Arthroscopic Drilling for Stable Juvenile Osteochondritis Dissecans of the Knee Is Safe and Patients Reliably Return to Daily Activities by 3 Months

Soroush Baghdadi; David Isaacs; Calvin T Chan; Lawrence Wells; Theodore J Ganley; J Todd R Lawrence

doi:10.1016/j.asmr.2021.12.006

Arthroscopic Drilling for Stable Juvenile Osteochondritis Dissecans of the Knee Is Safe and Patients Reliably Return to Daily Activities by 3 Months

Arthrosc Sports Med Rehabil. 2022 Feb 15;4(2):e645-e651. doi: 10.1016/j.asmr.2021.12.006. eCollection 2022 Apr.

Authors

Soroush Baghdadi¹, David Isaacs¹, Calvin T Chan¹, Lawrence Wells¹, Theodore J Ganley¹, J Todd R Lawrence¹

Affiliation

¹ Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.

Abstract

Purpose: 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.

Methods: 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.

Results: 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 (P = .02).

Conclusions: 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-cm² increase in lesion size increases the likelihood of reoperation by 2.93 times.

Level of evidence: Level IV, therapeutic case series.