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1.  Unusual Appearance of an Osteochondral Lesion Accompanying Medial Meniscus Injury 
Arthroscopy Techniques  2014;3(1):e111-e114.
An osteochondral lesion in the knee joint is caused by a focal traumatic osteochondral defect, osteochondritis dissecans, an isolated degenerative lesion, or diffuse degenerative disease. An osteochondral lesion with a cleft-like appearance accompanying medial meniscus injury is rare without trauma. We report the case of a 13-year-old boy who complained of right knee pain and swelling, with radiographic findings of an osteochondral defect. Arthroscopic inspection showed an osteochondral lesion in the medial condyle of the femur and tibial plateau accompanying a partial medial meniscus discoid tear. Partial meniscectomy was performed, and a microfracture procedure was carried out on the osteochondral defect. The patient was asymptomatic at 2 years' follow-up. This technique is a relatively easy, completely arthroscopic procedure that spares the bone and cartilage and has yielded a good clinical outcome in a skeletally immature patient who had an osteochondral lesion with a cleft-like appearance.
doi:10.1016/j.eats.2013.09.003
PMCID: PMC3986489  PMID: 24749028
2.  Fluoroquinolone Use in a Child Associated with Development of Osteochondritis Dissecans 
BMJ case reports  2014;2014:10.1136/bcr-2014-204544 bcr2014204544.
SUMMARY
Several etiological theories have been proposed for the development of osteochondritis dissecans. Cartilage toxicity after fluoroquinolone use has been well documented in vitro. We present a case report of a 10-year-old child who underwent a prolonged 18-month course of ciprofloxacin therapy for chronic urinary tract infections. This patient later developed an osteochondritis dissecans lesion of the medial femoral condyle. We hypothesize that the fluoroquinolone therapy disrupted normal endochondral ossification, resulting in development of osteochondritis dissecans. The etiology of osteochondritis dissecans is still unclear, and this case describes an association between fluoroquinolone use and osteochondritis dissecans development.
doi:10.1136/bcr-2014-204544
PMCID: PMC4166236  PMID: 25228675
Paediatrics (drugs and medicines); Drugs and medicines; Musculoskeletal and joint disorders; Drugs and medicines
3.  Extra-articular, Intraepiphyseal Drilling for Osteochondritis Dissecans of the Knee 
Arthroscopy Techniques  2013;2(3):e231-e235.
Symptomatic osteochondritis dissecans lesions of the knee frequently occur in skeletally immature patients. When conservative treatment fails, retro-articular drilling, also known as intraepiphyseal extra-articular drilling, becomes a viable treatment option. The purpose of this article is to describe our surgical technique and postoperative management of patients with stable osteochondritis dissecans lesions involving the femoral condyles. This technique is reproducible, uses readily available equipment, and has yielded good clinical outcomes with high healing rates and relatively early return to sports.
doi:10.1016/j.eats.2013.02.012
PMCID: PMC3834662  PMID: 24265990
4.  Arthroscopically-assisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle 
Summary
Background
Osteochondral fracture (OCF) of the lateral femoral condyle has a low incidence and old OCF is even more rarely seen; it is difficult to differentiate from late osteochondritis dissecans (OCD).
Case Report
In this report, we present the case of a 20-year-old male patient with an old OCF of the lateral femoral condyle. The possible etiology of OCF is discussed, along with its clinical manifestation, diagnosis, and treatment. He underwent arthroscopically-assisted reduction and fixation with cannulated screws. Four months after the surgery, arthroscopy showed good osteochondral healing, and screws were removed. He had achieved good functional recovery by the follow-up visit.
Conclusions
Old OCF should be distinguished from OCD in clinical practice, and osteochondral bodies should be preserved as much as possible. Osteochondral reduction and fixation under arthroscopy was minimal and the clinical effect was good.
doi:10.12659/MSM.883637
PMCID: PMC3560805  PMID: 23235545
osteochondral fracture (OCF); arthroscopy; femoral condyle
5.  Can Fresh Osteochondral Allografts Restore Function in Juveniles With Osteochondritis Dissecans of the Knee? 
Background
Failure of initial treatment for juvenile osteochondritis dissecans (OCD) may require further surgical intervention, including microfracture, autograft chondrocyte implantation, osteochondral autografting, and fresh osteochondral allografting. Although allografts and autografts will restore function in most adults, it is unclear whether fresh osteochondral allograft transplantations similarly restore function in skeletally immature patients who failed conventional treatment.
