AI Article Synopsis
- Osteochondrosis dissecans (OCD) is a significant cause of pain in the pediatric elbow, and this study evaluates a new treatment approach involving a hyaluronic acid scaffold and bone grafting for advanced stages of OCD.
- Five adolescents received the combined treatment and were assessed clinically and radiologically after an average of 34 months post-surgery, showing positive outcomes across various performance scores.
- Results indicated all patients reported no pain (NRS score of 0), and while some radiographic improvements were noted, full resolution of OCD occurred in only 2 out of 5 patients, with no complications experienced.
Article Abstract
Introduction: Osteochondrosis dissecans (OCD) is considered to be one of the main causes for pain, discomfort and morbidity in the pediatric elbow joint. Few treatment options, such as microfracture or autologous transplantation, of osteochondral bone grafts have been described to address advanced OCD. The aim of this retrospective case series is to present preliminary clinical and radiologic findings following advanced stage OCD repair using a novel combination of a hyaluronic acid-based scaffold with autologous iliac crest bone grafting.
Materials And Methods: Five adolescents, who underwent treatment of OCD (grade 3 or 4 according to Nelson) using a combination technique of defect debridement, transplantation of cancellous iliac crest bone and application of a HYALOFAST® membrane (Anika Therapeutics S.r.L., Italy), were re-assessed using clinical and radiologic examinations (defect diameter, depth, sclerosis, congruency, fragmentation, dissection, radiolucency, growth plate status; MRI) after a minimum of 2 years (mean, 34 months; range, 24-45) postoperatively. Dedicated outcome scores (Numeric Rating Scale [NRS], Pediatric Outcome Data Collection Instrument [PODCI], Mayo Elbow Performance Score [MEPS], and Timmerman-Andrews Score [TIMM] were collected.
Results: All patients reported a NRS score of 0. The mean total TIMM, MEPS and PODCI (Global Functioning Scale) scores were 189 (range 165-200), 94 (range, 70-100), and 92 (range 83-98; normative score 47; range 35-55), respectively, indicating good to excellent clinical outcomes. The radiographic analysis showed overall improvements with regard to OCD width and depth reduction (35%, - 27-100%; 52%, 4-100%), but full resolution in only 2 of 5 cases. Elbow motion improved slightly after surgery. No complications were noted.
Conclusion: This study showed promising clinical short- to mid-term results in adolescent patients with advanced OCD using a novel surgical treatment combination. Radiographic results showed partial healing; hence, residual changes should be monitored over a longer period.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354908 | PMC |
| http://dx.doi.org/10.1007/s00402-021-03773-8 | DOI Listing |
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