Ishikawa Masakazu, Nakamae Atsuo, Nakasa Tomoyuki, Ikuta Yasunari, Hayashi Seiju, Ochi Mitsuo, Deie Masataka, Adachi Nobuo
Department of Orthopaedic Surgery.
Laboratory of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Pediatr Orthop B. 2018 Nov;27(6):516-521. doi: 10.1097/BPB.0000000000000531.
Current treatment algorithms for stable juvenile osteochondritis dissecans (JOCD) of the knee have not been established. For arthroscopically stable lesion, in-situ arthroscopic fixation with bioabsorbable pins was introduced as a more desirable approach because of less surgical morbidity and faster recovery. However, there is a paucity of literature that concludes on its efficacy. The aim of this study is to determine the efficacy and limitation of in-situ arthroscopic fixation on stable JOCD lesion in the knee. Ninety-six patients with 110 affected knees were reviewed. Subsequently, patients who underwent in-situ arthroscopic fixation for arthroscopically stable JOCD lesions were grouped for further analysis. Arthroscopic lesion stability was graded according to the Guhl's grading system from the surgical description of each lesion. The grade I and II were defined as 'stable' lesions. The lesion status was also evaluated with the MRI grading system described by Dipaola in preoperative images retrospectively. The grade I and II lesions were also defined as 'stable' and more than III as 'unstable'. Clinical outcomes were evaluated by the Lysholm score at the final office visit. If the patient had a revision surgery, the case was classified as a complete failure. There were 13 lesions in 13 patients with open physis treated with in-situ arthroscopic fixation using bioabsorbable pins. In this population, radiographical lesion status and the Lysholm score were significantly improved in 10 cases (preoperative: 77.5±11.2, postoperative: 98.9±3.1, P=0.002); however, we found three revision cases (failure rate, 23%). Of these revision cases, all lesions were graded as 'unstable' in MRI. In this series, the failure rate was 23% for in-situ arthroscopic fixation for arthroscopically stable JOCD lesion of the knee. Because of the potential risk for underestimation of lesion instability, we strongly suggest that this less invasive approach should be chosen with great care for the lesion that presents arthroscopically stable, but as unstable status on MRI.
Level IV, case series.
目前尚未确立针对稳定型青少年膝关节剥脱性骨软骨炎（JOCD）的治疗方案。对于关节镜检查显示稳定的损伤，采用生物可吸收针进行关节镜原位固定被视为一种更理想的方法，因为其手术创伤较小且恢复较快。然而，关于其疗效的文献较少。本研究旨在确定关节镜原位固定治疗膝关节稳定型JOCD损伤的疗效及局限性。回顾了96例患者的110个患膝。随后，对接受关节镜原位固定治疗关节镜检查显示稳定的JOCD损伤的患者进行分组以作进一步分析。根据Guhl分级系统，从每个损伤的手术描述中对关节镜下损伤稳定性进行分级。I级和II级被定义为“稳定”损伤。术前图像还采用Dipaola描述的MRI分级系统对损伤状态进行回顾性评估。I级和II级损伤也被定义为“稳定”，III级以上为“不稳定”。在最后一次门诊时，通过Lysholm评分评估临床结果。如果患者接受了翻修手术，则该病例被归类为完全失败。13例骨骺未闭的患者的13个损伤采用生物可吸收针进行关节镜原位固定治疗。在这组患者中，10例患者的影像学损伤状态和Lysholm评分有显著改善（术前：77.5±11.2，术后：98.9±3.1，P = 0.002）；然而，我们发现3例翻修病例（失败率为23%）。在这些翻修病例中，所有损伤在MRI上均被分级为“不稳定”。在本系列研究中，膝关节关节镜检查显示稳定的JOCD损伤采用关节镜原位固定的失败率为23%。由于存在低估损伤不稳定性的潜在风险，我们强烈建议，对于关节镜检查显示稳定但MRI显示为不稳定状态的损伤，选择这种侵入性较小的方法时应格外谨慎。
IV级，病例系列。
