title: Meniscal suturing versus screw fixation for treatment of osteochondritis dissecans: clinical and magnetic resonance imaging results.
abstract: OBJECTIVE
  The purpose of this study was to compare meniscal stabilization alone with screw fixation in restoring subjective and objective knee function and structural cartilage integrity in skeletally immature patients with osteochondritis dissecans (OCD) of the knee.
  
  
  METHODS
  This study comprised 28 patients (32 knees) with magnetic resonance imaging (MRI)-confirmed OCD. Unstable menisci were treated with either stabilization (15 patients, 16 knees) or screw fixation (13 patients, 16 knees; control group). Patients were assessed by functional scoring (Hughston, International Knee Documentation Committee [IKDC]) and MRI for a minimum follow-up period of 2.5 years.
  
  
  RESULTS
  In the meniscus stabilization group, the Hughston score improved from 1.4 to 3.8 (P < .01). There was improvement in the IKDC grade, from grade C preoperatively to grade A in 14 knees and grade B in 2 (P < .01). Of 16 knees, 15 had complete defect resolution on MRI by 1 year. There were 3 complications: 1 wound infection, 1 case of trauma requiring reoperation, and 1 revision because of treatment failure at 6 months. In the screw fixation group, the Hughston score improved from 1.4 to 3.6 (P < .01). There was a significant improvement in IKDC grade, from grade C preoperatively to grade A in 11 knees and grade B in 5 (P < .01). At 2 years postoperatively, no differences in these variables were found between the groups.
  
  
  CONCLUSIONS
  Meniscal suturing alone for the treatment of an OCD of the knee shows good or excellent results in terms of clinical scoring and MRI assessment at almost 3 years' follow-up. The results are comparable with those of screw fixation but with a faster recovery in the postoperative course.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Paediatric Orthopaedic Department, University Children's Hospital Basle, Basel, Switzerland. Electronic address: carlo.camathias@ukbb.ch.
authors.forename: Carlo
authors.initials: C
authors.lastname: Camathias
authors.affiliation: Orthopaedic Department, Baselland Hospital, Bruderholz, Switzerland.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Hirschmann
authors.affiliation: Paediatric Orthopaedic Department, University Children's Hospital Basle, Basel, Switzerland; Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.affiliation: Paediatric Orthopaedic Department, University Children's Hospital Basle, Basel, Switzerland.
authors.forename: Erich
authors.initials: E
authors.lastname: Rutz
authors.affiliation: Paediatric Orthopaedic Department, University Children's Hospital Basle, Basel, Switzerland.
authors.forename: Reinald
authors.initials: R
authors.lastname: Brunner
authors.affiliation: Royal Hospital for Sick Children, Edinburgh, Scotland.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Gaston
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D010008:Osteochondritis Dissecans / Q000175:diagnosis* / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies