interconnected Crossing Suture Sliding Loops for the Knee. Arthrosc Tech 2020; 9:e1813-e1818. [PMID: 33294345 PMCID: PMC7695622 DOI: 10.1016/j.eats.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/05/2020] [Indexed: 02/03/2023] Open
Abstract
Osteochondral fractures of the knee represent a challenging entity to manage since there are many different surgical techniques for cartilage repair or other salvage procedures. In terms of cartilage repair, several hardware devices can be used, and many of them could imply a second-stage surgery for hardware removal. The purpose of this article is to describe in detail a one-stage osteochondral fracture repair technique with knotless anchors and interconnected crossing suture sliding loops for the knee. This technique is a one-stage open or arthroscopic procedure with an unlimited number of loops configurations with no particular need for a second surgery for hardware removal, no knot damage, and without the use of bone tunnels. It can be used in different cartilage anatomic locations, such as femoral condyles, trochlea, patella, or other joints.
Collapse
Affiliation(s)
- Gonzalo Samitier
- Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Address correspondence to Gustavo Vinagre, M.D., Ph.D., Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
| | - Ramón Cugat
- Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain
- Fundación García Cugat, Barcelona, Spain
| | - Roberto Seijas
- Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain
- Fundación García Cugat, Barcelona, Spain
| | - David Barastegui
- Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Millón-Cruz A, Martín-Granizo López R. Long-term clinical outcomes of arthroscopic discopexy with resorbable pins. J Craniomaxillofac Surg 2020; 48:1074-1079. [PMID: 32998852 DOI: 10.1016/j.jcms.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Discopexy using resorbable pins is an arthroscopic technique to treat internal derangement of the TMJ, restoring the normal relationship between disc, condyle, and temporal bone. The objective of our study was to assess the 5-year clinical outcome of a series of patients treated with this technique. METHODS A study was conducted on a series of patients who underwent arthroscopic discopexy using resorbable pins between January 2007 and February 2018. All the patients were refractory to conservative treatment and classified as Wilkes stage III. Clinical data were recorded at 1-year, 3-year, and 5-year visits. Pre- and postoperative evaluation parameters were: joint pain (VAS scale), mandibular movements (mm), and articular locking and clicking. RESULTS The study included 33 patients and the technique was performed in 38 joints. Mouth opening increased significantly with each visit after surgery compared with preoperative scores (mean value of 10.65 mm, p < 0.001), with the mean value increasing significantly at the 5-year visit in relation to the mean value obtained at the 3-year visit. Patients reported significant decreases in pain after surgery, obtaining VAS values of under 10 at the 5-year visit (mean improvement of 56.95 points, p < 0.001). CONCLUSIONS Discopexy using resorbable pins resulted in a good and stable clinical outcome at the long-term follow-up.
Collapse
Affiliation(s)
- Alejandrina Millón-Cruz
- Department of Surgery, Medical School, Universidad Complutense de Madrid, Ramón y Cajal S/N, 28040, Madrid, Spain.
| | - Rafael Martín-Granizo López
- Department of Oral and Maxillofacial Surgery, Hospital Clínico San Carlos, Profesor Martin Lago S/N, 28040, Madrid, Spain.
| |
Collapse
|
6
|
Late Repair, One Year After a Knee Twisting Injury, of a Missed Femoral Trochlea Osteochondral Fragment, With Bioabsorbable Nails, in a 14-Year-Old Boy. J Am Acad Orthop Surg Glob Res Rev 2019; 3:e040. [PMID: 31592004 PMCID: PMC6754220 DOI: 10.5435/jaaosglobal-d-18-00040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The authors report a case of a late repair of a missed, large, osteochondral fracture of the femoral trochlea in a 14-year-old boy due to lateral patellar dislocation after a twisting injury of the knee a year ago. The late—1 year after the knee injury—imaging assessment of the patient regarding radiograph images, CT scan, and MRI was misleading, misinterpreted, and failed to reveal this osteochondral fracture. The free osteochondral fragment was detected during diagnostic arthroscopy. Open reduction and fixation of the osteochondral fragment with bioabsorbable pins were done, and healing was achieved within an acceptable time. The patient's clinical and imaging examination with knee MRI, a year after the surgical treatment, was highly satisfactory. Fixation with bioabsorbable pins showed to be a worthwhile option in this case. The technique used was straightforward, with excellent short- and long-term results. Bioabsorbable pins may be used to restore successfully even an old, large osteochondral fracture in the immature skeleton.
