Baghdadi Soroush, Isaacs David, Chan Calvin T, Wells Lawrence, Ganley Theodore J, Lawrence J Todd R
Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.
Arthrosc Sports Med Rehabil. 2022 Feb 15;4(2):e645-e651. doi: 10.1016/j.asmr.2021.12.006. eCollection 2022 Apr.
To assess the postoperative timeline for the return to activities of daily living (ADLs) in pediatric patients after arthroscopic drilling of a stable osteochondritis dissecans (OCD) lesion of the knee and to determine the rate of and risk factors for complications after the procedure.
In a retrospective chart review, data from all patients aged 18 years or younger who underwent arthroscopic drilling for a stable OCD lesion of either femoral condyle from May 2009 through July 2017 were collected. Demographic data, lesion characteristics, operative data, postoperative course, radiographic outcomes, and complications were recorded. Statistical analysis was performed to determine the risk factors for reoperations.
A total of 139 knees in 131 patients were evaluated, with a mean age of 12.7 years, of which 102 (73%) were male knees. The average follow-up period was 17.8 ± 13.2 months after surgery. All patients regained full extension and flexion within 5° of the contralateral knee at a mean of 12.9 ± 3.2 weeks postoperatively, with 95% having returned fully to ADLs by the 3-month postoperative visit. No cases of infection, stiffness, arthrofibrosis, or other procedure-related complications were recorded. A total of 133 knees (95.7%) showed healing on radiographs, whereas 6 knees (4.3%) underwent additional surgical procedures, all of which were performed for treatment failure related to nonhealing lesions (including loose body removal, chondroplasty, and repeated drilling). Lesion size was the only significant risk factor for reoperation ( = .02).
Our findings suggest that arthroscopic drilling for stable, intact OCD lesions in the pediatric knee is a safe procedure with reliable outcomes and return to ADLs and a minimal risk of complications. Most patients return to their preoperative daily activity level with a full range of motion of the knee by 3 months after surgery. Complications, including reoperations, are related to the progression of the OCD lesion rather than to the surgical procedure. Each 1-cm increase in lesion size increases the likelihood of reoperation by 2.93 times.
Level IV, therapeutic case series.
评估儿童患者膝关节稳定型剥脱性骨软骨炎（OCD）病变关节镜下钻孔术后恢复日常生活活动（ADL）的时间线，并确定该手术后并发症的发生率及危险因素。
通过回顾性病历审查，收集2009年5月至2017年7月期间所有18岁及以下因股骨髁稳定型OCD病变接受关节镜下钻孔手术患者的数据。记录人口统计学数据、病变特征、手术数据、术后病程、影像学结果及并发症。进行统计分析以确定再次手术的危险因素。
共评估了131例患者的139个膝关节，平均年龄12.7岁，其中102个（73%）为男性膝关节。术后平均随访期为17.8±13.2个月。所有患者在术后平均12.9±3.2周时膝关节伸直和屈曲均恢复至对侧膝关节5°以内，95%的患者在术后3个月时已完全恢复ADL。未记录到感染、僵硬、关节纤维化或其他与手术相关的并发症病例。共133个膝关节（95.7%）影像学显示愈合，而6个膝关节（4.3%）接受了额外的手术，所有这些手术均因与未愈合病变相关的治疗失败而进行（包括取出游离体、软骨成形术和重复钻孔）。病变大小是再次手术的唯一显著危险因素（P = 0.02）。
我们的研究结果表明，儿童膝关节稳定、完整的OCD病变关节镜下钻孔术是一种安全的手术，具有可靠的结果，患者可恢复ADL且并发症风险极小。大多数患者在术后3个月时膝关节活动范围完全恢复，恢复到术前的日常活动水平。包括再次手术在内的并发症与OCD病变的进展有关，而非与手术操作有关。病变大小每增加1 cm，再次手术的可能性增加2.93倍。
IV级，治疗性病例系列。
