Early arthroscopic fixation of low-grade juvenile osteochondritis dissecans with bioabsorbable pins achieves excellent clinical and imaging outcomes in high-demand athletes.

Abstract

Juvenile osteochondritis dissecans (JOCD) of the knee is increasingly observed in skeletally immature athletes due to higher participation in competitive sports. Conservative treatment achieves healing in only 50% of cases, often delaying return to play. The purpose of this study was to evaluate the clinical and radiologic outcomes of early arthroscopic fixation of low-grade JOCD with bioabsorbable pins in high-demand juvenile athletes. We hypothesized that early fixation would result in complete consolidation, excellent functional recovery, and safe return to sport. A retrospective analysis was conducted on 32 consecutive patients (16 males, 10 females; mean age, 13.5 ± 2.1 years) with low-grade stable JOCD lesions treated with arthroscopic fixation using SmartNail® bioabsorbable pins between 2004 and 2022. Lesions were staged according to the Di Paola magnetic resonance imaging (MRI) and Guhl arthroscopic classifications, with instability evaluated using De Smet criteria. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, and Visual analogue score (VAS) pain score. The MRI follow-up at 3, 6, and 12 months confirmed consolidation. Statistical analysis was performed using paired t-tests with significance set at p < 0.05. The mean follow-up was 6.8 ± 3.2 years. The IKDC score improved from 72.1 ± 8.3 to 94.7 ± 4.5 (Δ +22.6; 95% CI, 18.9-26.2; p < 0.001), and the Lysholm score improved from 68.2 ± 7.6 to 93.5 ± 4.2 (Δ +25.3; 95% CI, 21.4-29.1; p < 0.001). Both exceeded minimal clinically important difference (MCID) thresholds with large effect sizes (Cohen's d > 2.8). The Tegner activity scale was restored to pre-injury levels (6.9 ± 0.5 vs 6.8 ± 0.4; p = 0.41). MRI confirmed 100% consolidation at 6 months, with no implant migration, synovitis, or degenerative changes. All patients returned to sport at their pre-injury level at a mean of 6.2 ± 1.1 months, and no reoperations were required. Early arthroscopic fixation with bioabsorbable pins in skeletally immature athletes with low-grade JOCD ensures complete consolidation, excellent functional outcomes, and reliable return to sport, demonstrating favorable outcomes compared with those reported in the literature for conservative treatment. This technique may represent a safe and effective surgical option for high-demand juvenile patients. Level IV, retrospective case series.