Collapse
|
7
|
Bochyńska AI, Hannink G, Grijpma DW, Buma P. Tissue adhesives for meniscus tear repair: an overview of current advances and prospects for future clinical solutions. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:85. [PMID: 26970767 PMCID: PMC4789195 DOI: 10.1007/s10856-016-5694-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
Menisci are crucial structures in the knee joint as they play important functions in load transfer, maintaining joint stability and in homeostasis of articular cartilage. Unfortunately, ones of the most frequently occurring knee injuries are meniscal tears. Particularly tears in the avascular zone of the meniscus usually do not heal spontaneously and lead to pain, swelling and locking of the knee joint. Eventually, after a (partial) meniscectomy, they will lead to osteoarthritis. Current treatment modalities to repair tears and by that restore the integrity of the native meniscus still carry their drawbacks and a new robust solution is desired. A strong tissue adhesive could provide such a solution and could potentially improve on sutures, which are the current gold standard. Moreover, a glue could serve as a carrier for biological compounds known to enhance tissue healing. Only few tissue adhesives, e.g., Dermabond(®) and fibrin glue, are already successfully used in clinical practice for other applications, but are not considered suitable for gluing meniscus tissue due to their sub-optimal mechanical properties or toxicity. There is a growing interest and research field focusing on the development of novel polymer-based tissue adhesives, but up to now, there is no material specially designed for the repair of meniscal tears. In this review, we discuss the current clinical gold standard treatment of meniscal tears and present an overview of new developments in this field. Moreover, we discuss the properties of different tissue adhesives for their potential use in meniscal tear repair. Finally, we formulate recommendations regarding the design criteria of material properties and adhesive strength for clinically applicable glues for meniscal tears.
Collapse
Affiliation(s)
- A I Bochyńska
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biomaterials Science and Technology, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - G Hannink
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - D W Grijpma
- Department of Biomaterials Science and Technology, MIRA Institute, University of Twente, Enschede, The Netherlands
- Department of Biomedical Engineering, W.J. Kolff Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P Buma
- Orthopaedic Research Laboratory, Department of Orthopaedics, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
8
|
Pedersen ME, DaCambra MP, Jibri Z, Dhillon S, Jen H, Jomha NM. Acute Osteochondral Fractures in the Lower Extremities - Approach to Identification and Treatment. Open Orthop J 2015; 9:463-74. [PMID: 26587063 PMCID: PMC4645968 DOI: 10.2174/1874325001509010463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/14/2015] [Accepted: 03/24/2015] [Indexed: 01/03/2023] Open
Abstract
Chondral and osteochondral fractures of the lower extremities are important injuries because they can cause pain and dysfunction and often lead to osteoarthritis. These injuries can be misdiagnosed initially which may impact on the healing potential and result in poor long-term outcome. This comprehensive review focuses on current pitfalls in diagnosing acute osteochondral lesions, potential investigative techniques to minimize diagnostic errors as well as surgical treatment options. Acute osteochondral fractures are frequently missed and can be identified more accurately with specific imaging techniques. A number of different methods can be used to fix these fractures but attention to early diagnosis is required to limit progression to osteoarthritis. These fractures are common with joint injuries and early diagnosis and treatment should lead to improved long term outcomes.
Collapse
Affiliation(s)
- M E Pedersen
- Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - Z Jibri
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - S Dhillon
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - H Jen
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - N M Jomha
- Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| |
Collapse
|
9
|
Abstract
Osteochondral fractures are traumatic shearing injuries to the cartilage and the subchondral bone which lead to defects in the articular surface and potentially lead to further degeneration and arthritis. Early diagnosis and therapy are therefore very important. As the resolving power of conventional X-rays is limited for this situation, magnetic resonance imaging (MRI) is regarded as the gold standard for diagnostics. Concomitant injuries often occur, such as tearing of the anterior cruciate ligament (ACL) or patellar dislocation resulting in instability of the patella. Concerning treatment options for osteochondral fractures, there are two potential strategies that can be applied: the first is removal of small osteochondral fragments with subsequent formation of regeneration tissue and the second is refixation of the dislocated fragment and therefore a 1-stage reconstruction of the joint surface. It is important to also address concomitant injuries. Even though there is no consensus for a standardized or evidence-based therapy in literature, this article gives an overview of the diagnostics and available therapeutic options.
