This study aimed to evaluate the clinical outcomes of paediatric patients who underwent a retrograde drilling treatment for their osteochondritis dissecans (OCD) of the talus. The secondary purpose was to identify factors that are predictive of a failure of the treatment. A retrospective study was done. All patients treated for talar OCD between 2014 and 2017 were reviewed to extract clinical and demographic information (age, sex, BMI, OCD size and stability, number of drilling, etc). Inclusion criteria were: (1) talar OCD treated with retrograde drilling, (2) less than 18 years, (3) at least one available follow up (4) stable lesion. Exclusion criteria was another type of treatment for a the talar OCD. Additionally, all pre-operative and post-operative medical imaging was reviewed. Outcome was classified based on the last follow-up appointment in two ways, first a score was attributed following the Berndt and Harty treatment outcome grading and second according to the necessity of a second surgery which was the failure group. Chi-square and Mann-Whitney tests were used to compared the success and failure group. Seventeen patients (16 girls and 1 boy, average age: 14.8±2.1 years) were included in our study group. The mean follow up duration was 11.5 (±12) months. Among this population, 4/17 (24%) had a failure of the treatment because they required a second surgery. The treatment result grading according to Berndt and Harty outcome scale identified good results in 8/17 (47%) patients, fair results in 4/17(24%) patients and poor results in 5/17 (29%) patients. The comparisons for various patient variables taken from the medical charts between patients who had a success of the treatment and those who failed did not find any significant differences. At a mean follow-up duration of 11.5 months, 76% of patients in this study had a successful outcome after talar OCD retrograde drilling. No statistically significant difference was identified between the success and failure group. Talar OCD in a paediatric population is uncommon, and this study reviewed the outcome of retrograde drilling with the largest sample size of the literature. Retrograde drilling achieved a successful outcome in 76% of the cases and represents a good option for the treatment of stable talar OCD

To determine if there are osteochondritis dissecans (OCD) lesions of the knee that are so unstable on MRI that they are incapable of healing without operative intervention. A secondary objective was to determine the ability of orthopaedic residents to accurately grade OCD lesions according to the Kijowski criteria of stable and unstable. A retrospective review was performed of patients who had femoral condyle OCD lesions from 2009-present. Only patients with open growth plates and serial MRIs were included. Each MRI was classified according to the Kijowski classification by a junior orthopaedic surgery resident as well as an MSK trained radiologist. A weighted kappa value was used to assess the inter-rater agreement. The final analysis included 16 patients (17 knees) with 49 MRI's. The weighted kappa agreement between reviewers for overall lesion stability was moderate (0.570 [95% CI 0.237–0.757]). The initial MRI lesion was graded as stable in 59% (10/17) of the knees. Two of these 10 knees became unstable during the study period, however, both stabilised again on subsequent MRIs, one with surgery and the other without surgery. The initial MRI was graded as unstable in 41% (7/17) of the knees. Two of the seven knees (29%) later demonstrated MRI evidence of lesion stability without surgical intervention. The most important finding in this study was the ability of unstable OCD lesions on MRI to heal without operative intervention. The ability of an orthopaedic surgery resident to grade these lesions on MRI was moderate

Objectives. Surgical treatment is standard for advanced osteochondritis dissecans (OCD) of the humeral capitellum. When cartilage is seen to be separated or completely detached, this fragment fixation is not usually applied. There have been reports of cases in which advanced OCD of the humeral capitellum progressed to osteoarthritis (Fig), particularly in cases which involved the lateral wall. In these cases, every attempt should be made to reconstruct the lateral wall to avoid osteoarthritis. In this study, we followed up cases with rib osteochondral autograft transplantation technique. Methods. Subjects were 20 cases who were followed up until after they started pitching. The mean age was 13.8 years old and the mean observation period was 2 years and 6 months (from 7 months to 6 year 3 months). Kocher's approach was used to give a good access to the aspect of the radiohumeral joint. The majority of cases suffered from extensive OCD of the elbow. Detached fragment was removed (Fig. 2a) and graft from 5. th. or 6. th. rib with screw fixation was performed on 12 patients and 8 received fixation with no material (Fig. 2b). Follow-up assessment included the range of motion, start time of playing catch and throwing a ball with full power, sports activity, evaluation of radiography, a subjective (including Pain, Swelling, Locking/Catching and Sport activity) and objective (Flexion contracture, Pronation/Supination and sagittal arc of motion) modified elbow rating system by Timmeman et al. We also investigated the details of the arthroscopy observations and the 2nd arthroscopy findings for 4 cases. Results. Preoperative elbow extension increased from −13.5 to −10 degrees and elbow flexion increased from 117 to 123 degrees, but no significant differences were found. All but one patient resumed baseball sporting activity. Catching was started at an average of 3.5 (2 to 5.5 months) months postoperatively and pitching the ball with full power was achieved at 6.7 months. One case was found to have degenerative changes on plain X-ray, and two cases were found to have deviated screws. The mean elbow rating system subjective score improved significantly from 63.9.5 to 89.5 points, as did the overall rating, increasing from 131.6 to 164.8 points. The 2. nd. arthroscopy observations for 4 patients showed that 2 experienced pain due to the loose body, 1 had a limitation in range of motion due to spur formation, and 1 had a screw deviation. Graft survival was observed in two out of four cases. Partial detachment was observed in two cases. Conclusion. Recovery of articular facets with hyaline cartilage were possible using this surgical technique, and in addition, the costal-costochondral grafts, comprising cortical and cancellous bone, were simultaneously transplanted en bloc. This indicates that it is adequate treatment for extensive OCD. All the patients started pitching 3 months postoperatively and returned to full baseball activities after 6 months. Even in cases with extensive OCD, with large osseous and cartilaginous deficits, the surgical technique was useful and showed favorable results

