Post-surgical Outcomes in Pediatric and Adolescent Patients With Osteogenesis Imperfecta Undergoing Knee Arthroscopy

Background: Osteogenesis imperfecta (OI) is a genetic disorder of type I collagen associated with a higher risk of musculoskeletal injury. While fracture management in OI is well described, the safety and outcomes of knee arthroscopy for intra-articular pathology in pediatric and adolescent patients with OI remain unknown. The purpose of this study is to evaluate indications, complications, revision surgery rates, and return to baseline activity following knee arthroscopy in this population. Methods: A multicenter retrospective case series was performed on pediatric and adolescent patients with OI who underwent knee arthroscopy between January 2004 and March 2025. Patients with <6 months of follow-up were excluded. Demographic information, diagnoses, procedures, complications, revision surgeries, time to regain full range of motion, and time to return to sport or baseline activity were recorded. Complications were classified using a modified Clavien-Dindo-Sink system. Results: Twenty patients (29 arthroscopic procedures) were included, with a mean age at surgery of 15.5 ± 3.2 years. The most common indications were meniscal injury (41.4%), patellar instability (31.0%), and fracture (27.6%). The most frequent procedures were meniscus repair or meniscectomy (24.1%), patellar stabilization surgery (24.1%), and anterior cruciate ligament reconstruction (17.2%). Postoperative complications of any type occurred after 48.3% of procedures, and 35% of patients required at least one revision surgery. No life-threatening or limb-threatening complications occurred. Seventeen patients (85%) returned to full baseline activities at a mean of 182 days postoperatively. Conclusions: Knee arthroscopy in pediatric and adolescent patients with OI is safe and can effectively restore function and allow return to baseline activity. However, patients should be counseled regarding higher rates of postoperative complications and revision surgery compared with the general pediatric and adolescent population. Level of Evidence: Level IV—case series.