Successful Fixation of Traumatic Articular Cartilage-Only Fragments in the Juvenile and Adolescent Knee: A Case Series.

Background: Some surgeons are now considering fixation of traumatic chondral-only fragments in juvenile knees, but few data remain to guide treatment.
Purpose: To determine if surgical fixation of chondral-only fragments in the juvenile knee results in an adequate healing response with successful imaging and clinical outcomes.
Study Design: Case series; Level of evidence, 4.
Methods: Data were collected on 16 skeletally immature patients treated with fixation of chondral-only fragments with a minimum 1-year follow-up. Patients were selected by the operating surgeons based on the quality and size of the chondral fragment. Demographic data, lesion characteristics, surgical procedure details, complications, and postoperative imaging were assessed. Validated outcome measures were collected pre- and postoperatively and included the following scores: International Knee Documentation Committee (IKDC), Marx Activity Scale, Knee injury and Osteoarthritis Outcome Score (KOOS), Hospital for Special Surgery Pediatric Functional Activity-Brief Scale (HSS Pedi-FABS), Patient-Reported Outcomes Measurement Information System (PROMIS)-Physical Health and PROMIS-Psychological Health, and Tegner.
Results: The mean age of our patient cohort was 14.9 years. The mean size of the repaired defects measured 3.2 cm ² . Injury sites included the patella (n = 1), medial femoral condyle (n = 3), trochlea (n = 4), and lateral femoral condyle (n = 8). Within the mean follow-up time of 42.3 months (range, 15-145), there was 1 clinical failure with loosening of the chondral fragment and the need for reoperation. At a mean follow-up of 3.5 years, the mean (interquartile range) patient-reported outcome scores were as follows: IKDC, 95.2 (94.3-100); Marx Activity Scale, 11.5 (11.5-16); KOOS, 95.81 (93.5-95.81); HSS Pedi-FABS, 16.94 (11.5-26); PROMIS-Physical Health, 93.75% (90%-100%); PROMIS-Psychological Health, 90% (88.75%-100%); and Tegner, 5.69 (4.75-7). All patients who were engaged in sports before injury returned to the same or higher level of competition with the exception of 1 patient.
Conclusion: Primary repair of chondral-only injuries with internal fixation can be a successful treatment option in selected patients. Clinical and imaging results at final follow-up suggest that reintegration of the cartilage fragment is achievable and leads to excellent clinical function and a high return-to-sports rate.
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Support was received from the Foderaro-Quattrone Musculoskeletal-Orthopaedic Surgery Research Innovation Fund. This study was also partially funded by the Deutsche Forschungsgemeinschaft (grant 466023693) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (grant T32AR56950). A.J.K. has received grant support from DJO; consulting fees from Arthrex, Joint Restoration Foundation, and Responsive Arthroscopy; speaking fees from Arthrex; honoraria from Vericel and Joint Restoration Foundation; and royalties from Arthrex and Responsive Arthroscopy; he is also a board member for the Musculoskeletal Transplant Foundation. M.J.S. has received education payments from Elite Orthopedics; consulting fees, speaking fees, and royalties from Arthrex; and hospitality payments from Stryker. T.A.M. has received consulting fees from Medtronic, OrthoPediatrics, and Zimmer Biomet. D.B.F.S. has received research funding from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
(© The Author(s) 2022.)