medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2014, Number 2

<< Back Next >>

Acta Ortop Mex 2014; 28 (2)

Unusual location of osteochondral lesions in adolescent’s knees

Cruz-Morandé S, Iñigo-Crespo, Llombart-Blanco R, Valentí-Nin JR

Language: Spanish
References: 21
Page: 128-133
PDF size: 456.78 Kb.


ABSTRACT

Osteochondral knee lesions in adolescents are primarily located in loading areas at the level of the femoral condyles. Lesions located in the trochlea are exceptional and account for less than 1%. The etiology of juvenile osteochondritis dissecans (JOCD) is still unknown. Osteochondral lesions may be caused by direct frontal trauma of the femoral condyles and by direct trauma of the patella on the trochlea in dislocations of the latter. At this level both mechanisms may cause both chondral and osteochondral lesions. We present herein two cases with the same characteristics that include one patient with bilateral involvement of the trochlea. Arthroscopy was performed with removal of loose bodies, regularization of the bed and perforations, with appropriate long term results. Osteochondral lesions are rarely found in the trochlea; the literature contains very few bilateral cases described. The exact etiology of JOCD of the knee continues to be debated. In our cases the mechanism could be explained by a low-pressure high-speed impact of the patella on the trochlea. This type of lesions may be added to defects or abnormalities of ossification during childhood. The bilaterality of one of these cases would support this hypothesis. Treatment depends on lesion stability and patient age. Surgical treatment should be considered in patients with open physes with an unstable or detached lesion and in those in whom the physis is about to close but have not responded to conservative treatment, as well as in patients with an intraarticular loose body. Another point to consider is that insufficient fixation or fixation without a bone chip leads to mediocre results.


REFERENCES

  1. Hunt N, Sánchez-Ballester J, Pandit R, Thomas R, Strachan R: Chondral lesions of the knee: A new localization method and correlation with associated pathology. Arthroscopy. 2001; 175: 481-90.

  2. Flynn J, Kocher M, Ganley T: Osteochondritis dissecans of the knee. J Pediatr Orthop. 2004; 24(4): 434-43.

  3. Hughston JC, Hergenroeder PT, Courtenay BG: Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg. 1984; 66: 1340-8.

  4. Linden B: The incidence of osteochondritis dissecans in the condyles of the femur. Acta Orthop Scand. 1976; 47: 664-7.

  5. Gilley JS, Gelman M: Chondral fracture of the knee arthrographic, arthroscopic and clinical manifestations. Diagn Radiol. 1981; 138: 51-4.

  6. Smith JB: Osteochondritis dissecans of the trochlea of the femur. Arthroscopy. 1990; 6(1): 11-7.

  7. Oohashi Y, Oohashi Y: Chondral fracture of the lateral trochlea of the femur occurring in an adolescent: mechanism of injury. Arch Orthop Trauma Surg. 2007; 127: 791-4.

  8. Nakamura N, Horibe S, Iwahashi T, Kawano K, Shino K, Yoshikawa H: Healing of a chondral fragment of the knee in an adolescent after internal fixation. A case report. J Bone Joint Surg Am. 2004; 86: 2741-6.

  9. Takahashi Y, Nawata K, Hashiguchi H, Kawaguchi K, Yamasaki D, Tanaka H: Bilateral osteochondritis dissecans of the lateral trochlea of the femur: a case report. Arch Orthop Trauma Surg. 2008; 128(5): 469-72.

  10. Kocher M, Tucker R, Ganley T, Flynn J: Management of osteochondritis dissecans of the knee: Current Concepts Review. Am J Sports Med. 2006; 34(7): 1181-91.

  11. Murray JRD, Chitnavis J, Dixon P, Hogan NA, Parker G, Parish EN, Cross MJ: Osteochondritis dissecans of the knee; long-term clinical outcome following arthroscopic debridement. The Knee. 2007. Doi: 10.1016.11.01

  12. Kutscha-Lissberg F, Singer P, Vécsei V, Marlovits S: Osteochodritis dissecans des Kniegelenks. Radiologe. 2004; 44: 783-8.

  13. Roga M, Zappala G, Cherubino M, Genovese E, Bulgheroni P: Osteochondritis dissecans of the entire trochlea. Am J Sports Med. 2006; 34(9); 1508-11.

  14. Flachsmann R, Broom ND, Hardy AE, Moltschaniwskyj G: Why is the adolescent joint particularly susceptible to osteochondral shear fracture? Clin Orthop Rel Res. 2000; 381: 212-21.

  15. Oeppen RS, Connolly SA, Bencardino JT, Jaramillo D: Acute injury of the articular cartilage and subchondral bone: a common but unrecognized lesion in the immature knee. AJR. 2004; 182: 111-7.

  16. Cahill BR: Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg. 1995; 3: 237-47.

  17. Dory MA: Chondral fracture of the anterior intercondylar groove of the femur. Clin Reumathology. 1983; 2(2): 175-7.

  18. Gobbi A, Kon E, Berruto M, Filardo G, Delcogliano M, Boldrini L, Bathan L, Marcacci M: Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med. 2009; 37(6): 1083-92.

  19. Trinh TQ, Harris JD, Flanigan DC: Surgical management of juvenile osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc. 2012 [Epub ahead of print].

  20. Fischer M, Koller U, Krismer M: The use of fresh allografts in osteochondrosis dissecans of the lateral femoral condyle. Oper Orthop Traumatol. 2006; 18(3): 245-58.

  21. Gomoll AH, Farr J, Gillogly SD, Kercher J, Minas T: Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010 Oct 20; 92(14): 2470-90.




2020     |     www.medigraphic.com