Evaluation of Clinical and Radiological Outcomes in Patients Undergoing Fixation of Osteochondral Fragments With Reasorbable Screws in the Knee Joint
NCT Number: NCT06462040
Acronym: OC-FIX
Status: NOT_YET_RECRUITING
Study Type: OBSERVATIONAL
Conditions: Osteochondral Defect|Osteochondritis Dissecans|Osteochondral Fracture|Osteochondral Fracture of Patella
Interventions: PROCEDURE: Fixation of osteochdral fragments with reabsorbable screws
Sponsor: Istituto Ortopedico Rizzoli
Sex: ALL
Age: CHILD, ADULT
Enrollment: 100
Study Design: Observational Model: |Time Perspective: p
Start Date: 2024-08
Completion Date: 2028-06-01

Summary:
Various techniques for the fixation of unstable osteochondral fragments have been used over the years, each with associated advantages and disadvantages, and differing clinical outcomes. However, the literature on the treatment of this type of injury in the adolescent and young adult population is scarce and involves small case series. Failure to treat these injuries can lead to serious consequences such as chronic pain, residual joint stiffness, and the development of early osteoarthritis, necessitating more invasive and burdensome interventions for the national health system, such as prosthetic replacements or osteotomies.

Due to the lack of real consensus within the scientific community regarding the ideal treatment for these patients and the insufficient medium/long-term follow-up data on the effects of these injuries on articular cartilage in young patients, this study aims to evaluate the clinical and radiological conditions of patients undergoing osteochondral fragment fixation using the same surgical technique (fixation with resorbable screws performed arthroscopically or via open surgery depending on the lesion's location) in order to clarify preventive measures against cartilage degeneration following these injuries, which are very common in adolescence.

Primary Outcome Measures: KOOS (Knee Injury and Ostearthritis Outcome Score) score, It represents a subjective score composed of 42 questions divided into 5 main domains. These domains investigate various aspects of symptoms and daily activities as well as the quality of life related to the knee and are divided as follows:

* Symptoms, composed of 7 questions, 2 of which pertain to stiffness;
* Pain, composed of 9 questions;
* Functions and daily activities, composed of 17 questions;
* Sports and recreational activities, composed of 5 questions;
* Quality of life in relation to the knee, composed of 4 questions. All questions use the same response format, utilizing a quantitative scale ranging from 0 (no issues) to 4 (severe difficulty). Scores are calculated separately for each domain and converted into a percentage score, where 100 represents excellent physical condition with no symptoms and 0 represents severe disability with limitations in daily activities and constant symptoms even at rest., At least 24 months after surgery
Secondary Outcome Measures: Kujala Anterior Knee Pain Scale, The Kujala score is a subjective knee assessment tool that quantifies limitations in daily and sports activities, as well as the presence or absence of symptoms. The questionnaire consists of 13 multiple-choice questions, with a total score ranging from 0 to 100. Each question has a variable score from 5 to 10 points and includes 3, 4, or 5 multiple-choice answers. The topics covered by each question include limping, pain, swelling, flexion deficit, and difficulty performing various types of activities. The maximum score of 100 represents no limitations or symptoms; the further the score deviates from 100, the worse the outcome., At least 24 months after surgery|International Knee Documentation Committee (IKDC) Score, The IKDC score is a subjective knee assessment tool that assesses limitations in daily and sports activities, as well as the presence or absence of symptoms.

The IKDC score comprises three main domains:

1. Symptoms, which include pain, stiffness, swelling, and the sensation of locking.
2. Sports and daily activities.
3. Current knee function and function before the injury.

The questionnaire consists of 10 questions:

* Seven items inquire about the patient's symptoms.
* One item focuses on participation in sports.
* One item, composed of 9 points, addresses the difficulties the patient experiences in performing daily activities.
* The last item measures the current functionality of the knee.

Scores range from 0 to 100, where 100 represents the absence of limitations and symptoms. The further the score deviates from 100, the worse the outcome, which can be categorized into four groups: excellent (80-100), good (60-80), fair (30-60), and poor (0-30)., At least 24 months after surgery|Objective IKDC (IKDC standard evaluation form), This represents a clinical chart that is completed by the physician following a comprehensive knee examination where various clinical tests are performed to assess for any joint deformities, objective instability, and meniscal injuries. The score obtained determines an objective evaluation grade coded using letters. According to this scale, grade "A" is assigned to a knee with "normal functionality, as healthy," grade "B" is assigned to a knee with "almost normal functionality," grade "C" is assigned to a knee with "moderately abnormal functionality," and grade "D" is assigned to a knee with "severely abnormal functionality.", At least 24 months after surgery|MARX Activity Rating Scale, The MARX questionnaire is a subjective assessment tool designed to evaluate the activity level of patients with knee disorders who engage in sports. It focuses on four domains of sports activity: running, deceleration, cutting, pivoting.

Patients are asked to approximate how many times they have performed each of these activities over the past twelve months. The four knee functions are evaluated on a 5-point frequency scale, and the scores are summed up to a maximum of sixteen points, where a higher score indicates more frequent participation and thus is correlated with a higher knee health status.

The MARX questionnaire differs from many other activity measures because it is not based on participation in specific sports activities. Instead, patients are asked about different components of physical function (such as running and pivoting) common to various sports. The aim of this tool is to identify the overall activity level of the patient rather than their most recent activity., At least 24 months after surgery|VAS (Visual Analog Scale) for pain, This is a quantitative, one-dimensional numeric pain assessment scale, ranging from 0 to 10. The scale requires the patient to select the number that best describes the intensity of their pain, from 0 to 10, at the time of the visit and before the surgical intervention. 0 indicates no pain, while 10 indicates the worst possible pain., At least 24 months after surgery|Radiological evaluation (MRI, magnetic resonance imaging) throughout ICRS Cartilage Score, Assessment of healing of the fragment fixation, 24 months after surgery|Radiological evaluation (MRI, magnetic resonance imaging) throughout Outerbridge Classification, Healing status of ostechondral fragment, 24 months after surgery|Sports Activity Level, Tegner Score, Allows estimation of a subject's motor activity level with a score ranging from 0 to 10, where 0 represents 'inability' and 10 represents 'participation in competitive sports, such as national or international-level soccer. This score is commonly used to define the motor activity level of patients with knee disorders. Additionally, patients will be asked how many years they have been active in sports and whether the reduction or cessation of activity is related to knee pathology or not., At least 24 months after surgery|Thigh circumference, Measuring the circumference of the thigh at 5 cm and 15 cm from the superior pole of the patella allows for the evaluation of the degree of muscle trophism of the subjects under examination, and thus the potential influence of the type of technique used on muscle trophism., At least 24 months after surgery|Anterior knee pain / pain during knee flexion, In order to specifically assess the symptoms of the patellofemoral joint, patients will be asked to respond to these questions dichotomously (YES/NO)., At least 24 months after surgery|Likert scale, In order to assess the level of patient satisfaction, they will be asked to respond to a question composed of 5 levels of satisfaction (from 1 to 5), where 1 indicates that the patient is very satisfied with the intervention, while 5 indicates a high degree of dissatisfaction., At least 24 months after surgery|Complications, subsequent interventions, or surgical failures, Any complications, subsequent interventions, and surgical failures will be documented and recorded in the CRF., At least 24 months after surgery