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    • Postoperative follow up was preceded by radiography or MRI

    2018-10-29

    Postoperative follow-up was preceded by radiography or MRI, and the patients were asked to complete the questionnaire of Knee injury and Osteoarthritis Outcome Score (KOOS) at clinics or via telephone call. The KOOS consists of five subscales: pain, other symptoms, activities of daily living, function in sports and recreation and knee-related quality of life. The questions were requested to be answered at the final week of follow-up. Standardized answer options were provided (5 Likert boxes) and each question received a score from 0 to 4. A normalized score (100 indicating no symptoms, and 0 indicating extreme symptoms) was calculated for each subscale. The result was then plotted as an outcome profile. All patients completed these questionnaires preoperatively and postoperatively. The patients were surveyed by one resident who mps1 did not participate in the course of the treatment. The KOOS score was calculated for each patient who had completed the questionnaire. The five KOOS preoperative components were then compared with the postoperative ones via an independent t test. The statistical significance was evaluated with the criterion of p < 0.05. Calculation was performed via SPSS Version 13.0 (SPSS Inc., Chicago, IL, USA).
    Results All patients in our study were male. The ages ranged from 15 years to 28 years with an average of 20.9 years. The follow-up intervals were from 14 months to 68 months and with a mean of 30.1 months. The lesions were located at the medial femoral condyle (n = 7) and lateral femoral condyle (n = 1). The size of the lesions ranged from 2.0 cm2 to 5.0 cm2 (mean, 2.6 cm2). The staging of OCD were II (n = 5) and III (n = 3). Table 2 summarizes the data. All involved knees were noted to have various degrees of cartilage wear under arthroscopic examination. Synovitis, joint effusion and fibrous tissue at the site of the defect were also noted. All patients completed the entire KOOS questionnaire preoperatively and postoperatively. They were also checked using preoperative and postoperative radiography. A preoperative MRI was performed in all patients. However, only three had a postoperative MRI. One patient underwent second-look arthroscopy. The mean preoperative KOOS subscale score for pain was 47.5 (range, 40–52); for other symptoms, 46.63 (range, 38–53); for activities of daily living 47.5 (range, 40–52); for function in sports and recreation, 44.5 (range, 36–50); and for knee-related quality of life, 47.63 (range, 38–52). The mean postoperative KOOS subscale score for pain was 91.25 (range, 80–97); for other symptoms, 89.88 (range, 82–96); for activities of daily living, 92.88 (range, 80–97); for sports and recreation function, 88.25 (range, 75–96); and for knee-related quality of life, 88.88 (range, 69–96). All comparisons between pre- and postoperative data were statistically significant (p < 0.05) (Table 2). Among the eight patients included in our study, Patient 4 had the worst clinical outcome. The patient had the largest preoperative lesion size (5.0 cm2) and highest OCD staging (Stage III). Among all preoperative and postoperative KOOS subscales, Repeating unit patient had the lowest score. Even the clinical outcome was not satisfactory, as compared with other patients, but the quality of life was improved significantly after surgical intervention. The remaining seven patients had satisfactory clinical outcomes and radiographic results. All these seven patients had the diagnostic confirmation within 6 months after the onset of their symptoms. In Case 1, in comparison of the MRI preoperatively and plain film 1-year postoperatively (Figures 1A and 1B), a satisfactory lesion healing and stable fixation were obtained. The clinical outcome of the patient was also excellent (pain, 97; other symptoms, 96; activities of daily living, 96; function in sports and recreation, 96; and knee-related quality of life, 94). For Case 6, the result of surgical treatment was also impressive. Comparing the preoperative and 1-year postoperative radiographs (Figures 1K and 1L), the result was also satisfactory. Compared with intra-operative and 1-year postoperative second-look arthroscopic photographs (Figures 1Q and 1R), the bone union at the site of the OCD lesion was complete 1 year after the operation.