Arthroscopic reattachment of osteochondritis dissecans lesions using resorbable polydioxanone pins.

The study explores the use of resorbable polydioxanone pins in reattaching cartilage flaps caused by osteochondritis dissecans (OCD) in horses, suggesting it could be an effective alternative to standard treatments that involve debridement or removal of the cartilage flaps.

Background and Objective

• The research focuses on osteochondritis dissecans (OCD), a condition where a fragment of bone begins to separate from its surrounding region due to a lack of blood supply. This separation leads to the formation of cartilage ‘flaps’.
• The traditional treatment method involves the debridement – surgical removal – of these cartilage flaps. This procedure, however, usually leads to imperfect repair tissues and permanent irregularity to the subchondral bone plate – the layer of bone underneath the cartilage.
• The objective of this research was to evaluate a new approach of OCD treatment. This alternative method involves the reattachment of the cartilage flaps to the hyaline cartilage surface from where they separated, using resorbable polydioxanone pins.
• This reattachment procedure was trialed in specific cases where an unmineralised cartilage flap was seen on preoperative radiographs and a somewhat smooth surface, with some residual perimeter attachment, noticed during the operation.

Methodology and Results

• The reattachment process using resorbable polydioxanone pins was tested on 16 joints of 12 horses. The horses varied in breed and age, with effusion noted in their affected joints.
• The extent of the lesions varied, with the number of pins required depending on the lesion’s size. Radiographic examination of the lesions was used to determine whether the cartilage flap was salvageable.
• After monitoring these animals in the long-term, the researchers found that the majority of the horses were sound and had returned to work, demonstrating the effective healing offered by the reattachment procedure.
• Additionally, radiographic resolution of the OCD lesion occurred in most joints that had undergone the pinning procedure. A few cases retained mineral residues at the original defect sites.

Conclusions

• The research suggests that flap reattachment can be an alternative to debridement in managing selected OCD lesions.
• Salvaging relatively smooth OCD cartilage flaps through reattachment can result in normal radiographic subchondral contour and a higher likelihood of the animal returning to athletic performance.
• However, the researchers note the need for further research to determine which lesions are too irregular or contain too much mineral for effective incorporation after reattachment.