PMID- 25126843
OWN - NLM
STAT- MEDLINE
DCOM- 20141010
LR  - 20140816
IS  - 1539-2570 (Electronic)
IS  - 0271-6798 (Linking)
VI  - 34
IP  - 6
DP  - 2014 Sep
TI  - Trochlear groove osteochondritis dissecans of the knee patellofemoral joint.
PG  - 625-30
LID - 10.1097/BPO.0000000000000212 [doi]
AB  - BACKGROUND: The trochlear groove is the rarest location for osteochondritis 
      dissecans (OCD) of the knee, with only about 50 previously reported cases, most 
      of which were treated before the advent of magnetic resonance imaging (MRI) and 
      modern techniques of cartilage fixation or osteochondral transplantation. The 
      purpose of this multicenter study was to assess the patient presentation and 
      clinical, radiographic, and functional results of treatment for trochlear groove 
      OCD lesions. METHODS: Hospital records from 5 institutions of the Research in 
      Osteochondritis of the Knee (ROCK) study group were retrospectively reviewed for 
      cases of trochlear groove OCD. Demographics, clinical presentation, diagnosis, 
      treatment, time to pain resolution, and return to sports were recorded. Lesion 
      appearance, size, stability, and time to radiographic healing were evaluated on 
      plain x-rays and MRIs. RESULTS: Trochlear groove OCD lesions were evaluated in 24 
      knees in 21 adolescents (17 male, 4 female), with an average age of 14 years 
      (range, 10 to 18 y). Fifty-four percent (13/24) of the lesions were identifiable 
      on radiographs, and all were identifiable on MRI, 38% of which (9/24) was 
      unstable. One fourth (6/24) of knees had coexistent femoral condyle OCD lesions. 
      Treatment outcomes were evaluated in patients with a minimum of 1-year follow-up 
      (average: 3 y; range: 1 to 12 y) or healing before 1 year. Half of the knees 
      (2/4) treated nonoperatively and two thirds (8/12) treated operatively showed 
      radiographic signs of healing with patients returning to full activity without 
      pain. Operative treatment success rates were as follows: drilling (3/3), fixation 
      (3/3), microfracture (1/2), drilling with subsequent delayed microfracture (1/1), 
      and drilling with fixation (0/3). CONCLUSIONS: MRI aids in the diagnosis and 
      staging of trochlear groove OCD lesions, as almost one half may not be 
      identifiable on radiographs, and one quarter are associated with OCD lesions in 
      other locations of the same knee. Multiple operative treatments can be used to 
      achieve healing or resolution of symptoms in stable and unstable lesions; 
      however, a larger comparative study is needed to make specific recommendations. 
      LEVEL OF EVIDENCE: Therapeutic Level IV.
FAU - Wall, Eric J
AU  - Wall EJ
AD  - Divisions of *Orthopaedic Surgery #Sports Medicine, Cincinnati Children's 
      Hospital, Cincinnati, OH daggerDepartment of Orthopedic Surgery, Division of Sports 
      Medicine, Boston Children's Hospital, Boston, MA double daggerSt. Luke's Intermountain 
      Orthopaedics, Boise, ID  section signDivision of Orthopaedic Surgery, Rady Children's 
      Hospital, San Diego, CA  parallelDepartment of Orthopaedic Surgery, Washington University 
      School of Medicine, St. Louis, MO  paragraph signTennessee Orthopaedic Alliance, Nashville, TN.
FAU - Heyworth, Benton E
AU  - Heyworth BE
FAU - Shea, Kevin G
AU  - Shea KG
FAU - Edmonds, Eric W
AU  - Edmonds EW
FAU - Wright, Rick W
AU  - Wright RW
FAU - Anderson, Allen F
AU  - Anderson AF
FAU - Eismann, Emily A
AU  - Eismann EA
FAU - Myer, Gregory D
AU  - Myer GD
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - J Pediatr Orthop
JT  - Journal of pediatric orthopedics
JID - 8109053
SB  - IM
MH  - Adolescent
MH  - Athletes
MH  - Cartilage, Articular/pathology/surgery
MH  - Child
MH  - Female
MH  - Femur/pathology
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Osteochondritis Dissecans/diagnosis/surgery/*therapy
MH  - Pain/etiology
MH  - Patellofemoral Joint/pathology/*surgery
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2014/08/16 06:00
MHDA- 2014/10/11 06:00
CRDT- 2014/08/16 06:00
PHST- 2014/08/16 06:00 [entrez]
PHST- 2014/08/16 06:00 [pubmed]
PHST- 2014/10/11 06:00 [medline]
AID - 01241398-201409000-00009 [pii]
AID - 10.1097/BPO.0000000000000212 [doi]
PST - ppublish
SO  - J Pediatr Orthop. 2014 Sep;34(6):625-30. doi: 10.1097/BPO.0000000000000212.