Evaluation and treatment of osteochondral injury of knee joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Hui ¹ , LI Jian ² , ZOU Hong ¹ , SHEN Jianping ¹ , ZHANG Yan ¹ , LI Jianfeng ¹ , GONG Shuangquan ¹

1. Department of Knee Joint, Mianyang Orthopaedic Hospital, Mianyang Sichuan, 621000, P.R.China;
2. Sports Medicine Center of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

WANG Hui, Email: mywhdoctor@163.com

Keywords：

Knee joint; osteochondral injury; internal fixation

DOI：

10.7507/1002-1892.201903085

Video：

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Objective To investigate evaluation and treatment of osteochondral injury of knee joint and its effectiveness.Methods Between January 2010 and January 2016, 17 patients with osteochondral injury of knee joint were admitted. There were 2 males and 15 females, with an average age of 19.3 years (range, 15-33 years). The causes of injury included the sprain in 14 cases and knee hyper-extension and varus due to violence in 3 cases. The osteochondral injury located at patella in 8 cases, lateral femoral condyle in 4 cases, medial femoral condyle in 1 case, and tibial plateau in 4 cases. There were 15 cases of fresh fractures and 2 cases of old fractures. The Lysholm score of the knee joint was 31.6±2.3. After open reduction of osteochondral fractures of 14 cases, the absorbable rods (9 cases), absorbable cartilage nail (3 cases), or absorbable sutures (2 cases) were selected for fixation. The osteochondral fractures at the medial tibial plateau margin (non-weight-bearing area) in 3 cases were removed.Results The incision fat liquefaction occurred in 1 case after operation and healed after debridement. The other incisions had primary healing. All 17 patients were followed up 6 months to 2 years (mean, 13 months). Thirteen of 14 patients with internal fixation had good fractures healing without traumatic arthritis; 1 case of patella osteochondral fracture did not heal. Three patients with non-weight-bearing osteochondral removal had no narrowing of the medial joint space and traumatic arthritis during the follow-up. The Lysholm score of knee joint at 1 year after operation was 91.3±1.1, which significantly improved when compared with preoperative score (t=7.136, P=0.001).Conclusion For the osteochondral injury of the knee joint, the osteochondral block with full-layer cancellous bone can be treated with open reduction and internal fixation; while osteochondral block with punctate cancellous bone can be directly remove.

Citation： WANG Hui, LI Jian, ZOU Hong, SHEN Jianping, ZHANG Yan, LI Jianfeng, GONG Shuangquan. Evaluation and treatment of osteochondral injury of knee joint. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1384-1388. doi: 10.7507/1002-1892.201903085 Copy

1.	Sgaglione NA, Miniaci A, Gillogly SD, et al. Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy, 2002, 18(2 Suppl 1): 9-32.
2.	蒋欣, 李箭, 刘利君, 等. 儿童单纯性膝关节骨软骨骨折的关节镜治疗. 临床小儿外科杂志, 2011, 10(1): 28-29, 38.
3.	Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy, 2003, 19(7): 717-721.
4.	程智涛, 夏春明, 何振华, 等. 326 例膝关节骨软骨骨折病例流行病学分析. 创伤外科杂志, 2015, 17(4): 364-365.
5.	Sanders TG, Paruchuri NB, Zlatkin MB. MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. AJR Am J Roentgenol, 2006, 187(5): 1332-1337.
6.	Callewier A, Monsaert A, Lamraski G. Lateral femoral condyle osteochondral fracture combined to patellar dislocation: a case report. Orthop Traumatol Surg Res, 2009, 95(1): 85-88.
7.	Mashoof AA, Scholl MD, Lahav A, et al. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy, 2005, 21(2): 228-232.
8.	Ege G, Akman H, Kuzucu K, et al. Knee injuries: MRI findings. Ulus Travma Derg, 2001, 7(1): 60-65.
9.	黄耀渠, 伍琼慧, 赵晓梅, 等. 膝关节急性骨软骨骨折的MRI分析. 实用放射学杂志, 2013, 29(3): 443-445, 454.
10.	McCauley TR, Disler DG. Magnetic resonance imaging of articular cartilage of the knee. J Am Acad Orthop Surg, 2001, 9(1): 2-8.
11.	Sanders RK, Crim JR. Osteochondral injuries. Semin Ultrasound CT MR, 2001, 22(4): 352-370.
12.	吕秉伦, 范明, 黄东生. 关节镜技术在青少年膝关节骨软骨骨折诊治中的应用. 中医正骨, 2000, 12(1): 18.
13.	戴祝, 尤迪, 廖瑛, 等. 髌骨复发性脱位伴陈旧性骨软骨骨折的治疗. 中国修复重建外科杂志, 2016, 30(1): 10-14.
14.	Recht MP, Goodwin DW, Winalski CS, et al. MRI of articular cartilage: revisiting current status and future directions. AJR Am J Roentgenol, 2005, 185(4): 899-914.
15.	陈光兴, 杨柳, 戴刚, 等. 关节镜下Spin螺定固定治疗膝关节髁骨软骨骨折. 重庆医学, 2006, 35(20): 1827-1828, 1831.
16.	徐向峰, 刘鹏鹤, 岳龙, 等. 软组织带线铆钉治疗大块髌骨软骨骨折的临床观察. 中国骨伤, 2018, 31(12): 1140-1143.
17.	Solheim E, Øyen J, Hegna J, et al. Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients. Knee Surg Sports Traumatol Arthrosc, 2010, 18(4): 504-508.
18.	Millington KL, Shah JP, Dahm DL, et al. Bioabsorbable fixation of unstable osteochondritis dissecans lesions. Am J Sports Med, 2010, 38(10): 2065-2070.