Questions/purposes
Therefore, we determined function in (1) daily activity; (2) sports participation; and (3) healing (by imaging) in children with juvenile OCD who failed conventional therapy and underwent fresh osteochondral allograft transplantation.
Methods
We retrospectively reviewed 11 children with OCD of the knee treated with a fresh stored osteochondral allograft between 2004 and 2009 (six males and five females). The average age of the children at the time of their allograft surgery was 15.2 years (range, 13–20 years). The clinical assessments included physical examination, radiography, MRI, and a modified Merle D’Aubigné-Postel score. The size of the allograft was an average of 5.11 cm2. The minimum followup was 12 months (average, 24 months; range, 12–41 months).
Results
All patients had returned to activities of daily living without difficulties at 6 months and returned to full sports activities between 9 and 12 months after surgery. The modified Merle D’Aubigné-Postel score improved from an average of 12.7 preoperatively to 16.3 at 24 months postoperatively. Followup radiographs at 2 years showed full graft incorporation and no demarcation between the host and graft bone.
Conclusions
Our observations suggested fresh osteochondral allografts restored short-term function in patients with juvenile OCD who failed standard treatments.
Level of Evidence
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
doi:10.1007/s11999-012-2523-0
PMCID: PMC3586015  PMID: 22972653
6.  Fixation of osteochondral fragments in the human knee using Meniscus Arrows® 
The aim of this study is to compare the hold in bone of Meniscus Arrows® and Smart Nails®, followed by the report of the results of the clinical application of Meniscus Arrows® as fixation devices. First, pull-out tests were performed to analyse the holdfast of both nails in bone. Statistical analysis showed no significant difference; therefore, the thinner Meniscus Arrow® was chosen as fixation device in the patient series of two patients with a symptomatic Osteochondritis dissecans fragment and three patients with an osteochondral fracture of a femur condyle. The cartilage margins were glued with Tissuecoll®. All fragments consolidated. Second look arthroscopy in three patients showed fixed fragments with stable, congruent cartilage edges. At an average follow-up period of 5 years no pain, effusion, locking, restricted range of motion or signs of osteoarthritis were reported. Based on the results of the pull-out tests and available clinical studies, Meniscus Arrows® and Smart Nails® are both likely to perform adequately as fixation devices in the treatment of Osteochondritis dissecans and osteochondral fractures in the knee. They both provide the advantage of one stage surgery. However, based on their smaller diameter, the Meniscus Arrows® should be preferred for this indication.
doi:10.1007/s00167-010-1158-5
PMCID: PMC3023860  PMID: 20464370
Osteochondritis dissecans; Osteochondral fragments; Biodegradable; Fixation devices; Meniscus Arrows®
7.  Does Extracorporeal Shock Wave Therapy Enhance Healing of Osteochondritis Dissecans of the Rabbit Knee?: A Pilot Study 
Background
Severe osteochondritis dissecans (OCD) in children and adolescents often necessitates surgical interventions (ie, drilling, excision, or débridement). Since extracorporeal shock wave therapy (ESWT) enhances healing of long-bone nonunion fractures, we speculated ESWT would reactivate the healing process in OCD lesions.
Questions/purposes
We asked whether ESWT would enhance articular cartilage quality, bone and cartilage density, and histopathology of osteochondral lesions compared to nontreated controls in an OCD rabbit model.
Methods
We harvested a 4-mm-diameter plug of the weightbearing osteochondral surface on the medial femoral condyle of each knee in 20 skeletally immature (8-week-old) female rabbits. We placed a piece of acellular collagen-glycosaminoglycan matrix into the cavity and then replaced the plug. Two weeks after surgery, we sedated each rabbit and treated the right knee in a single setting with shock waves: 4000 impulses at 4 Hz and 18 kV. The left knee was a sham control. Ten weeks after surgery, we assessed cartilage morphology of the lesion using a modified Outerbridge Grading System, bone and cartilage density using histologic imaging, bone and cartilage morphology using the histopathology assessment system, and radiographic bone density and union and compared these parameters between ESWT-treated and control knees.
Results
Histologically, we observed more mature bone formation and better healing (1.1 versus 3.4) and density of the cartilage (60 versus 49) on the treated side. Radiographically, we noted an increase in bony density (154 versus 138) after ESWT.
Conclusions
ESWT accelerated the healing rate and improved cartilage and subchondral bone quality in the OCD rabbit model.
