Outcomes of surgical fixation of osteochondral fracture: a systematic review.

Abstract

Background: Dealing with knee osteochondral defects presents a substantial clinical challenge due to the variable nature of repair outcomes and intricate biomechanical complexities inherent to the knee joint. Numerous surgical alternatives exist for addressing knee osteochondral lesions, yet there is limited evidence available for comparing their respective outcomes.

Methods: According to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines, a systematic literature search was conducted to identify publications from inception to September 2023 on PubMed, Cochrane, and Medline academic search engines with the MeSH terms "osteochondral" AND ("patella" OR "patellar" OR "patellofemoral" OR "femoral condyle lesions" OR "trochlear lesions"). Inclusion criteria were clinical human studies, English language, subjects who underwent surgical management (fixation, reconstruction, or debridement) for knee osteochondral lesions with reported treatment outcomes, and a minimum sample size of ten patients. The methodological index for non-randomized studies (MINORS) was used to evaluate the non-randomized studies' methodological quality. Main outcome measurements Pediatric International Knee Documentation Committee (Pedi IKDC) scale, Tegner-Lysholm Scoring Scale, Tegner Activity Score, Visual Analog Scale, Knee Society Score (KSS) Score, Kujala Score, and Fulkerson score were collected.

Results: In all, 25 studies were included with 1093 patients in total. The analysis revealed that patellar lesions had similar outcomes to femoral lesions. Surgical fixation demonstrated superior outcomes compared with debridement, with improvements observed across multiple validated outcome measures. Both fixation and reconstruction resulted in significant improvement in outcomes. Osteochondral fragment size, age, and sex did not influence postoperative outcomes.

Conclusions: While surgical management of knee osteochondral defects consistently yields significant functional improvement, the current evidence favors anatomic restoration via fixation or reconstruction over debridement. Despite the variability in patient demographics and reported outcomes, these findings suggest that treatment selection should be prioritized on the basis of lesion characteristics and specific surgical technique rather than age alone. However, given the significant heterogeneity, wide age range, and missing demographic data across the literature, these findings should be interpreted as observed associations rather than definitive evidence of clinical superiority. They underscore the need for tailored treatment strategies and highlight the requirement for high-level, standardized research with consistent use of validated outcome measures and established minimal clinically important difference (MCID) thresholds to further clarify optimal surgical interventions.

Level of evidence: 4:

Trial registration: The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) international prospective register of systematic reviews database (CRD42024596365).