A prospective case control study analysed clinical and radiographic results in patients operated on with the periosteum autologous chondrocyte implantation (ACI) due to cartilage lesions on the femoral condyles over 10 years ago. 31 out of the 45 patients (3 failures, 9 non-responders, 2 others) were available for a continuous clinical (Lyshom/Tegner, IKDC, KOOS) and radiographic (Kellgren-Lawrence) follow-up at 0, 2, 5, and 10 years after the ACI procedure. The patients were sub-grouped into focal cartilage lesions (FL) – 10, osteochondritis dissecans (OCD) – 12, and cartilage lesions with simultaneous ACL reconstruction (ACL) – 9 subgroups. Lysholm, Tegner, and IKCD subjective scores revealed stable results over the period from 2 to 10 years with a significant improvement toward the pre-operative levels, but the patients had not reached their pre-injury Tegner levels. KOOS profile at 10 years was: Pain 78.6, Symptoms 78.1, Activities of daily living 82.5, Sports 56.9, and Quality of life 55.1. A 10-year IKDC knee examination classified operated knees as: 14 normal, 10 nearly normal, 5 abnormal and 2 severely abnormal. Kellgren-Lawrence scores of 2 and above were found in 10 patients (FL 5, OCD 0, and ACL 5). Seven patients in the group required an arthroscopic re-intervention (3 ACI related, 4 ACI unrelated). ACI provided safe and stable performance of operated knees over ten years. High incidence of knee osteoarthritis in FL and ACL subgroups, and low incidence in OCD patients indicate that best long performance is expected in localised low-impact cartilage lesions of young patients

Purpose. To assess the reliability of a biomimetic osteochondral scaffold Maioregen (Finceramica Faenza SpA, Faenza, Italt) as a salvage and joint-preserving procedure in the treatment of late stages of osteonecrosis of the knee. Methods. Nine active patients aged under 65 year presenting with clinical and radiological signs of SPONK were treated with a biomimetic osteochondral scaffold. All patients were clinically evaluated preoperatively and yearly with a minimum follow-up of 2 years. Subjective IKDC and Lysholm Knee Scale were used to assess clinical outcome. Pre-operative and post-operative pain was quantified with VAS scale. Activity level were evaluated pre-operatively and at follow-up according to Tegner Activity Scale. Results. Subjective IKDC (35 ± 14.5 to 75.7 ± 20) and Lysholm Knee Scale (49.7 ± 17.9 to 86.6 ± 12.7) significantly improved from pre-operative evaluation (p < .01). VAS decreased from a mean pre-operative value of 6.3 ± 2.5 to 1.6 ± 2.7 at 2 years follow-up. Tegner Activity Scale doesn't show significant differences between pre-operative values and those obtained at two-year follow up. Two of nine patients returned to be symptomatic after 18 months from the implants and progressed to condylar collapse, despite the joint-preserving treatment, and underwent a total knee arthroplasty. Conclusions. Biomimetic scaffold can be a valid option in surgical treatment of SPONK in young active patients. Use of this surgical technique, originally developed for OCD, gives good clinical results at a mid-term follow up also in treatment of osteonecrosis and could postpone or even spare joint replacement procedures

Background. Lateral ligament injuries of the ankle are common. They account for up to 50% of all sporting injuries. Recovery times vary, leading to time away from sport and training for the professional athlete. Predicting this time is important for the treating surgeon, the athlete and the rehabilitation team. This can be difficult as associated ankle injuries occurring at the time of the trauma may alter recovery and rehabilitation. Aim. To compare the time to return to training and sports of isolated lateral ligament injuries with more complex injuries of the ankle treated surgically and to evaluate if lateral ligament repair is safe and effective in the professional athlete. Study design: Case series; level of evidence 4. Methods. A consecutive series of professional sportsmen and women were treated operatively for radiologically and clinically confirmed grade III lateral ligament injury between 2005 and 2009. The patients were split into two groups; isolated lateral ligament injuries and those with other associated injuries. The end points studied were the time to return to training in weeks and the time to return to play in weeks. Results. There were 26 ankles in 26 patients. 16 were isolated injuries (Group A) and 10 had associated injuries (Group B). The associated injuries included, osteochondral defects (OCD) (3), deltoid ligament injury (5), syndesmotic injury (1) and deltoid ligament injury combined with an OCD (1). The mean time to return to training in group A was 61.3 days (range 55–110) and in group B was 99.5 days (63–152). The mean time to return to play in Group A was 78.2 days (range 63–127) and group B 116.7 days (82–178). The time to return to training and play was significantly shorter for the isolated lateral ligament injury group, (p=0.0003) and (p=0.0004) respectively. The only complications were two minor wound infections that responded to oral antibiotics. No patient returned for recurrent instability and all returned to their pre-injury level of play. Conclusion. Lateral ligament repair was a successful and safe procedure leading to return to pre-injury level of play for all the athletes. Time to return to training and play was significantly shorter if there were no associated injuries to the ankle. NO DISCLOSURES