Juvenile Osteochondritis Dissecans
Conditions
Keywords
osteochondritis dissecans (OCD), juvenile osteochondritis dissecans (JOCD), knee osteochondritis dissecans, retro-articular drilling, trans-articular drilling, stable osteochondritis dissecans lesion
Brief summary
The purpose of this study is to compare the functional, clinical and radiographic outcomes associated with trans-articular drilling versus retro-articular drilling, two commonly employed techniques of operative treatment for stable forms of juvenile osteochondritis dissecans (JOCD) lesions. This study also aims to better define the natural history of this condition in its most commonly identified pathological state (as a stable lesion) following surgical intervention by determining the rate of radiographic healing and any need for secondary surgery.
Interventions
PROCEDURERetro-articular drilling
* Drilling must be performed under AP and lateral fluoroscopic guidance, with no additional drilling in 'trans-articular', or intra-articular trans-condylar fashion. * Use a 0.045 K-wire for drilling. * Minimum of 8 wire passes per square centimeter with no maximum number of wire passes.
PROCEDURETrans-articular drilling
* Drilling must be performed, under arthroscopic visualization, directly through the articular cartilage, with no additional drilling in 'retro-articular', 'extra-articular', or trans-condylar (through the intercondylar notch) * Use a 0.045 K-wire for drilling * A minimum 4 wire passes per square centimeter, with a maximum of 5 wire passes per square centimeter
Sponsors
Pediatric Orthopaedic Society of North America
University of Pennsylvania
Tennessee Orthopedic Alliance
Children's Hospital Medical Center, Cincinnati
Children's Hospital and Health System Foundation, Wisconsin
Washington University School of Medicine
The Hospital for Sick Children
Children's Hospital of Philadelphia
Kaiser Permanente
Rady Children's Hospital, San Diego
St. Luke's Children's Hospital
Medical College of Wisconsin
Connecticut Children's Medical Center
Hospital for Special Surgery, New York
Boston Children's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
8 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of JOCD, * Lesion located on the lateral aspect of the medial femoral condyle, * Lesion considered stable based on MRI, * Patient deemed skeletally immature based on MRI, * Completed a course of conservative therapy.
Exclusion criteria
* Significant concomitant knee pathology (AVN, fracture, inflammatory arthritis, ACL tear, discoid/meniscal tear, etc.) * Lesion healed sufficiently and surgery is not recommended, * Prior surgery on the affected knee, * Diagnosis of metabolic bone disorder (e.g. osteogenesis imperfecta), * Diagnosis of sickle cell disease, * History of prolonged corticosteroid or chemotherapy treatment,
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Physical functioning measured by the Pedi-IKDC (International Knee Documentation Committee) total score | One year post-surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Activity level as measured by the Marx Activity Scale | One year post-surgery | — |
| Physical functioning as measured by the Pedi-IKDC total score | Two years post-surgery | — |
| Time to lesion healing | 3 months to 2 years post-surgery | Lesion healing will be assessed by x-ray at multiple time points |
Other
| Measure | Time frame | Description |
|---|---|---|
| Surgical complications | 1 week to 1 year post-surgery | Inadvertent displacement of OCD fragment; damage to articular cartilage and physes |
Countries
Canada, United States
Outcome results
None listed