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Abstract
The purpose of this study was to investigate clinical and radiological outcomes of multiple drilling in case of failed conservative treatment of juvenile osteochondritis dissecans in athletes. We treated 37 lesions from 30 athletic patients who failed conservative treatment for juvenile osteochondritis dissecans. Multiple drillings were done for 32 lesions and multiple drilling and bioabsorbable pin fixations were done for 5 lesions. Lysholm score, Hughston clinical scale were used for clinical evaluation before and last follow up of treatment. For radiologic evaluation we used magnetic resonance imaging at 3 months and 12 months after operation. Of all 37 lesions, 11 lesions were located on medial femoral condyle, 2 lesions on lateral femoral condyle and 24 lesions on trochlear groove. There were clinical and radiological improvement from Hughston scale after operative treatment. Twenty-five patients among 30 returned to the sports activity. There were no specific complications after operation. Multiple drilling and bioabsorbable pin fixation of juvenile athletic osteochondritis dissecans patients after failure of conservative treatment showed good clinical and radiologic results. So it would be helpful for juvenile athletic patients to return to sports activities.
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Fig. 1.
This illustration shows Bedouelle's radiologic classification (Data from Hayan et al. Child Orthop 2010;4: 39–448)).
Fig. 2.
A 16-year-old male patient with osteochondritis dissecans in the left trochlear lesion. (A) Arthroscopic multiple drilling with K-wire was done. (B) Preoperative coronal and sagittal T1 weighted magnetic resonance (MR) images are shown that the presence of a low signal line beneath the lesion and a breach of the articular cartilage with 10 mm×20 mm size. (C) Postoperative 3 months follow-up MR images are shown the trace of multiple drilling. (D) Postoperative 12 months follow-up MR images are shown that there are decrease of low signal intensity rim and the size of lesion.
Fig. 3.
A 15-year-old male patient with unstable osteochodral lesion. (A) Vertical incision was made along the patella border and open multiple drilling was done. (B) Unstable osteochondral lesion was fixed with bioabsorbable pins after multiple drilling.
Table 1.
Hughston clinical scale
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