Clinical Relevance
This therapeutic modality may be applicable in OCD treatment in the pediatric population. Future research will be necessary to determine whether it may play a role in healing of human osteochondral defects.
doi:10.1007/s11999-012-2410-8
PMCID: PMC3586044  PMID: 22669551
8.  Osteochondritis dissecans of the knee fixed with biodegradable self-reinforced polyglycolide and polylactide rods in 24 patients 
International Orthopaedics  1998;21(6):355-360.
Summary.
Over a period of 7 years (1987 – 1994), 24 cases of osteochondritis dissecans of the knee were treated with self-reinforced polyglycolic acid (SR-PGA) and polylactic acid (SR-PLLA) rods. Rods measuring 1.1 mm, 1.5 mm and 2 mm in diameter, and 20 – 40 mm in length were used in the fixation of the fragment depending on the size of the lesions. There were 23 patients with osteochondritis dessicans in the medial and 1 in the lateral femoral condyle. The average age of the patients was 25 years (range: 16 – 48). Follow-up was for 3.3 years (range: 1 – 7.6). There were 6 lesions in situ, 3 early separations, 11 were partially detached, and there were 4 loose bodies. SR-PGA rods were used in 12 patients, SR-PLLA rods in 11 patients, and both SR-PGA and SR-PLLA rods in 1 patient. The rod in each case was inserted subchondrally and in 9 cases arthroscopically, using a special instrument. In our study, the clinical result was excellent in 13 patients, good in 6, fair in 1 and poor in 4. On radiological assessment the fragment had healed in 19 cases. Synovitis occurred in 1 patient in the SR-PGA group (1/13): the effusion continued for 6 months postoperatively but, after treatment by needle aspiration, there were no symptoms at follow-up 4.2 years later. We conclude that SR-PGA and SR-PLLA rods can be used intra-articularly for the adequate fixation of osteochondritis dissecans.
doi:10.1007/s002640050184
PMCID: PMC3619568  PMID: 9498141
9.  Familial Discoid Medial Meniscus Tear in Three Members of a Family: A Case Report and Review of Literature 
Case Reports in Orthopedics  2014;2014:285675.
Background. A discoid meniscus is a thickened variant of the normal C-shaped meniscus prone to injury. Discoid medial meniscal tears have rarely been reported within families and may suggest familial or developmental origins. Methods. We report the cases of two Caucasian brothers with symptomatic discoid medial meniscus tears. A literature review was conducted addressing discoid medial meniscus and cases of familial meniscus tears. Case Presentation. Physically active brothers presented with progressively worsening knee pain. MRI revealed medial meniscus tears in both brothers. The family history of medial meniscus tears in their mother and the discoid medial meniscus injuries found on arthroscopy suggested evidence for familial discoid medial meniscus tears. Conclusions. Discoid medial meniscus tears within a family have not been previously reported. Two cases of families with discoid lateral meniscus tears have been reported. Discoid medial meniscus is rare relative to the discoid lateral meniscus and predisposes children to symptomatic tears.
doi:10.1155/2014/285675
PMCID: PMC4274651  PMID: 25548700
10.  Osteochondral autograft transplantation for juvenile osteochondritis dissecans of the knee: a series of twelve cases 
International Orthopaedics  2012;36(11):2243-2248.
Purpose
The purpose of this study was to evaluate the clinical outcomes of osteochondral autograft transplantation (OAT) for juvenile osteochondritis dissecans (JOCD) lesions of the knee, especially time to return to sports.
Methods
Twelve knee JOCD lesions with OCD grade 3 and 4 categorised by magnetic resonance imaging (MRI) were treated with OAT. Nine male and two female skeletally immature patients averaging 13.7 years old were included. The OCD lesions were assessed arthroscopically and then fixed in situ using multiple osteochondral plugs harvested under fluoroscopy from the distal femoral condyle without damaging the physis. International Cartilage Repair Society (ICRS) score and Lysholm score were assessed pre- and postoperatively.
Results
After a mean follow-up of 26.2 ± 15.1 months, the International Knee Documentation Committee (IKDC) subjective score significantly improved (p < 0.01). According to the IKDC score, objective assessment showed that ten of 12 (83 %) had excellent results (score: A) after OAT and significantly improved (p < 0.01). Based on ICRS criteria, results were satisfactory in all patients. No patients experienced complications at the graft harvest site. All patients returned to their previous level of athletic activity at an average of 5.7 months after the surgery.
