■在青少年和年轻成人膝关节急性或慢性损伤的情况下保留关节软骨对于长期关节健康至关重要。实现骨结合,尽量减少与植入物相关的伤害,消除创伤性软骨和骨软骨损伤(OCLs)和剥脱性骨软骨炎(OCD)的再手术需求仍然是骨科医师面临的挑战。
■为了评估影像学愈合,患者报告的结果,和软骨碎片缝合桥固定后的短期并发症,骨软骨骨折,和膝盖的强迫症病变。
■案例系列;证据级别,4.
■该研究包括连续的患者(38名患者,40个膝盖)在单个学术运动医学机构中接受治疗,该机构从2019年10月至2021年3月开始对OCL或膝关节强迫症病变进行了缝合桥固定。缝合桥技术需要将生物可吸收的无结锚放置在病变的外侧边缘,并带有多股手张紧的可吸收锚(编号0或否1Vicryl)或不可吸收(1.3毫米编织聚酯胶带)桥接缝合线。通过射线照相术和磁共振成像(MRI)评估愈合情况,对所有强迫症病变和任何仅软骨病变进行MRI扫描。在手术后1年内,40个膝盖中的33个(82.5%)可进行MRI扫描,并评估了病变的愈合情况。评估了并发症,恢复运动的速度和时间。使用膝关节损伤和骨关节炎结果评分(KOOS)评估OCD队列中患者报告的结果,以确定早期疼痛和功能改善。
■总共,33例(82.5%)病灶显示完全愈合,没有病变治疗失败。MRI对愈合的评估(平均,5.8个月;范围,3-12个月)显示9个(64.3%)强迫症病变完全愈合,5例(35.7%)强迫症病灶愈合稳定,无强迫症病变伴骨不连.在OCL中,17人(89.5%)有完全工会,2(10.5%)有稳定的工会,也没有不工会。未进行MRI扫描的7例骨OCL表现出完全的影像学结合。在30个(75.0%)病变中,患者平均恢复运动6.5个月(范围,3.8-10.2个月)。KOOS日常生活活动,疼痛,生活质量,在6个月和1年时,症状评分与基线相比有显著改善.有2例(5%)并发症,包括对原本稳定的病变进行边缘软骨成形术的再次手术,并再次手术治疗未治疗的髌骨不稳定,没有因缝合桥结构失败或翻修而再次手术。
■在这一系列的OCLs和强迫症损伤中,缝合桥固定术表现出优异的MRI和影像学愈合率以及良好的早期结局,短期并发症最少.该技术可用于修复病变,以替代金属和非金属螺钉/大头钉结构,以治疗这些具有挑战性的病变。需要长期的随访和调查。
Preservation of articular cartilage in the setting of acute or chronic injury in the adolescent and young adult knee is paramount for long-term joint health. Achieving osseous union, minimizing implant-related injury, and eliminating the need for reoperation for traumatic chondral and osteochondral lesions (OCLs) and osteochondritis dissecans (OCD) remain a challenge for the orthopaedic surgeon.
To evaluate radiographic healing, patient-reported outcomes, and short-term complications after suture-bridge fixation of chondral fragments, osteochondral fractures, and OCD lesions in the knee.
Case series; Level of evidence, 4.
The study included consecutive patients (38 patients, 40 knees) treated within a single academic sports medicine institution who underwent suture-bridge fixation of an OCL or an OCD lesion of the knee from initiation of the technique in October 2019 through March 2021. The suture-bridge technique entailed bioabsorbable knotless anchors placed on the outside margins of the lesion with multiple strands of hand-tensioned absorbable (No. 0 or No. 1 Vicryl) or nonabsorbable (1.3-mm braided polyester tape) bridging suture. Healing was assessed by radiography and magnetic resonance imaging (MRI), with MRI scans obtained on all OCD lesions and any chondral-only lesions. MRI scans were available for 33 of 40 (82.5%) knees within 1 year of surgery and were evaluated for lesion healing. Complications and rates and timing of return to sport were evaluated. Patient-reported outcomes in the OCD cohort were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) to determine early pain and functional improvement.
In total, 33 (82.5%) lesions demonstrated full union, and no lesions failed treatment. MRI assessment of healing (mean, 5.8 months; range, 3-12 months) demonstrated 9 (64.3%) OCD lesions with full union, 5 (35.7%) OCD lesions with stable union, and no OCD lesions with nonunion. Of the OCLs, 17 (89.5%) had full union, 2 (10.5%) had stable union, and none had nonunion. The 7 bony OCLs without an MRI scan demonstrated complete radiographic union. In 30 (75.0%) lesions, patients returned to sports at a mean of 6.5 months (range, 3.8-10.2 months). KOOS Activities of Daily Living, Pain, Quality of Life, and Symptoms scores demonstrated significant improvement from baseline at 6 months and at 1 year. There were 2 (5%) complications, consisting of reoperation for marginal chondroplasty on an otherwise stable lesion, and re-operation for intial un-treated patellar instability, with no reoperations for failure or revision of the suture-bridge construct.
In this series of OCLs and OCD lesions of the knee, suture-bridge fixation demonstrated excellent rates of MRI and radiographic union and good early outcomes with minimal short-term complications. This technique may be used for lesion salvage as an alternative to metallic and nonmetallic screw/tack constructs in the treatment of these challenging lesions. Longer term follow-up and investigation are warranted.