Collapse
Affiliation(s)
- J Kühle
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79098, Freiburg, Deutschland,
| | | | | |
Collapse
|
10
|
The role of arthroscopy in articular fracture management: the lower limb. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:807-13. [DOI: 10.1007/s00590-015-1601-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
|
11
|
Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence. INTERNATIONAL ORTHOPAEDICS 2014; 37:2385-94. [PMID: 24022737 DOI: 10.1007/s00264-013-2070-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Although traumatic osteochondral fractures of the knee represent a common pathology of the knee joint, there is no general agreement concerning specific treatment of this entity. This meta-analysis was initiated in order to evaluate scientific evidence on different treatment options for acute osteochondral fractures of the knee. METHODS For this purpose an OVID-based systematic literature search was performed including the following databases: MEDLINE, MEDLINE preprints, Embase, CINAHL, Life Science Citations, British National Library of Health and Cochrane Central Register of Controlled Trials. The literature search period was from 1946 to January 2012, which led to the identification of 1,226 articles. After applying study-specific inclusion criteria a total of 19 studies with clinical follow-up of 638 patients were included. The methodology of these studies was systematically analysed by means of the Coleman Methodology Score. Outcome and success rates were evaluated depending on treatment applied. RESULTS All studies (n = 19) identified represent case series (evidence-based medicine level IV) and included a total of 638 patients. The average post-operative follow-up was 46 ± 27 months (range 3.75-108). The mean number of study subjects per study was 33 ± 44 patients (range 4-169). The average Coleman Methodology Score was 29 ± 17 points (range 5-72). Six different scoring systems were used for clinical assessment. The overall clinical success rate was 83% and varied between 45 and 100%. CONCLUSIONS This meta-analysis reveals a significant lack of scientific evidence for treatment of osteochondral fractures of the knee. No valid conclusion can be drawn from this study concerning the recommendation of a specific treatment algorithm. Nevertheless, the overall failure rate of 17% underlines that an acute osteochondral fracture of the knee represents an important pathology which is not a self-limiting injury and needs further investigation.
Collapse
|
12
|
Ottink DA, van Zutphen SWAM, van Doorn R, Wouters DB. Successful fixation of Mason type 2 radial head fractures using Meniscus Arrows. Knee Surg Sports Traumatol Arthrosc 2014; 22:49-52. [PMID: 22972313 DOI: 10.1007/s00167-012-2193-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 08/21/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous experience has revealed excellent outcomes when using the Meniscus Arrow (Conmed Linvatec Ltd., Tampere, Finland) bioabsorable meniscal repair system for the fixation of small fracture fragments. This study describes the results of the fixation of Mason type 2 radial head fractures with these Arrows in a prospective series of 21 patients. METHODS Between 2006 and 2010, a total of 21 patients were treated with Meniscus Arrows for the fixation of Mason type 2 fractures of the radial head during an open procedure. Twenty-one, twenty and seventeen patients were followed up at 2 and 6 post-operative weeks, 18 weeks and 24 months, respectively. Radiographs were obtained during follow-up visits, and range of motion was classified according to the Weseley classification. RESULTS At 24 post-operative months, 88 % of patients showed 'excellent' and 12 % showed 'good' results in terms of extension. All patients (100 %) showed 'excellent' results for flexion, supination and pronation. Uneventful healing of the fracture was observed in all patients. No complications were noted. CONCLUSION This study shows promising outcomes for the use of Meniscus Arrows as fixation devices in the treatment for Mason type 2 fractures of the radial head.
