Study of Two Surgical Drilling Techniques to Treat Juvenile Osteochondritis Dissecans of the Knee

Study Overview
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Brief Summary
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The purpose of this study is to compare the functional, clinical and radiographic outcomes associated with trans-articular drilling versus retro-articular drilling, two commonly employed techniques of operative treatment for stable forms of juvenile osteochondritis dissecans (JOCD) lesions. This study also aims to better define the natural history of this condition in its most commonly identified pathological state (as a stable lesion) following surgical intervention by determining the rate of radiographic healing and any need for secondary surgery.

Official Title
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Retro Versus Trans Articular Drilling for Juvenile Osteochondritis Dissecans of the Knee: A Multicenter, Randomized Controlled Trial

Conditions
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Juvenile Osteochondritis Dissecans

Intervention / Treatment
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* Procedure: Retro-articular drilling
* Procedure: Trans-articular drilling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of JOCD, Lesion located on the lateral aspect of the medial femoral condyle, Lesion considered stable based on MRI, Patient deemed skeletally immature based on MRI, Completed a course of conservative therapy. Exclusion Criteria: Significant concomitant knee pathology (AVN, fracture, inflammatory arthritis, ACL tear, discoid/meniscal tear, etc.) Lesion healed sufficiently and surgery is not recommended, Prior surgery on the affected knee, Diagnosis of metabolic bone disorder (e.g. osteogenesis imperfecta), Diagnosis of sickle cell disease, History of prolonged corticosteroid or chemotherapy treatment,

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Retro-articular drilling<br>Retro-articular drilling goes through the cortical margin of the affected condyle, thereby sparing the articular surface and physes. | Procedure: Retro-articular drilling<br>* Drilling must be performed under AP and lateral fluoroscopic guidance, with no additional drilling in 'trans-articular', or intra-articular trans-condylar fashion. Use a 0.045 K-wire for drilling. Minimum of 8 wire passes per square centimeter with no maximum number of wire passes.<br>* Other names: extra-articular;|
| Active Comparator: Trans-articular drilling<br>Trans-articular drilling penetrates the articular cartilage through multiple sites to create subchondral penetrations. | Procedure: Trans-articular drilling<br>* Drilling must be performed, under arthroscopic visualization, directly through the articular cartilage, with no additional drilling in 'retro-articular', 'extra-articular', or trans-condylar (through the intercondylar notch) Use a 0.045 K-wire for drilling A minimum 4 wire passes per square centimeter, with a maximum of 5 wire passes per square centimeter<br>* Other names: extra-articular;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Physical functioning measured by the Pedi-IKDC (International Knee Documentation Committee) total score |  | One year post-surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Activity level as measured by the Marx Activity Scale |  | One year post-surgery | 
| Physical functioning as measured by the Pedi-IKDC total score |  | Two years post-surgery | 
| Time to lesion healing | Lesion healing will be assessed by x-ray at multiple time points | 3 months to 2 years post-surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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trans-articular drilling, stable osteochondritis dissecans lesion, osteochondritis dissecans (OCD), juvenile osteochondritis dissecans (JOCD), knee osteochondritis dissecans, retro-articular drilling