Arthroscopic reattachment of osteochondritis dissecans lesions using resorbable polydioxanone pins.
BACKGROUND
Debridement of osteochondritis dissecans (OCD) cartilage lesions results in fibrocartilage and imperfect hyaline repair tissue, and forms a permanent irregularity to the subchondral bone plate.


OBJECTIVE
To evaluate the clinical, radiographic and outcome effects of OCD cartilage flap reattachment for select lesions as an alternative to OCD debridement.


OBJECTIVE
Separated cartilage flaps resulting from OCD lesions may be re-incorporated into the hyaline cartilage surface by reattachment rather than debridement and removal.


METHODS
Resorbable polydioxanone pins were used to reattach OCD flap lesions in 16 joints of 12 horses. Criteria for attachment, rather than removal, included an unmineralised cartilage flap on preoperative radiographs and a relatively smooth surface with some residual perimeter attachment at surgery.


RESULTS
There were 12 subjects, 6 males and 6 females, 7 Thoroughbred or Standardbred weanlings, 3 Warmbloods, 1 Arabian and 1 Quarter Horse, mean age at surgery 6.8 months. All horses had effusion of the affected femoropatellar joint (n = 9), tarsocrural joint (n = 1) or fetlock (n = 2). Radiographic lesions varied in length between 1.8-6.3 cm; reattachment was used in 16 of 18 affected joints and the OCD cartilage was not satisfactory for salvage in 2 stifles. Number of pins required was 2-10. One horse was subjected to euthanasia due to a tendon laceration 8 weeks after surgery; of the remaining 11 horses, mean duration of follow-up was 3.9 years (range 4 months-8 years). Nine of these were sound and had entered work, while 2 were sound but remained unbroken 4 and 6 months post operatively, respectively. Radiographic resolution of the OCD lesion occurred in 14 of 16 pinned joints in the 9 horses with long-term follow-up. The 2 remaining joints had a 3 and a 5 mm mineralised flap in the original defect sites.


CONCLUSIONS
This study indicated cartilage flap reattachment was an alternative to removal in selected OCD lesions.


CONCLUSIONS
Relatively smooth OCD cartilage flaps may be salvaged by reattachment and can result in normal radiographic subchondral contour and a high likelihood of athletic performance. Further case numbers are required to determine which lesions are too irregular or contain too much mineral for effective incorporation after reattachment.
Nixon
A J
AJ
Department of Clinical Science, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853-6401, USA.
Fortier
L A
LA
Goodrich
L R
LR
Ducharme
N G
NG
D000818:Animals; D001182:Arthroscopy / Q000662:veterinary; D001858:Bone Nails / Q000662:veterinary*; D003646:Debridement / Q000379:methods / Q000662:veterinary; D005260:Female; D005500:Follow-Up Studies; D006734:Horse Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006736:Horses; D007150:Immunohistochemistry / Q000662:veterinary; D008297:Male; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging / Q000601:surgery / Q000662:veterinary*; D016687:Polydioxanone; D011859:Radiography; D013264:Stifle; D013524:Surgical Flaps / Q000662:veterinary; D016896:Treatment Outcome
D016687:Polydioxanone