Division of Pediatric Orthopaedic Surgery, Children's Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Am J Sports Med. 2011 Oct;39(10):2212-7. doi: 10.1177/0363546511416594. Epub 2011 Aug 9.
Osteochondritis dissecans (OCD) lesions of the medial femoral condyle in the adolescent population can cause significant impairment and restriction in physical activity. Studies have established the efficacy of transarticular antegrade drilling for juvenile OCD lesions of the knee, although concerns of consequences from drilling through the articular cartilage remain. Alternatively, retrograde extra-articular drilling avoids drilling the cartilage while ensuring adequate channels for revascularization and healing.
The authors present the results of 31 skeletally immature patients who underwent retrograde drilling of OCD lesions of the knee with an average follow-up of 4 years.
Case series; Level of evidence, 4.
The procedure consisted of a standard arthroscopic evaluation of the knee and subsequent percutaneous retrograde drilling obliquely through the condylar epiphysis starting distal to the physis and ending in the center-center of the OCD lesion. Outcome measures included radiographic signs of healing, Lysholm scoring and the Tegner activity scale to measure performance and activity restriction, and visual analog scale (VAS) pain scores.
Average follow-up for the 31 patients was 4 years (range, 1.5-7 years). Sixteen of the 34 lesions were grade I or II based on radiographic findings with signs and symptoms greater than 6 months. The remaining 18 were grade III secondary to a sclerotic rim surrounding the defect. Overall, improvement in Lysholm scores (70 to 95; standard deviation [SD] ± 14.95), Tegner scores (4 to 7; SD ± 2.31), and VAS pain scores (6.9 to 1.3; SD ± 2.16) were found to be statistically significant. Radiographs showed stable or improved lesions in all cases.
Retrograde extra-articular drilling provided clinical and radiographic improvement in most juveniles with OCD lesions who failed nonoperative management. This method serves to decompress the lesion and allow revascularization without disrupting the articular cartilage surface in stable OCD lesions.
青少年股骨内侧髁的剥脱性骨软骨炎（OCD）病变可导致明显的身体活动受损和受限。研究已经证实关节内顺行钻孔治疗青少年膝关节 OCD 病变的疗效，尽管人们仍然担心钻孔穿过关节软骨会带来后果。然而，逆行关节外钻孔可避免钻透软骨，同时确保为血运重建和愈合提供足够的通道。
作者介绍了 31 例接受膝关节 OCD 病变逆行钻孔的未成年患者的结果，平均随访 4 年。
病例系列；证据等级，4 级。
该手术包括膝关节标准关节镜评估，随后经皮逆行斜向穿过骺板，从骺板远端开始，止于 OCD 病变的中心-中心。评估指标包括愈合的影像学征象、Lysholm 评分和 Tegner 活动量表，以测量运动表现和活动受限，以及视觉模拟评分（VAS）疼痛评分。
31 例患者的平均随访时间为 4 年（范围，1.5-7 年）。根据影像学发现，34 个病变中有 16 个为 I 级或 II 级，有超过 6 个月的症状和体征。其余 18 个为 III 级，原因是缺损周围有硬化环。总体而言，Lysholm 评分（70 至 95；标准差 [SD] ± 14.95）、Tegner 评分（4 至 7；SD ± 2.31）和 VAS 疼痛评分（6.9 至 1.3；SD ± 2.16）均有显著改善。所有病例的影像学均显示病变稳定或改善。
逆行关节外钻孔为大多数经非手术治疗失败的 OCD 病变青少年提供了临床和影像学改善。这种方法可用于减压病变并允许血运重建，而不会在稳定的 OCD 病变中破坏关节软骨表面。
