Ogura Takahiro, Sakai Hiroki, Asai Shigehiro, Fukuda Hideaki, Takahashi Tatsuya, Kanisawa Izumi, Yamaura Ichiro, Tsuchiya Akihiro, Forney Michael, Winalski Carl S, Takahashi Kenji
Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan.
Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Orthop J Sports Med. 2020 Nov 17;8(11):2325967120963050. doi: 10.1177/2325967120963050. eCollection 2020 Nov.
Little is known regarding the optimal treatment for displaced, purely chondral fragments in the knee.
To report the clinical and radiographic outcomes of chondral fragment fixation in adolescents through use of autologous bone pegs.
Case series; Level of evidence, 4.
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 cm (range, 0.8-9.0 cm). Patients were evaluated via physical examination and magnetic resonance imaging (MRI) using magnetic resonance observation of cartilage repair tissue scores.
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.
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.
对于膝关节移位的单纯软骨碎片的最佳治疗方法，人们了解甚少。
报告青少年使用自体骨栓固定软骨碎片的临床和影像学结果。
病例系列；证据等级，4级。
这项回顾性单中心研究评估了6例患者（平均年龄12.9岁），他们使用自体骨栓固定软骨碎片（未见附着骨）（平均术后随访5.2年；范围1.4 - 10.9年）。病因包括创伤（n = 5）和剥脱性骨软骨炎（n = 1）。病变位于滑车沟（外侧，n = 3；内侧，n = 2）或股骨外侧髁后部（n = 1）。平均病变大小为3.8 cm（范围0.8 - 9.0 cm）。通过体格检查和磁共振成像（MRI），使用软骨修复组织评分的磁共振观察对患者进行评估。
总共5例患者在术后平均7个月（范围6 - 8个月）成功恢复运动且无限制。在最近一次随访时，这5例患者关节活动范围正常且无关节积液。在平均3年（范围1 - 5年）时，软骨修复组织评分的平均磁共振观察值为85（范围70 - 95）。1例患者在术后1.3年因创伤性损伤治疗失败，随后接受了固定碎片取出和钻孔手术。
在大多数青少年中，使用自体骨栓固定未见骨质部分的软骨碎片成功率令人满意，且MRI扫描证实软骨组织愈合良好。
