Outcomes of extra-articular, intra-epiphyseal drilling for OCD lesions of the knee with intact articular cartilage - PowerPoint PPT Presentation

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Outcomes of extra-articular, intra-epiphyseal drilling for OCD lesions of the knee with intact articular cartilage

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Outcomes of extra-articular, intra-epiphyseal drilling for OCD lesions of the knee with intact articular cartilage Eric W Edmonds, MD Jay Albright, MD – PowerPoint PPT presentation

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Title: Outcomes of extra-articular, intra-epiphyseal drilling for OCD lesions of the knee with intact articular cartilage


1
Outcomes of extra-articular,intra-epiphyseal
drilling for OCD lesions of the knee with intact
articular cartilage
  • Eric W Edmonds, MD
  • Jay Albright, MDScott J Mubarak, MDTracey
    Bastrom, MAHenry G Chambers, MD

2
Introduction
  • Juvenile Osteochondritis dissecans (JOCD)
  • Subchondral lesion with degrees of osseous
    resorption, collapse, and sequestrum formation,
    possible delamination of articular cartilage in
    the skeletally immature

3
Guhl Classification
4
Management
  • Non-operative management
  • Activity modification, PT, casting
  • 50 heal in 10 to 18 months (Cahill, 1989)
  • Operative techniques
  • Intra-articular drilling
  • Four outcome studies 82 to 95 successful union

5
Outcomes of Intra-articular Drilling
  • Multiple perforations in the previously intact
    cartilage.

6
Outcomes of Intra-articular Drilling
  • Less perpendicular perforations in the sclerotic
    rim of the lesion.

7
Purpose
  • Evaluate
  • Extra-articular, intra-epiphyseal drilling
  • Does not damage intact articular cartilage
  • Increased fenestration of sclerotic rim

8
Methods
  • Retrospective review
  • Years 1997 to 2005
  • 68 children, 75 knees (76 OCD lesions)
  • Inclusion criteria
  • Open growth plates, failed six months
    conservative management, arthroscopically
    confirmed intact articular cartilage
  • Exclusion criteria
  • Arthroscopic drilling through cartilage, detached
    cartilage, or closed growth plates.

9
Technique
  1. Diagnostic arthroscopy to confirm Guhl grade
  2. A 0.062 inch K-wire, percutaneous,
    intra-epiphyseal to center of lesion

10
Technique
  1. This center-center guide wire is then preserved
    as a guide for further wire placement.

11
Technique
  • A parallel wire guide is used to direct a
    subsequent drilling K-wire
  • 15 to 20 holes are drilled through the sclerotic
    rim

12
Outcome Determination
  • Radiographic outcomes
  • Success complete resolution of OCD lesion
  • Clincial outcomes
  • Failure further intervention

13
Results
  • 59 lesions with complete data
  • 17 lateral condyles and 42 medial condyles
  • Mean age 13.4 years (8 to 18.6)
  • 15 girls and 36 boys

14
Results
Pre-drilling
  • 52 lesions with successful healing (87)
  • 7 lesions requiring further intervention (13)

Post-drilling
15
Results
  • Mean duration to healing
  • 11.8 months (1.3 to 47.3)
  • Mean follow-up
  • 23.7 months (1.3 to 72)

Duration to Complete Healing
Time (months)
12
6
3
Each Lesion in Study
16
Failures
  • 2nd operation, mean 18 months after index
    operation
  • 4 required repeat drillings
  • 2 required repeat drilling with bone graft
  • 1 required trans-articular drilling with
    osteochondral tack

17
Failures
  • 3rd operation requiring matchstick bone graft
    and chondroplasty
  • 39 months after the index procedure (15 months
    after the second procedure of repeat drilling)

18
Complications
  • No other complications resulted from this
    procedure

19
Comparing Our Results
  • Our rate of 87 complete radiographic healing
    represents comparable outcomes to previous
    intra-articular drilling reports of 82 to 95
    successful union

20
Discussion
  • Extra-articular, intra-epiphyseal drilling of OCD
    lesions
  • Similar rate of healing compared to
    intra-articular drilling
  • Improved fenestration of subchondral rim
  • Nullifies damage to the overlying articular
    cartilage

21
Conclusion
  • Less iatrogenic damage
  • A safe and effective technique

22
Thank You
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