Conclusions
OAT for JOCD of the knee provided satisfactory results in all patients at a mean follow-up of 26.2 months.
doi:10.1007/s00264-012-1648-9
PMCID: PMC3479294  PMID: 22955675
11.  Meniscus Tear Patterns in Relation to Skeletal maturity: Children Versus Adolescents 
Background
Meniscus tear patterns in the pediatric population have not been well described.
Hypothesis/Purpose
The purpose of this study was to delineate the pattern of meniscus tears and the likelihood of repair at the time of surgery in both children and adolescents.
Study Design
Case series; Level of evidence, 4.
Methods
Retrospective review was performed on all patients between the age of 10 and 19 years who underwent arthroscopic surgery for meniscus pathology. Patients were classified into two groups: those with open growth plates were classified as children while those with closed growth plates were classified as adolescents. Demographic data was documented, including: age, sex, BMI, mechanism of injury, and duration from injury to surgery. Operative reports and intraoperative photographs were used to assess tear pattern: type, location, zone, as well as all concomitant procedures and pathology. Tears were classified as discoid, vertical, bucket-handle, radial, oblique, horizontal, fray, root detachment, or complex. ANOVA and chi-squared tests were then performed.
Results
Of the 293 patients reviewed, 197 (67%) had lateral meniscus tears, 65 (22%) had medial meniscus tears, and 31 (11%) had tears to both menisci. The cohort was separated into groups: 119 (41%) children (open growth plates) and 174 (59%) adolescents (closed growth plates). The mean age between groups was 13.5 years compared to 16.4 years (p < 0.001), respectively. Children were more likely to have discoid meniscus tears, lower BMI, and meniscus pathology not associated with ligamentous injuries (p<0.05). The rate of associated ligament injuries in children was 29% compared to 51% in adolescents. Overall, the most frequent tear pattern was complex (28%) followed by vertical (16%), discoid (14%), bucket-handle (14%), radial (10%), horizontal (8%), oblique (5%), fray (3%), and root detachment (2%). Complex tears were associated with boys (32% vs. 20% girls, p < 0.03) and greater mean BMI (27.4 vs. 25.1 kg/m2, p < 0.002), even when taking sex into account. Surgical repair was performed in 46% of all cases (56% in those treated within 3 months of injury compared to 42% in those treated after 6 months (p<0.03) and there was no difference in repair rate based on patient age (46% vs 48%; p>0.05)).
Conclusions
Adolescents and children sustain more complex meniscus injuries that are often less repairable than previously reported in the literature. Factors that are associated with greater tear complexity include: male sex and obesity. Our findings also suggest that earlier treatment of meniscus tears may increase the likelihood of repair in younger patients.
doi:10.1177/0363546513504286
PMCID: PMC4280010  PMID: 24071370
Meniscus tear; children; adolescents; repair
12.  Re-growth of an incomplete discoid lateral meniscus after arthroscopic partial resection in an 11 year-old boy: a case report 
Background
Discoid lateral meniscus is common in children. Arthroscopic partial resection is indicated in symptomatic cases generally achieving satisfactory results.
Case presentation
We present a case of an incomplete discoid lateral meniscus of the right knee in an 11 year-old boy, treated with arthroscopic partial resection, which developed a re-growth of the remnant, restoring the pre-operative incomplete discoid shape. To the best of our knowledge this is the first report about re-growth of a discoid meniscus after surgery. Debate still exists regarding the etiology of a discoid meniscus. Some authors proposed it is the persistence of the normal stage during fetal development. However, most other authors believe it is anomalous and arises through variant morphogenesis. The re-growth of the discoid lateral meniscus following surgery in this patient seems to prove this latter theory. The residual growth of the knee involves also the lateral meniscus and that may have contributed to restoring the meniscus to the previous condition.
