Advertisement

Skeletal Radiology

, Volume 49, Issue 1, pp 65–73 | Cite as

Magnetic resonance evaluation of the pediatric knee after arthroscopic fixation of osteochondral lesions with biodegradable nails

  • Jie C. NguyenEmail author
  • Daniel W. Green
  • Bin F. Lin
  • Yoshimi Endo
Scientific Article
  • 138 Downloads

Abstract

Purpose

To use magnetic resonance imaging (MRI) to investigate the knee joint of children following arthroscopic fixation of osteochondral lesions using bioabsorbable nails and to correlate these imaging findings with time from arthroscopic treatment and with risk factors at the time of imaging.

Materials and methods

Our study included postarthroscopic MRI studies from 58 children (mean age at arthroscopy, 13.8 + 2.1 years) who have undergone bioabsorbable nail fixation of unstable osteochondral lesions between February 1, 2011 and September 30, 2017. All studies were retrospectively reviewed for broken nails, intra-articular debris, and internal knee derangement. Demographic information and information pertaining to active symptoms was obtained from both MRI questionnaire that was completed at the time of the study and clinical note that preceded the study. Marginal logistic regression models estimated using generalized estimating equations (GEE) were used to identify factors associated with a broken nail and joint effusion.

Results

A total of 104 postoperative studies were reviewed, which included 60 with symptoms and 44 without symptoms. Nail breakage was present in 38 (36.6%) studies and associated with presence of symptoms (OR 2.43, p = 0.036) and effusion (OR 2.76, p = 0.025). An effusion was present in 40 (38.5%) studies which decreased with increasing time from treatment (OR 0.89, p = 0.007) and increased with symptoms (OR 10.87, p < 0.001). Meniscal tear was present on 8 (7.7%) and chondral irregularity on 14 (13.5%) studies.

Conclusion

Broken nail, effusion, and less commonly, meniscal tears and chondral irregularity, are all complications that can arise following fixation of osteochondral lesions with bioabsorbable nails. MRI can serve as a valuable tool in assessing these complications.

Keywords

Children Knee Implant MRI OCD Osteochondritis dissecans Osteochondral fracture Smartnail 

Notes

Acknowledgements

This study was approved by the institutional review board.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no reverent conflict of interest.

Grant support

None.

Disclosures

None of the authors has any disclosures.

