Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee
Purpose: To determine whether adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee in pediatric patients. Methods: This retrospective matched case-control study was performed at a single tertiary care ped...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-02-01
|
| Series: | Arthroscopy, Sports Medicine, and Rehabilitation |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666061X22001900 |
| _version_ | 1797903336467333120 |
|---|---|
| author | Borna Guevel, M.A., M.B., B.Chir., M.R.C.S., M.P.H. Stephen T. Mathew, M.D. Ryan P. Coene, M.S. Kathleen j. Maguire, M.D. Kathryn A. Williams, M.S. Lyle J. Micheli, M.D. Matthew D. Milewski, M.D. |
| author_facet | Borna Guevel, M.A., M.B., B.Chir., M.R.C.S., M.P.H. Stephen T. Mathew, M.D. Ryan P. Coene, M.S. Kathleen j. Maguire, M.D. Kathryn A. Williams, M.S. Lyle J. Micheli, M.D. Matthew D. Milewski, M.D. |
| author_sort | Borna Guevel, M.A., M.B., B.Chir., M.R.C.S., M.P.H. |
| collection | DOAJ |
| description | Purpose: To determine whether adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee in pediatric patients. Methods: This retrospective matched case-control study was performed at a single tertiary care pediatric hospital between January 2015 and September 2018. Patients who underwent antegrade drilling for stable femoral condyle OCD with greater than 2 years’ follow-up were included. Preference was for all to receive postoperative bone stimulation; however, some were denied because of insurance coverage. This enabled us to create 2 matched groups of those who received postoperative bone stimulation and those who did not. Patients were matched on skeletal maturity, lesion location, sex, and age at surgery. The primary outcome measure was the rate of healing of the lesions determined by postoperative magnetic resonance imaging measurements at 3 months. Results: Fifty-five patients were identified who met the inclusion and exclusion criteria. Twenty patients from the bone stimulator group (BSTIM) were matched to 20 patients from the no bone stimulator group (NBSTIM). Mean age for BSTIM at surgery was 13.2 years ± 2.0 (range, 10.9-16.7) and for NBSTIM at surgery 12.9 years ± 2.0 (range, 9.3-17.3). At 2 years, 36 patients (90%) in both groups went on to clinical healing without further interventions. In BSTIM, there was a mean decrease of 0.9 (±1.8) mm in lesion on coronal width and 12 patients (63%) had overall improved healing; in NBSTIM there was a mean decrease of 0.8 (±3.6) mm in coronal width and 14 patients (78%) had improved healing. No statistical differences in the rate of healing were found between the 2 groups (P = .706). Conclusion: In antegrade drilling of stable knee OCD lesions in pediatric and adolescent patients, adjuvant bone stimulator use did not appear to improve radiographic or clinical healing. Level of evidence: Level III, retrospective case-control study. |
| first_indexed | 2024-04-10T09:31:16Z |
| format | Article |
| id | doaj.art-b01a6145b35b4d57a7ef2aafb0fa38bf |
| institution | Directory Open Access Journal |
| issn | 2666-061X |
| language | English |
| last_indexed | 2024-04-10T09:31:16Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroscopy, Sports Medicine, and Rehabilitation |
| spelling | doaj.art-b01a6145b35b4d57a7ef2aafb0fa38bf2023-02-19T04:27:25ZengElsevierArthroscopy, Sports Medicine, and Rehabilitation2666-061X2023-02-0151e225e232Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the KneeBorna Guevel, M.A., M.B., B.Chir., M.R.C.S., M.P.H.0Stephen T. Mathew, M.D.1Ryan P. Coene, M.S.2Kathleen j. Maguire, M.D.3Kathryn A. Williams, M.S.4Lyle J. Micheli, M.D.5Matthew D. Milewski, M.D.6Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.Boston Children’s Hospital, Biostatistics and Research Design Center, ICCTR Boston, Massachusetts, U.S.A.Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.; Harvard Medical School, Boston, Massachusetts, U.S.A.Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.; Harvard Medical School, Boston, Massachusetts, U.S.A.; Address correspondence to Matthew Milewski, M.D., Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, 300 Longwood Avenue, Boston, MA 02115, U.S.A.Purpose: To determine whether adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee in pediatric patients. Methods: This retrospective matched case-control study was performed at a single tertiary care pediatric hospital between January 2015 and September 2018. Patients who underwent antegrade drilling for stable femoral condyle OCD with greater than 2 years’ follow-up were included. Preference was for all to receive postoperative bone stimulation; however, some were denied because of insurance coverage. This enabled us to create 2 matched groups of those who received postoperative bone stimulation and those who did not. Patients were matched on skeletal maturity, lesion location, sex, and age at surgery. The primary outcome measure was the rate of healing of the lesions determined by postoperative magnetic resonance imaging measurements at 3 months. Results: Fifty-five patients were identified who met the inclusion and exclusion criteria. Twenty patients from the bone stimulator group (BSTIM) were matched to 20 patients from the no bone stimulator group (NBSTIM). Mean age for BSTIM at surgery was 13.2 years ± 2.0 (range, 10.9-16.7) and for NBSTIM at surgery 12.9 years ± 2.0 (range, 9.3-17.3). At 2 years, 36 patients (90%) in both groups went on to clinical healing without further interventions. In BSTIM, there was a mean decrease of 0.9 (±1.8) mm in lesion on coronal width and 12 patients (63%) had overall improved healing; in NBSTIM there was a mean decrease of 0.8 (±3.6) mm in coronal width and 14 patients (78%) had improved healing. No statistical differences in the rate of healing were found between the 2 groups (P = .706). Conclusion: In antegrade drilling of stable knee OCD lesions in pediatric and adolescent patients, adjuvant bone stimulator use did not appear to improve radiographic or clinical healing. Level of evidence: Level III, retrospective case-control study.http://www.sciencedirect.com/science/article/pii/S2666061X22001900 |
| spellingShingle | Borna Guevel, M.A., M.B., B.Chir., M.R.C.S., M.P.H. Stephen T. Mathew, M.D. Ryan P. Coene, M.S. Kathleen j. Maguire, M.D. Kathryn A. Williams, M.S. Lyle J. Micheli, M.D. Matthew D. Milewski, M.D. Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee Arthroscopy, Sports Medicine, and Rehabilitation |
| title | Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee |
| title_full | Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee |
| title_fullStr | Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee |
| title_full_unstemmed | Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee |
| title_short | Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee |
| title_sort | low intensity pulsed ultrasonography plus arthroscopic drilling does not improve bone healing more than arthroscopic drilling alone in pediatric patients with stable osteochondritis dissecans of the knee |
| url | http://www.sciencedirect.com/science/article/pii/S2666061X22001900 |
| work_keys_str_mv | AT bornaguevelmambbchirmrcsmph lowintensitypulsedultrasonographyplusarthroscopicdrillingdoesnotimprovebonehealingmorethanarthroscopicdrillingaloneinpediatricpatientswithstableosteochondritisdissecansoftheknee AT stephentmathewmd lowintensitypulsedultrasonographyplusarthroscopicdrillingdoesnotimprovebonehealingmorethanarthroscopicdrillingaloneinpediatricpatientswithstableosteochondritisdissecansoftheknee AT ryanpcoenems lowintensitypulsedultrasonographyplusarthroscopicdrillingdoesnotimprovebonehealingmorethanarthroscopicdrillingaloneinpediatricpatientswithstableosteochondritisdissecansoftheknee AT kathleenjmaguiremd lowintensitypulsedultrasonographyplusarthroscopicdrillingdoesnotimprovebonehealingmorethanarthroscopicdrillingaloneinpediatricpatientswithstableosteochondritisdissecansoftheknee AT kathrynawilliamsms lowintensitypulsedultrasonographyplusarthroscopicdrillingdoesnotimprovebonehealingmorethanarthroscopicdrillingaloneinpediatricpatientswithstableosteochondritisdissecansoftheknee AT lylejmichelimd lowintensitypulsedultrasonographyplusarthroscopicdrillingdoesnotimprovebonehealingmorethanarthroscopicdrillingaloneinpediatricpatientswithstableosteochondritisdissecansoftheknee AT matthewdmilewskimd lowintensitypulsedultrasonographyplusarthroscopicdrillingdoesnotimprovebonehealingmorethanarthroscopicdrillingaloneinpediatricpatientswithstableosteochondritisdissecansoftheknee |