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Outcomes of extra-articular,intra-epiphyseal drilling for OCD
lesions of the knee with intact articular cartilage
Eric W Edmonds, MDJay Albright, MD
Scott J Mubarak, MDTracey Bastrom, MA
Henry G Chambers, MD
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
Guhl Classification
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
Outcomes of Intra-articular Drilling
• Multiple perforations in the previously intact cartilage.
Outcomes of Intra-articular Drilling
• Less perpendicular perforations in the sclerotic rim of the lesion.
Purpose
• Evaluate:– Extra-articular, intra-epiphyseal drilling– Does not damage intact articular cartilage– Increased fenestration of sclerotic rim
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.
Technique1. Diagnostic arthroscopy to confirm
Guhl grade2. A 0.062 inch K-wire, percutaneous,
intra-epiphyseal to center of lesion
Technique
1.This center-center “guide” wire is then preserved as a guide for further wire placement.
Technique• A parallel wire
guide is used to direct a subsequent “drilling” K-wire
• 15 to 20 holes are drilled through the sclerotic rim
Outcome Determination• Radiographic
outcomes– Success: complete
resolution of OCD lesion
• Clincial outcomes– Failure: further
intervention
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
Results• 52 lesions with
successful healing (87%)
• 7 lesions requiring further intervention (13%)
Pre-drilling
Post-drilling
Duration to complete healing
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
0 10 20 30 40 50 60 70 80
Each lesion
Results• Mean duration to healing:
– 11.8 months (1.3 to 47.3)• Mean follow-up:
– 23.7 months (1.3 to 72)
Each Lesion in Study
Duration to Complete Healing
Time (months)
1263
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
Failures• 3rd operation: requiring
matchstick bone graft and chondroplasty– 39 months after the index
procedure (15 months after the second procedure of repeat drilling)
Complications• No other complications
resulted from this procedure
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
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
Conclusion• Less iatrogenic
damage
• A safe and effective technique
Thank You