References

  1. 1.
    Matsusue Y, Nakamura T, Suzuki S, Iwasaki R. Biodegradable pin fixation of osteochondral fragments of the knee. Clin Orthop Relat Res. 1996;322:166–73.CrossRefGoogle Scholar
  2. 2.
    Gkiokas A, Morassi LG, Kohl S, Zampakides C, Megremis P, Evangelopoulos DS. Bioabsorbable pins for treatment of osteochondral fractures of the knee after acute patella dislocation in children and young adolescents. Adv Orthop. 2012;249687:14.Google Scholar
  3. 3.
    Dines JS, Fealy S, Potter HG, Warren RF. Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device. Arthroscopy. 2008;24:62–8.CrossRefGoogle Scholar
  4. 4.
    Makino A, Muscolo DL, Puigdevall M, Costa-Paz M, Ayerza M. Arthroscopic fixation of osteochondritis dissecans of the knee: clinical, magnetic resonance imaging, and arthroscopic follow-up. Am J Sports Med. 2005;33:1499–504.CrossRefGoogle Scholar
  5. 5.
    Barrett I, King AH, Riester S, et al. Internal fixation of unstable osteochondritis dissecans in the skeletally mature knee with metal screws. Cartilage. 2016;7:157–62.CrossRefGoogle Scholar
  6. 6.
    Chun KC, Kim KM, Jeong KJ, Lee YC, Kim JW, Chun CH. Arthroscopic bioabsorbable screw fixation of unstable osteochondritis dissecans in adolescents: clinical results, magnetic resonance imaging, and second-look arthroscopic findings. Clin Orthop Surg. 2016;8:57–64.CrossRefGoogle Scholar
  7. 7.
    Adachi N, Deie M, Nakamae A, Okuhara A, Kamei G, Ochi M. Functional and radiographic outcomes of unstable juvenile osteochondritis dissecans of the knee treated with lesion fixation using bioabsorbable pins. J Pediatr Orthop. 2015;35:82–8.CrossRefGoogle Scholar
  8. 8.
    Kocher MS, Czarnecki JJ, Andersen JS, Micheli LJ. Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med. 2007;35:712–8.CrossRefGoogle Scholar
  9. 9.
    Bostman OM. Absorbable implants for the fixation of fractures. J Bone Joint Surg Am. 1991;73:148–53.CrossRefGoogle Scholar
  10. 10.
    Bostman O, Hirvensalo E, Makinen J, Rokkanen P. Foreign-body reactions to fracture fixation implants of biodegradable synthetic polymers. J Bone Joint Surg Br. 1990;72:592–6.CrossRefGoogle Scholar
  11. 11.
    Camathias C, Gogus U, Hirschmann MT, et al. Implant failure after biodegradable screw fixation in osteochondritis dissecans of the knee in skeletally immature patients. Arthroscopy. 2015;31:410–5.CrossRefGoogle Scholar
  12. 12.
    Bostman OM. Osteolytic changes accompanying degradation of absorbable fracture fixation implants. J Bone Joint Surg Br. 1991;73:679–82.CrossRefGoogle Scholar
  13. 13.
    Scioscia TN, Giffin JR, Allen CR, Harner CD. Potential complication of bioabsorbable screw fixation for osteochondritis dissecans of the knee. Arthroscopy 2001;17(2):1–5.CrossRefGoogle Scholar
  14. 14.
    Takizawa T, Akizuki S, Horiuchi H, Yasukawa Y. Foreign body gonitis caused by a broken poly-L-lactic acid screw. Arthroscopy. 1998;14:329–30.CrossRefGoogle Scholar
  15. 15.
    Friederichs MG, Greis PE, Burks RT. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. Arthroscopy. 2001;17:542–5.CrossRefGoogle Scholar
  16. 16.
    Camathias C, Festring JD, Gaston MS. Bioabsorbable lag screw fixation of knee osteochondritis dissecans in the skeletally immature. J Pediatr Orthop B. 2011;20:74–80.CrossRefGoogle Scholar
  17. 17.
    Bostman OM, Pihlajamaki HK. Adverse tissue reactions to bioabsorbable fixation devices. Clin Orthop Relat Res. 2000;371:216–27.CrossRefGoogle Scholar
  18. 18.
    Millington KL, Shah JP, Dahm DL, Levy BA, Stuart MJ. Bioabsorbable fixation of unstable osteochondritis dissecans lesions. Am J Sports Med. 2010;38:2065–70.CrossRefGoogle Scholar
  19. 19.
    Tabaddor RR, Banffy MB, Andersen JS, et al. Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop. 2010;30:14–20.CrossRefGoogle Scholar
  20. 20.
    Weckstrom M, Parviainen M, Kiuru MJ, Mattila VM, Pihlajamaki HK. Comparison of bioabsorbable pins and nails in the fixation of adult osteochondritis dissecans fragments of the knee: an outcome of 30 knees. Am J Sports Med. 2007;35:1467–76.CrossRefGoogle Scholar
  21. 21.
    Din R, Annear P, Scaddan J. Internal fixation of undisplaced lesions of osteochondritis dissecans in the knee. J Bone Joint Surg Br. 2006;88:900–4.CrossRefGoogle Scholar
  22. 22.
    Carey JL, Wall EJ, Grimm NL, et al. Novel arthroscopic classification of osteochondritis dissecans of the knee: a multicenter reliability study. Am J Sports Med. 2016;44:1694–8.CrossRefGoogle Scholar
  23. 23.
    Nguyen JC, Liu F, Blankenbaker DG, Woo KM, Kijowski R. Juvenile osteochondritis Dissecans: cartilage T2 mapping of stable medial femoral condyle lesions. Radiology. 2018;288:536–43.CrossRefGoogle Scholar
  24. 24.
    De Smet AA, Norris MA, Yandow DR, Quintana FA, Graf BK, Keene JS. MR diagnosis of meniscal tears of the knee: importance of high signal in the meniscus that extends to the surface. AJR Am J Roentgenol. 1993;161:101–7.CrossRefGoogle Scholar
  25. 25.
    De Smet AA, Tuite MJ. Use of the "two-slice-touch" rule for the MRI diagnosis of meniscal tears. AJR Am J Roentgenol. 2006;187:911–4.CrossRefGoogle Scholar
  26. 26.
    Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 2003;2:58–69.CrossRefGoogle Scholar
  27. 27.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefGoogle Scholar
  28. 28.
    Pietrzak WS, Sarver DR, Verstynen ML. Bioabsorbable polymer science for the practicing surgeon. J Craniofac Surg. 1997;8:87–91.CrossRefGoogle Scholar
  29. 29.
    Barfod G, Svendsen RN. Synovitis of the knee after intraarticular fracture fixation with biofix. Report of two cases. Acta Orthop Scand. 1992;63:680–1.PubMedGoogle Scholar
  30. 30.
    Friden T, Rydholm U. Severe aseptic synovitis of the knee after biodegradable internal fixation. A case report. Acta Orthop Scand. 1992;63:94–7.CrossRefGoogle Scholar
  31. 31.
    Matsusue Y, Yamamuro T, Oka M, Shikinami Y, Hyon SH, Ikada Y. In vitro and in vivo studies on bioabsorbable ultra-high-strength poly(L-lactide) rods. J Biomed Mater Res. 1992;26:1553–67.CrossRefGoogle Scholar
  32. 32.
    Prokop A, Jubel A, Helling HJ, et al. Soft tissue reactions of different biodegradable polylactide implants. Biomaterials. 2004;25:259–67.CrossRefGoogle Scholar

Copyright information

© ISS 2019

Authors and Affiliations

  1. 1.Department of RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  3. 3.Department of Radiology and ImagingHospital for Special SurgeryNew YorkUSA

Personalised recommendations