Conclusion
This case report demonstrates discoid meniscal re-growth in a child. The growth spurt may have an impact on meniscal regeneration. Re-growth of the discoid lateral meniscus in our patient favors the hypothesis of variant morphogenesis.
doi:10.1186/1471-2474-14-285
PMCID: PMC3852015  PMID: 24099316
Discoid meniscus; Arthroscopy; Re-growth; Morphogenesis
13.  Intraosseous ganglion in the subchondral region of the lateral femoral condyle in an 11-year-old girl: a case report 
We report the case of a patient with intraosseous ganglion in the lateral femoral condyle. An 11-year-old girl presented with right knee pain following a twisting injury. Plain radiographs of the knee showed a small circumscribed radiolucency with a thin sclerotic margin in the subchondral region of the lateral femoral condyle. Although the image findings and location are not typical, the lesion was tentatively diagnosed as osteochodritis dissecans. Six months after the conservative treatment with a break from vigorous sports activities, the size of the bony lesion had not decreased. Thus, we performed arthroscopy to make a definitive diagnosis. Arthroscopic examination revealed an area with dimple and surface irregularity at the lateral femoral condyle. On excision of the overlying tissue, the lesion was cystic containing brown mucous fluid. No association between the cyst and the articular structures was observed. Histologic examination of the resected cyst wall showed dense fibrous tissue with spotty areas of calcification. Base on these findings, we made a diagnosis of intraosseous ganglion. At the nine-month postoperative follow-up, the radiographic examination showed healing of the lesion. We speculate that the lesion in this case might have occurred as a result of repetitive overstress or microtrauma.
doi:10.1186/1758-2555-1-25
PMCID: PMC2776581  PMID: 19891774
14.  Two Patients with Osteochondral Injury of the Weight-Bearing Portion of the Lateral Femoral Condyle Associated with Lateral Dislocation of the Patella 
Case Reports in Orthopedics  2014;2014:876410.
Complications of patellar dislocation include osteochondral injury of the lateral femoral condyle and patella. Most cases of osteochondral injury occur in the anterior region, which is the non-weight-bearing portion of the lateral femoral condyle. We describe two patients with osteochondral injury of the weight-bearing surface of the lateral femoral condyle associated with lateral dislocation of the patella. The patients were 18- and 11-year-old females. Osteochondral injury occurred on the weight-bearing surface distal to the lateral femoral condyle. The presence of a free osteochondral fragment and osteochondral injury of the lateral femoral condyle was confirmed on MRI and reconstruction CT scan. Treatment consisted of osteochondral fragment fixation or microfracture, as well as patellar stabilization. Osteochondral injury was present in the weight-bearing portion of the lateral femoral condyle in both patients, suggesting that the injury was caused by friction between the patella and lateral femoral condyle when the patella was dislocated or reduced at about 90° flexion of the knee joint. These findings indicate that patellar dislocation may occur and osteochondral injury may extend to the weight-bearing portion of the femur even in deep flexion, when the patella is stabilized on the bones of the femoral groove.
doi:10.1155/2014/876410
PMCID: PMC4251879  PMID: 25506015
15.  Treatment principles for osteochondral lesions in foot and ankle 
International Orthopaedics  2013;37(9):1697-1706.
Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the condition is often symptomatic enough to warrant treatment. In more than one third of cases, conservative treatment is unsuccessful, and surgery is indicated. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Surgical options are lesion excision, excision and curettage, excision combined with curettage and microfracturing, filling the defect with autogenous cancellous bone graft, antegrade (transmalleolar) drilling, retrograde drilling, fixation and techniques such as osteochondral transplantation [osteochondral autograft transfer system (OATS)] and autologous chondrocyte implantation (ACI). Furthermore, smaller lesions are symptomatic and when left untreated, OCDs can progress; current treatment strategies have not solved this problem. The target of these treatment strategies is to relieve symptoms and improve function. Publications on the efficacy of these treatment strategies vary. In most cases, several treatment options are viable, and the choice of treatment is based on defect type and size and preferences of the treating clinician.
doi:10.1007/s00264-013-2076-1
PMCID: PMC3764304  PMID: 23982639
Osteochondral lesions; Osteochondritis dissecans; Talus; Foot and ankle; Cartilage damage; Subchondral bone
16.  Three Osteochondritis Dissecans Lesions in One Knee: A Case Report 
Background
Osteochondritis dissecans (OCD) has been defined as a localized process in which a focus of subchondral bone and adjacent articular cartilage separates from the surrounding bone. With the knee being the most common location for OCD development and the propensity for this lesion to be found in those who participate in sports, a repetitive microtrauma hypothesis for its cause has gained favor. However, the cause of OCD remains controversial, as does the most appropriate treatment for the varying degrees of OCD lesions.
Case Description
We present a unique case of three OCD lesions in one knee. The patient was a young, athletic boy who developed three separate OCD lesions in his right knee over the course of 4 years. Temporally, the OCD lesions developed first in the lateral femoral condyle, then in the medial femoral condyle, and finally in the trochlea.
