Abstract
RATIONALE
Osteochondritis dissecans (OCD) lesions involve disruption of the osteochondral unit along articular surfaces, with significant potential for joint deterioration if not managed appropriately.
PATIENT CONCERNS
A 15-year-old male presented with persistent and insidious right knee pain, which had worsened following a collision with another player during a basketball game, resulting in episodes of locking.
DIAGNOSES
Magnetic resonance imaging revealed a lateral trochlear OCD extending into the anterior lateral femoral condyle.
INTERVENTIONS
Chondral fraying was observed along the margins of the OCD. Retrograde drilling ensued with use of a 0.045-inch Kirschner wire throughout the lesion to a depth that would allow for penetration of healthy underlying subchondral bone to create an influx of healing factors. Three resorbable pegs were arthroscopically placed through an accessory portal overlying the lesion to stabilize the fracture and compress the gapped cartilage mantle to reduce flow of synovial fluid behind the lesion. Bipolar radiofrequency coblation was used to stabilize the chondral fraying and seal the gap along the periphery of the lesion.
OUTCOMES
The patient was put on a nonweight bearing protocol for 6 weeks, after which crutches and brace were discontinued, but therapy persisted. Repeat imaging at 3 months demonstrated excellent interval healing. The patient was released to slowly engage impact activities. Although he returned at approximately 8 months postoperatively with a contralateral anterior cruciate ligament tear, he reported the operative knee with the OCD was doing extremely well.
LESSONS
Radiofrequency coblation appears to be a viable strategy as an adjunct to management for OCD in children.
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