Juvenile osteochondritis dissecans (JOCD) is a fairly common cause of knee pain and dysfunction in young children and adolescents, particularly those between 10 and 15 years who participate in athletic activities. The most common location of these lesions is the medial femoral condyle with an occurrence of 70% to 85% reported in the literature.
Both nonoperative and operative treatments have been described for medial femoral condyle lesions. Surgical options include fixation, drilling, and chondral remodeling with the ultimate goal of revitalizing the osteochondral environment and reestablishing the joint surface.
According to a new study, internal fixation of lateral trochlear groove osteochondritis dissecans with simultaneous lateral retinacular lengthening can be effective in adolescent athletes with a high rate of return to sport.
The study, “Internal Fixation of Lateral Trochlear Groove Osteochondritis Dissecans With Simultaneous Lateral Retinacular Lengthening in Adolescent Athletes,” appears online in the November 10, 2021 edition of the The American Journal of Sports Medicine.
The researchers conducted a retrospective review of adolescent athletes who had undergone internal fixation and simultaneous lateral retinacular lengthening for an unstable osteochondritis dissecans lesion of the lateral trochlear groove.
Data collected included the Lysholm score, International Knee Documentation Committee subjective score, Tegner activity scale, an athletic questionnaire and functional tests on isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance.
The mean ± SD age of the 17 patients included in this study was 15.9 ± 0.9 years; last clinical follow-up duration was 37.7 ± 8.1 months.
At the last follow-up, the Lysholm score improved from 68.7 ± 15.3 to 93.4 ± 12.4 and the International Knee Documentation Committee subjective score from 60.2 ± 14.7 to 88.7 ± 12.7 (p < .001).
The mean Tegner activity scale score was 9.4 ± 0.5 before injury and 8.9 ± 1.2 at the last follow-up (p = .059). The limb symmetry indices of isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance also improved at the last follow-up.
The mean limb symmetry index was ≥85% in each functional test and 16 (94.1%) patients were satisfied with the surgery in the questionnaire.
At the final follow-up, 2 patients performed better after returning to sports, 11 returned to sport at the same level, and 3 had lower ability than the preinjury level. Seven (41.2%) patients fully healed by the 12-month follow and 9 partially healed (52.9%).
“Internal fixation of lateral trochlear groove osteochondritis dissecans with simultaneous lateral retinacula lengthening in adolescent athletes achieved satisfactory clinical and radiological outcomes. Therefore, this combined surgical technique could be considered an effective treatment for lateral trochlear groove osteochondritis dissecans, with a high rate of return to sport,” they wrote.
The study authors included Dhong Won Lee, M.D., Joon Kyu Lee, M.D., Young Chang Cho, M.D., and Seung Ik Cho of KonKuk University in Seoul, Korea. Sang Jin Yang of TongWon University in Gwangja, Korea and Jin Goo Kim, M.D., of Myongji Hospital.
