eprintid: 33292
rev_number: 18
eprint_status: archive
userid: 5878
dir: disk0/00/03/32/92
datestamp: 2023-05-24 13:25:37
lastmod: 2024-03-13 10:45:08
status_changed: 2023-05-24 13:25:37
type: article
metadata_visibility: show
creators_name: Husen, Martin
creators_name: Van der Weiden, Goran S.
creators_name: Custers, Roel J.H.
creators_name: Poudel, Keshav
creators_name: Stuart, Michael J.
creators_name: Krych, Aaron J.
creators_name: Saris, Daniël B.F.
title: Internal Fixation of Unstable Osteochondritis Dissecans of the Knee: Long-term Outcomes in Skeletally Immature and Mature Patients
subjects: ddc-610
divisions: i-911460
divisions: i-999999
keywords: osteochondritis dissecans, OCD, cartilage repair, osteochondral repair, skeletal immaturity, knee joint
note: Dieser Beitrag ist aufgrund einer (DFG-geförderten) Allianz bzw. Nationallizenz frei zugänglich. *** This publication is freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.
abstract: Background:
Osteochondritis dissecans (OCD) is a disorder originating in the subchondral bone, leading to focal lesions with risk of fragmentation and secondary damage of the articular cartilage. It remains controversial if surgical treatment of such lesions is equally successful in skeletally immature and mature patients.
Purpose:
To determine (1) the long-term clinical success rate after internal fixation of unstable OCD in skeletally immature and mature patients based on physeal status, (2) if patient-specific and procedural variables influence the risk of failure, and (3) patient-reported outcome measures over time.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A multicenter retrospective cohort study was conducted investigating skeletally immature and mature patients treated for unstable OCD lesions of the knee between 2000 and 2015. The healing rate was assessed by radiological imaging and clinical follow-up. Failure was defined as any definitive reoperation for the initially treated OCD lesion.
Results:
A total of 81 patients met inclusion criteria, including 25 skeletally immature patients and 56 patients with closed physes at the time of surgery. After a mean follow-up time of 11.3 ± 4 years, 58 (71.6%) patients had healed lesions, whereas the lesions failed to heal in 23 (28.4%) patients. No significant difference in risk of failure was observed based on physeal maturation status (hazard ratio, 0.78; 95% CI, 0.33-1.84; P = .56). Lateral versus medial condylar lesion location conferred an increased risk of failure (P < .05) for both skeletally immature and mature patients. Multivariate analysis of skeletal maturity status showed that a lateral femoral condylar location was an independent risk factor for failure (hazard ratio, 0.22; 95% CI, 0.1-0.5; P < .05). The mean patient-reported outcome scores (International Knee Documentation Committee [IKDC] score and Knee injury and Osteoarthritis Outcome Score [KOOS]) increased significantly after surgery and remained high at the final follow-up (P < .05). The final scores (mean ± SD) at a mean follow-up of 135.8 months (range, 80-249 months) were IKDC, 86.6 ± 16.7; KOOS Pain, 88.7 ± 18.1; KOOS Symptoms, 89.3 ± 12.6; KOOS Activities of Daily Living, 89.3 ± 21.6; KOOS Sport and Recreation, 79.8 ± 26.3; and KOOS Quality of Life, 76.7 ± 26.3.
Conclusion:
The long-term results after internal fixation of OCD fragments show high rates of healing and sustainable subjective improvement of knee function and quality of life. A healing rate of 72% was noted at a mean follow-up of 11.3 years. The stage of skeletal maturity had no significant influence on the rate of failure. Lateral femoral condylar lesion location is an independent risk factor for failure in skeletally mature and immature patients.
date: 2023
publisher: Sage
id_scheme: DOI
id_number: 10.11588/heidok.00033292
official_url: https://doi.org/10.1177/03635465231164410
ppn_swb: 1883318130
own_urn: urn:nbn:de:bsz:16-heidok-332923
language: eng
bibsort: HUSENMARTIINTERNALFI2023
full_text_status: public
publication: The American Journal of Sports Medicine
volume: 51
number: 6
place_of_pub: Thousand Oaks, Calif.
pagerange: 1403-1413
issn: 0363-5465 (Druck-Ausg.); 1552-3365 (Online-Ausg.)
edition: Zweitveröffentlichung
citation:   Husen, Martin ; Van der Weiden, Goran S. ; Custers, Roel J.H. ; Poudel, Keshav ; Stuart, Michael J. ; Krych, Aaron J. ; Saris, Daniël B.F.  (2023) Internal Fixation of Unstable Osteochondritis Dissecans of the Knee: Long-term Outcomes in Skeletally Immature and Mature Patients.  The American Journal of Sports Medicine, 51 (6).  pp. 1403-1413.  ISSN 0363-5465 (Druck-Ausg.); 1552-3365 (Online-Ausg.)     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/33292/1/10.1177_03635465231164410.pdf