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Screw Versus Suture Bridge Fixation for Medial Femoral Condyle Osteochondritis Dissecans Demonstrate Comparable
Michael J Kutschke1, Keinan B Agonias1, Charles W Wyatt1
1Scottish Rite for Children Orthopedic and Sports Medicine Center, Frisco, Texas, USA.
Background:
Fixation of unstable medial femoral condyle (MFC) osteochondritis dissecans (OCD) lesions aims to achieve osseous union while preserving the articular cartilage. Suture bridge fixation has emerged as an alternative to bioabsorbable implants or metallic headless compression screws.
Hypothesis:
The authors hypothesized that rates of union, conversion to a secondary cartilage restoration procedure, and patient-reported outcomes would not differ significantly between screw and suture bridge fixation, with fewer implant-related complications after suture bridge fixation.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A cohort of consecutive patients at a single center with unstable MFC OCD lesions treated with metallic headless compression screws or suture bridge constructs was studied using prospectively collected data from the multicenter Research in Osteochondritis of the Knee (ROCK) registry. Inclusion required a minimum of 6-month follow-up. Patient and lesion characteristics and surgical variables were recorded. Radiographic and advanced imaging outcomes, including magnetic resonance imaging-based healing criteria, were assessed to determine union status. Reoperation, secondary articular surface changes, conversion to a secondary cartilage restoration procedure, and patient-reported outcomes were compared between groups.
Results:
A total of 69 lesions were included, with a mean patient age of 14.3 ± 2.4 years. Final union status and conversion rates to a secondary cartilage restoration procedure were similar between screw (17.2%) and suture bridge (20%) fixation (P≥ .999), with no difference in timing of conversion (12.7 ± 8.7 vs 12.6 ± 9.2 months, respectively; P = .833). Implant removal rates were similar between screw (89.7%) and suture bridge (81.3%) groups (P = .478); however, screw fixation was associated with earlier time to permanent implant removal (5.1 ± 4.1 vs 8.5 ± 7.8 months; P = .019), and more severe secondary articular surface changes, including International Cartilage Repair Society grade 4 defects (10.7%) observed exclusively in the screw cohort (P < .001). No differences were observed between groups in improvement from baseline or final Pediatric International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score subscores, or Pediatric Functional Activity Brief Scale scores.
Conclusion:
Metallic headless compression screw and suture bridge fixation demonstrated comparable union rates, equivalent improvements in patient-reported outcomes, and no statistically significant difference in conversion to a secondary cartilage restoration procedure in unstable MFC OCD lesions. Suture bridge fixation allowed longer implant retention with reduced secondary articular surface damage.