Literature Review
Our literature review yielded a few reports of bicondylar OCD lesions. We identified no previous reports of three separate OCD lesions found in a single joint.
Purposes and Clinical Relevance
This report illustrates how a uniquely affected knee with three OCD lesions was treated in three different ways with resolution of symptoms. Each of the OCD lesions was evaluated individually and treatment for each based on the severity of the lesion from the physical examination, imaging studies, and arthroscopic findings.
doi:10.1007/s11999-012-2324-5
PMCID: PMC3586005  PMID: 22453935
17.  Treatment of osteochondritis dissecans of the femoral condyle with autologous bone grafts and matrix-supported autologous chondrocytes 
International Orthopaedics  2009;34(6):819-825.
The objective of this study was to determine the clinical outcome of combined bone grafting and matrix-supported autologous chondrocyte transplantation in patients with osteochondritis dissecans of the knee. Between January 2003 and March 2005, 21 patients (mean age 29.33 years) with symptomatic osteochondritis dissecans (OCD) of the medial or lateral condyle (grade III or IV) of the knee underwent reconstruction of the joint surface by autologous bone grafts and matrix-supported autologous chondrocyte transplantation. Patients were followed up at three, six, 12 and 36 months to determine outcomes by clinical evaluation based on Lysholm score, IKDC and ICRS score. Clinical results showed a significant improvement of Lysholm-score and IKDC score. With respect to clinical assessment, 18 of 21 patients showed good or excellent results 36 months postoperatively. Our study suggests that treatment of OCD with autologous bone grafts and matrix-supported autologous chondrocytes is a possible alternative to osteochondral cylinder transfer or conventional ACT.
doi:10.1007/s00264-009-0841-y
PMCID: PMC2989013  PMID: 19626325
18.  Case Report: Osteochondritis Dissecans in Twins: Treatment with Fresh Osteochondral Grafts 
Osteochondritis dissecans is a lesion of subchondral bone with subsequent involvement of the overlying cartilage. Although the etiology of the disease is unknown, mechanical, traumatic, and ischemic etiologies have been suggested, in addition to developmental and genetic factors. There are several treatment options depending on the stage of the disease and surgeon preference. The use of a fresh osteochondral allograft for treatment of a lesion of the femoral condyle is relatively new, and we report its use in a unique situation involving identical twins who both presented with osteochondritis dissecans of the same anatomic location within 2 years of each other. Since these were identical lesions in identical twins, this commonality supports the suggestion that some genetic component may be present in the etiology, especially in this situation where a genetic connection existed. We recommend genetic studies to determine the extent of genetic influence on the disease.
doi:10.1007/s11999-009-1017-1
PMCID: PMC2816755  PMID: 19662464
19.  Arthroscopic Centralization of an Extruded Lateral Meniscus 
Arthroscopy Techniques  2012;1(2):e209-e212.
Extrusion of the lateral meniscus has been reported after posterior root tear or radial tear, partial meniscectomy, and meniscoplasty of discoid meniscus. It has also been shown to be associated with the development of osteoarthritis. This technical note describes a new arthroscopic technique to centralize and stabilize the mid body of the lateral meniscus to restore and maintain the lateral meniscus function by repairing/preventing extrusion of the meniscus. A JuggerKnot Soft Anchor (Biomet, Warsaw, IN), loaded with a MaxBraid suture (Biomet), was placed on the lateral edge of the lateral tibial plateau, just anterior to the popliteal hiatus, through a midlateral portal. A Micro Suture Lasso Small Curve with Nitinol Wire Loop (Arthrex, Naples, FL) was used to pass 2 limbs of the MaxBraid suture through the meniscus at the margin between the meniscus and the capsule. Another anchor was inserted on the lateral edge of the lateral tibial plateau, 1 cm anterior to the first anchor, and the same procedure was repeated. The sutures were then tied by use of a self-locking sliding knot, achieving centralization and secure stabilization of the lateral meniscus.
doi:10.1016/j.eats.2012.08.001
PMCID: PMC3678624  PMID: 23766997
20.  Surgical Treatment for Osteochondritis Dissecans of the Capitellum 
Sports Health  2012;4(5):425-432.
Context:
Osteochondritis dissecans (OCD) of the capitellum is most often seen in adolescents who participate in sports that involve repetitive loading of the elbow. Unstable defects typically require surgical intervention that involves fragment fixation, debridement, or reconstruction with an osteochondral autograft transfer. Optimum surgical management of unstable defects remains controversial.