Collapse
Affiliation(s)
- Dirk A Ottink
- Department of General-, Trauma- and Arthroscopical Surgery, TweeSteden Hospital Tilburg, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | | | | | | |
Collapse
|
13
|
Late-diagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report. J Pediatr Orthop B 2013; 22:344-9. [PMID: 23511583 DOI: 10.1097/bpb.0b013e3283602650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this case report, we describe a large osteochondral fracture of the anterolateral femoral condyle in an adolescent athlete while dancing. At 3 months after the misdiagnosed injury, the condylar defect was covered by a layer of disorganized fibrous tissue rich in blood vessels. To achieve good repair, an accurate curettage of the fractured surfaces, a precise reduction, and a stable internal fixation of the fragments were performed. Two poly-L-lactic acid bioabsorbable screws were used to obtain appropriate compression. At the 2-year follow-up, the patient was asymptomatic and had resumed her previous dancing activity. An MRI scan showed no interruptions of the cartilage layer at the boundary with the healthy tissue, but cartilage thinning and extensive subchondral remodeling were detected.
Collapse
|
14
|
Schepers T, De Rooij PP, Van Lieshout EMM, Patka P. Reinsertion of an inverted osteochondral lesion of the talus: a case report. J Foot Ankle Surg 2011; 50:486-9. [PMID: 21571553 DOI: 10.1053/j.jfas.2011.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Indexed: 02/03/2023]
Abstract
Osteochondral lesions of the talus (OLTs) occur infrequently and are missed at the initial presentation in up to 67% of cases. Probably more than 1500 OLTs have been reported in published studies, of which, thus far, only 5 cases have been an inverted anterolateral OLT. An anterolateral OLT results from a hypersupination trauma, in which the talar dome is caught behind the fibula. Apparently, if the forces are large enough a "flip of the coin" phenomenon occurs, causing the fragment to invert 180° upside down. We present the case of a young female patient with an inverted OLT that was treated with open reduction and internal fixation using bioabsorbable pins. Follow-up radiographs and computed tomography showed a congruent joint and complete healing of the osteochondral fragment. At the short-term follow-up visit, the functional outcome was promising.
Collapse
Affiliation(s)
- Tim Schepers
- Department of Surgery-Traumatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
15
|
Wouters DB, de Graaf JS, Hemmer PH, Burgerhof JGM, Kramer WLM. The arthroscopic treatment of displaced tibial spine fractures in children and adolescents using Meniscus Arrows®. Knee Surg Sports Traumatol Arthrosc 2011; 19:736-9. [PMID: 21153538 PMCID: PMC3076577 DOI: 10.1007/s00167-010-1341-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE This article summarises the results of a newly developed technique that utilises Meniscus Arrows(®) for the arthroscopic fixation of displaced tibial spine fractures in children and adolescents. METHOD Twelve tibial spine fractures in the knees of eleven children between 6 and 15 years old, with an average age of 12 years, were arthroscopically fixed with Meniscus Arrows(®), after a reduction of their fractures. This was followed by 5 weeks immobilisation in a plaster of Paris. Postoperative follow-up included radiographs, Lachmann tests on all of the children's knees and KT-1000 tests of eight out of twelve of the children's knees. The postoperative follow-up time ranged from 3 to 10 years, with patients being seen for an average of 4 years. RESULTS All of the fractures consolidated uneventfully, and all of the patients returned unrestricted to their previous activity level. The Lachmann tests revealed no, or a non-functional, laxity in any of the patients' knees. The KT-1000 tests showed a difference between the operated side, and non-operated side, of between 3 mm in the first knee operated on and an average of 1 mm in the remaining knees. CONCLUSION The arthroscopic fixation of tibial spine fractures using Meniscus Arrows(®) showed that this minimally invasive procedure resulted in the uneventful consolidation of all twelve of the fractures, with excellent results, and without the need for a second, hardware removal, operation. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Diederick B. Wouters
- Department of General Surgery, Traumatology and Arthroscopic Surgery, TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD Tilburg, The Netherlands
| | - Joost S. de Graaf
- The Department of Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Patrick H. Hemmer
- The Department of Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands
| | - Johannes G. M. Burgerhof
- Department of Epidemiology, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - William L. M. Kramer
- The Department of Pediatric Traumatology, University Medical Centre, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| |
Collapse
|