Clinical and Radiographic Outcomes After Fixation of Chondral Fragments of the Knee in 6 Adolescents Using Autologous Bone Pegs

• Published in: Orthopaedic journal of sports medicine Vol. 8; no. 11; p. 2325967120963050
• Main Authors: Ogura, Takahiro, Sakai, Hiroki, Asai, Shigehiro, Fukuda, Hideaki, Takahashi, Tatsuya, Kanisawa, Izumi, Yamaura, Ichiro, Tsuchiya, Akihiro, Forney, Michael, Winalski, Carl S., Takahashi, Kenji
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2020; Sage Publications Ltd
• Subjects: Cartilage; Magnetic resonance imaging; Orthopedics; Sports medicine; Teenagers; fixation; chondral fracture; chondral fragment; bone peg; cartilage
• ISSN: 2325-9671; 2325-9671
• DOI: 10.1177/2325967120963050

Background:
Little is known regarding the optimal treatment for displaced, purely chondral fragments in the knee.
Purpose:
To report the clinical and radiographic outcomes of chondral fragment fixation in adolescents through use of autologous bone pegs.
Study Design:
Case series; Level of evidence, 4.
Methods:
This retrospective, single-center study evaluated 6 patients (mean age, 12.9 years) who underwent fixation of chondral fragments (no visualized bone attached) using autologous bone pegs (mean postoperative follow-up, 5.2 years; range, 1.4-10.9 years). The causes were trauma (n = 5) and osteochondritis dissecans (n = 1). Lesions were located in the trochlear groove (lateral, n = 3; medial, n = 2) or posterior part of the lateral femoral condyle (n = 1). The mean lesion size was 3.8 cm2 (range, 0.8-9.0 cm2). Patients were evaluated via physical examination and magnetic resonance imaging (MRI) using magnetic resonance observation of cartilage repair tissue scores.
Results:
In total, 5 patients successfully returned to sports without restrictions at a mean of 7 months (range, 6-8 months) postoperatively. At the latest follow-up, these 5 patients had full range of motion and no joint effusion. The mean magnetic resonance observation of cartilage repair tissue score was 85 (range, 70-95) at a mean duration of 3 years (range, 1-5 years). One patient experienced failure at 1.3 years postoperatively after a traumatic injury and subsequently underwent removal of the fixed fragment and a drilling procedure.
Conclusion:
In most adolescents, fixation of chondral fragments with no visualized bony portion using autologous bone pegs provided a satisfactory success rate and good healing of cartilage tissue confirmed on MRI scans.