Type of Study:
Clinical review.
Evidence Acquisition:
Relevant articles published after 1992 were identified using MEDLINE, the EMBASE database, and the Cochrane Library.
Results:
Both debridement and osteochondral autograft transfer for treatment of capitellar OCD lesions result in good short- and midterm outcomes with a high rate of return to sports. Larger defects involving more than 50% of the articular surface or involving the lateral margin of the capitellum may have worse outcomes after debridement and may be better treated with fragment fixation or osteochondral autograft transfer.
Conclusions:
High-level evidence is lacking to determine the superiority of debridement or osteochondral autograft transfer for the treatment of capitellar OCD lesions. A prospective longitudinal multicenter study, using validated outcome measures, that enrolls a large number of patients is needed to establish optimal treatment for unstable capitellar OCD lesions.
doi:10.1177/1941738112444707
PMCID: PMC3435938  PMID: 23016116
osteochondritis dissecans; elbow; capitellum
21.  Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study 
Background
Lateral Patella dislocations are common injuries seen in the active and young adult populations. Our study focus was to evaluate medial patellofemoral ligament (MPFL) injury patterns and associated knee pathology using Magnetic Resonance Imaging studies.
Methods
MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella dislocation were screened for this study. Of the 324 cases that were found, 195 patients with lateral patellar dislocation traumatic enough to cause bone bruises on the lateral femoral trochlea and the medial facet of the patella were selected for this study. The MRI images were reviewed by three independent observers for location and type of MPFL injury, osteochondral defects, loose bodies, MCL and meniscus tears. The data was analyzed as a single cohort and by gender.
Results
This study consisted of 127 males and 68 females; mean age of 23 yrs. Tear of the MPFL at the patellar attachment occurred in 93/195 knees (47%), at the femoral attachment in 50/195 knees (26%), and at both the femoral and patella attachment sites in 26/195 knees (13%). Attenuation of the MPFL without rupture occurred in 26/195 knees (13%). Associated findings included loose bodies in 23/195 (13%), meniscus tears 41/195 (21%), patella avulsion/fracture in 14/195 (7%), medial collateral ligament sprains/tears in 37/195 (19%) and osteochondral lesions in 96/195 knees (49%). Statistical analysis showed females had significantly more associated meniscus tears than the males (27% vs. 17%, p = 0.04). Although not statistically significant, osteochondral lesions were seen more in male patients with acute patella dislocation (52% vs. 42%, p = 0.08).
Conclusion
Patients who present with lateral patella dislocation with the classic bone bruise pattern seen on MRI will likely rupture the MPFL at the patellar side. Females are more likely to have an associated meniscal tear than males; however, more males have underlying osteochondral lesions. Given the high percentage of associated pathology, we recommend a MRI of the knee in all patients who present with acute patella dislocation.
doi:10.1186/1758-2555-1-17
PMCID: PMC2732599  PMID: 19643022
22.  The 5.5-year results of MegaOATS – autologous transfer of the posterior femoral condyle: a case-series study 
Introduction
Large osteochondral defects of the weight-bearing zones of femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle (large osteochondral autogenous transplantation system (MegaOATS)). The technique presented is a sound and feasible salvage procedure to address large osteochondral defects in weight-bearing zones.
Methods
Thirty-six patients between July 1996 and December 2000 were included. Thirty-three patients (10 females, 23 males) were evaluated by the Lysholm score and X-ray scans. A random sample of 16 individuals underwent magnetic resonance imaging analysis. The average age at the date of surgery was 34.3 (15 to 59) years, and the mean follow up was 66.4 (46 to 98) months. The mean defect size was 6.2 (2 to 10.5) cm2, in 27 patients affecting the medial femoral condyle and in six patients affecting the lateral femoral condyle. Trauma or osteochondrosis dissecans were pathogenetic in 82%.
Results
The Lysholm score in all 33 individuals showed a highly significant increase from a preoperative median 49.0 points to a median 86.0 points (P ≤ 0.001). Twenty-seven patients returned to recreational sports. X-ray scans showed a rounding of the osteotomy edge in 24 patients, interpreted as a partial remodelling of the posterior femoral condyle. Preoperative osteoarthritis in 17 individuals was related to significant lower Lysholm scores (P = 0.014), but progression in 17 patients did not significantly influence the score results (P = 0.143). All 16 magnetic resonance imaging examinations showed vital and congruent grafts.