1. Sgaglione NA, Miniaci A, Gillogly SD, et al. Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy, 2002, 18(2 Suppl 1): 9-32.
2. 蒋欣, 李箭, 刘利君, 等. 儿童单纯性膝关节骨软骨骨折的关节镜治疗. 临床小儿外科杂志, 2011, 10(1): 28-29, 38.
3. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy, 2003, 19(7): 717-721.
4. 程智涛, 夏春明, 何振华, 等. 326 例膝关节骨软骨骨折病例流行病学分析. 创伤外科杂志, 2015, 17(4): 364-365.
5. Sanders TG, Paruchuri NB, Zlatkin MB. MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. AJR Am J Roentgenol, 2006, 187(5): 1332-1337.
6. Callewier A, Monsaert A, Lamraski G. Lateral femoral condyle osteochondral fracture combined to patellar dislocation: a case report. Orthop Traumatol Surg Res, 2009, 95(1): 85-88.
7. Mashoof AA, Scholl MD, Lahav A, et al. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy, 2005, 21(2): 228-232.
8. Ege G, Akman H, Kuzucu K, et al. Knee injuries: MRI findings. Ulus Travma Derg, 2001, 7(1): 60-65.
9. 黄耀渠, 伍琼慧, 赵晓梅, 等. 膝关节急性骨软骨骨折的MRI分析. 实用放射学杂志, 2013, 29(3): 443-445, 454.
10. McCauley TR, Disler DG. Magnetic resonance imaging of articular cartilage of the knee. J Am Acad Orthop Surg, 2001, 9(1): 2-8.
11. Sanders RK, Crim JR. Osteochondral injuries. Semin Ultrasound CT MR, 2001, 22(4): 352-370.
12. 吕秉伦, 范明, 黄东生. 关节镜技术在青少年膝关节骨软骨骨折诊治中的应用. 中医正骨, 2000, 12(1): 18.
13. 戴祝, 尤迪, 廖瑛, 等. 髌骨复发性脱位伴陈旧性骨软骨骨折的治疗. 中国修复重建外科杂志, 2016, 30(1): 10-14.
14. Recht MP, Goodwin DW, Winalski CS, et al. MRI of articular cartilage: revisiting current status and future directions. AJR Am J Roentgenol, 2005, 185(4): 899-914.
15. 陈光兴, 杨柳, 戴刚, 等. 关节镜下Spin螺定固定治疗膝关节髁骨软骨骨折. 重庆医学, 2006, 35(20): 1827-1828, 1831.
16. 徐向峰, 刘鹏鹤, 岳龙, 等. 软组织带线铆钉治疗大块髌骨软骨骨折的临床观察. 中国骨伤, 2018, 31(12): 1140-1143.
17. Solheim E, Øyen J, Hegna J, et al. Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients. Knee Surg Sports Traumatol Arthrosc, 2010, 18(4): 504-508.
18. Millington KL, Shah JP, Dahm DL, et al. Bioabsorbable fixation of unstable osteochondritis dissecans lesions. Am J Sports Med, 2010, 38(10): 2065-2070.

Chinese Journal of Reparative and Reconstructive Surgery

Evaluation and treatment of osteochondral injury of knee joint

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