Surgical management of unstable juvenile osteochondritis dissecans of the knee: clinical outcomes, return to sport, complications, and reoperation rates with an average follow-up of 6.5 years

To evaluate clinical outcomes, return to sport, complications, and reoperation rates associated with three internal fixation methods for unstable juvenile osteochondritis dissecans (JOCD). A retrospective review was conducted of patients less than or equal to 18 years with unstable JOCD who underwent internal fixation and had more than 1 year of follow-up. Fixation methods included metal screws ( n = 13), Smart Nails ( n = 15), and hybrid fixation ( n = 15). Demographic data, radiographic healing, complications, and reoperations were documented. Functional outcomes were assessed using Lysholm and Pediatric International Knee Documentation Committee Scales. Forty-three knees from 40 patients (26 males) were evaluated. The average age was 15.1 years (SD = 1.8 years) with a follow-up of 74.8 months. Healing occurred in 88.4% (38/43) of the knees after surgery. Complications were observed in 9.3% of the cases, including synovitis ( n = 3)and screw breakage ( n = 1). Ninety-three percent of the patients returned to sports within an average of 7.9 months (SD = 2.7 months). Fifty-three percent of the participants required a second intervention. Smart Nails were associated with a higher complication rate, whereas metal screws showed higher reoperation rates, primarily because of elective implant removal. Healing rates and functional outcomes were comparable across lesion location, fixation method, growth plate status, and lesion grade. Internal fixation for unstable JOCD in adolescents shows a high healing rate and a low rate of complications, with most patients successfully returning to sports within a year. Nevertheless, a significant reoperation rate, mainly for elective hardware and loose body removal, should be considered in patient management plans. Level of Evidence: III