Conclusion
Patients significantly improve in the Lysholm score, in daily-life activity levels and in return to recreational sports. Thirty-one out of 33 patients were comfortable with the results and would undergo the procedure again. The MegaOATS technique is therefore recommended as a salvage procedure for young individuals with large osteochondral defects in the weight-bearing zone of the femoral condyle.
doi:10.1186/ar2439
PMCID: PMC2483459  PMID: 18558007
23.  Juvenile osteochondritis of femoral condyles: treatment with transchondral drilling. Analysis of 40 cases 
Introduction
Osteochondritis dissecans (OCD) of the femoral condyle is a rare lesion.
Materials and methods
A retrospective study (level IV evidence) analyzing a series of 40 pediatric cases with juvenile femoral condyles osteochondritis treated by arthroscopic multiple transchondral drilling between February 1999 and June 2008 was undertaken. This lesion affected the medial condyle in 87.5% of cases. The average age at treatment was 13.4 years. Our study took into account the location of the lesion and its radiological evolutionary stage. The average follow up was 14.8 months. The postoperative evaluation was based on the clinical and radiological scores of Hughston.
Results
Good clinical and radiological results in 97.5 and 95% of cases, respectively were obtained, with a significant correlation (P < 0.001) between clinical scores and radiological Hughston scores. The closed nature of the growth plate during surgery has a significant deleterious effect (P < 0.001) on the clinical and radiological score of Hughston.
Conclusion
All patients presenting juvenile condylar osteochondritis with open growth plate during treatment had good clinical and radiological results, confirming the validity and effectiveness of multiple transchondral drilling in this type of lesion.
doi:10.1007/s11832-009-0225-2
PMCID: PMC2811686  PMID: 20016956
Juvenile osteochondritis dissecans; Femoral condyles; Arthroscopic transchondral drilling
24.  Transient Patellar Dislocation Resulting in Simultaneous Osteochondral Fractures of Patella and Lateral Femoral Condyle – A Case Report 
Transient Patellar dislocations are commonly associated with bony contusions or osteochondral fractures involving the medial facet of patella or lateral femoral condyle. Simultaneous osteochondral fractures are rare and have not been reported in the adult. The authors report a case of combined osteochondral fracture of patella and lateral femoral condyle following acute patellar dislocation in an adult, which was misdiagnosed as meniscal injury. Both the osteochondral fracture fragments were rigidly fixed with headless compression screws and repair of the medial retinaculum was done. At latest follow up after two years, patient had regained full range of motion with no further episodes of patellar dislocation. The rarity of this combination of injury along with difficulty in interpreting radiographs makes this case interesting.
doi:10.7860/JCDR/2014/8857.4944
PMCID: PMC4253196  PMID: 25478378
Lateral femoral condyle; Medial facet patella; Osteochondral fracture; Patellar dislocation
25.  Case Report: Osteochondral Avulsion Fracture of the Posteromedial Bundle of the PCL in Knee Hyperflexion 
Background
Injury of the PCL of the knee in adults usually results in rupture rather than avulsion fracture and avulsions usually occur at the tibial insertion.
Case Description
We report an avulsion of the PCL with a femoral origin in a 22-year-old man who was injured by hyperflexion of the knee and was treated with arthroscopy. There were two parts in the partial osteochondral avulsion fracture of the PCL posteromedial (PM) bundle. One part was fixed with polydioxanone suture through drill holes and the other was removed. The fracture healed after 3 months and the knee was stable. At 11 months postoperatively the patient had returned to full-time work without pain or restrictions. The Lysholm II knee score was 95 points. Physical examination showed a negative posterior drawer sign.
Literature Review
We identified four other reported cases of PCL femoral origin avulsion fractures in adults. The subjects were 20 to 25 years old in four of five reports, including our patient. Three of the five patients had involvement of only the lateral cortex of the medial femoral condyle whereas two other patients including our patient, had an osteochondral fracture. The mechanism of PCL avulsion seems to be similar to that of a PCL rupture.
Purposes and Clinical Relevance
The hyperflexion injury may result in injury of the PM bundle of the PCL. Our case and one other in the literature suggest such avulsions need not involve the entire PCL.
doi:10.1007/s11999-012-2632-9
PMCID: PMC3492605  PMID: 23054525

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