Summary

Cartilage fixation technique and results

Abstract

Solid fixation of osteochondral lesions is a surgical challenge. Rigid fixation is mandatory to obtain bony healing. The use of countersunk screws or bioresorbable nails often provides rigid fixation, but problems with implant loosening and/or detrimental wear on the cartilage surface is often seen.
When fixing osteochondral lesions transosseously with resorbable suture tape, the hardware problems are avoided as the sutures dissolve within 8 weeks.

Aim

To present a safe and cheap method for rigid fixation of osteochondral lesions in the patella or in the femoral condyles, and to assess the postoperative healing using clinical data and imaging.
Material
25 consecutive patients (period 2017-23) who had a loose and suturable osteochondral fragment were operated using a transosseous suture wrapping technique.
There were 15 cases with traumatic osteochondral fragments following patella dislocation and 10 cases with symptomatic osteochondritis dissicans from the femoral condyles. Average age was 19 years (11 – 44).
Follow-up period was 1-7 years.
Technical procedure
Transosseous K-wire drilling x 4 (6) in the periphery around the lesion, with the shutteling of 2 x 2 Vicryl tape® loops through the K-wire tunnels over the reduced osteochondral fragment. The fragment is subsequently secured by tensioning and tying the tape 2 and 2 over the cortex on the opposite side.

Method

Postoperative medical records and imaging were retrospectively evaluated for healing and complications.
Clinical rating:
A) Good / Excellent – No or slight pain, swelling, krepitus
B) Acceptable - Moderate pain, swelling, krepitus
C) Failure - Severe pain, swelling, krepitus and/or cartilage re-operation
Healing on MRI:
A) Good /Excellent – Total/ Subtotal healing
B) Acceptable – Partial healing and/or bone-bruise
C) Failure – No healing and/or reoperation with removal of the the osteochondral fragment

Results

Clinical healing / MRI healing
Patella OCL: (n=15) A) 67 % B) 33% C) 0 % / (n = 5) A) 60 % B) 40 % C) 0%
Femoral OCD: (n=10) A) 67 % B) 33% C) 0 % / (n = 5) A) 60 % B) 20 % C) 20%
5 patients had one subsequent operation because of stiffness and adherences.
1 patient had removal of an OCD which failed to heal – this patient is scheduled for a mega OATS allograft.

Conclusion

The transosseous wrapping technique using resorbable suture tape is a reliable method for the fixation of osteochondral fragments in the knee, which provides good clinical results and a high healing rate.
No adverse effects have been registered.
The method is now used routineously for fixation of osteochondral lesions at our clinic.