Prospects for the use of platelet-rich plasma in the complex treatment of stage II–III osteochondritis dissecans of femoral condyles in children: A preliminary report

Abstract

BACKGROUND: Osteochondritis dissecans of the femoral condyles is characterized by subchondral bone lesions, with subsequent formation of an osteonecrosis area. In nearly half of the cases, gonarthrosis developed in the long-term period despite timely treatment of such patients, including children. The development of new techniques and the improvement of existing ones will help enhance the treatment results of patients with this pathology.

AIM: To evaluate the efficacy of treatment in a small clinical series of pediatric patients with osteochondritis dissecans by triple injections of platelet-rich plasma (PRP) according to the developed scheme in combination with revascularizing tunnelization of the lesion area.

MATERIALS AND METHODS: Seven patients with stage I or II osteochondritis dissecans were treated by revascularizing stimulation of the osteonecrosis center by triple injections of PRP (the first procedure was conducted intraoperatively intraosseously and the two other injections subsequently intraarticularly). The follow-up period was 10 (6–11) months, with a maximum duration of 12 months.

RESULTS: The observation results demonstrate a high efficacy of PRP therapy to enhance the effect of mechanical methods of osteochondrogenesis stimulation in children with osteochondritis dissecans.

CONCLUSIONS: The use of orthobiological technologies is an actively developing and promising approach in the complex treatment of children with osteochondritis dissecans of the femur condyles. However, further observation is required to evaluate the long-term results.

Keywords

osteochondritis dissecans / children / arthroscopy / knee joint / PRP-therapy

References

[1] Kulyaba TA, Kornilov NN. Rassekayushchii osteokhondrit kolennogo sustava: natsional’nye klinicheskie rekomendatsii. Saint Petersburg; 2013. (In Russ.)

[2] Куляба Т.А., Корнилов Н.Н. Рассекающий остеохондрит коленного сустава: национальные клинические рекомендации. Санкт-Петербург, 2013.

[3] Kulyaba TA, Kornilov NN. Rassekayushchii osteokhondrit kolennogo sustava: natsional’nye klinicheskie rekomendatsii. Saint Petersburg; 2013. (In Russ.)

[4] Sanders T, Pareek A, ObeyM, et al. High rate of osteoarthritis after osteochondritis dissecans fragment excision compared with surgical restoration at a mean 16-year follow-up. Am J Sports Med. 2017;45(8):1799–1805. DOI: 10.1177/0363546517699846

[5] Sanders T., Pareek A., Obey M., et al. High rate of osteoarthritis after osteochondritis dissecans fragment excision compared with surgical restoration at a mean 16-year follow-up // Am. J. Sports Med. 2017. Vol. 45. No. 8. P. 1799–1805. DOI: 10.1177/0363546517699846

[6] Sanders T, Pareek A, ObeyM, et al. High rate of osteoarthritis after osteochondritis dissecans fragment excision compared with surgical restoration at a mean 16-year follow-up. Am J Sports Med. 2017;45(8):1799–1805. DOI: 10.1177/0363546517699846

[7] Vorotnikov AA, Airapetov GA, Vasyukov VA, et al. Modern aspects of the treatment of Koenig’s disease in children. N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):79–86. (In Russ.) DOI: 10.17816/vto202027379-86

[8] Воротников А.А., Айрапетов Г.А., Васюков В.А., и др. Современные аспекты лечения болезни Кенига у детей // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2020. № 3. С. 79–86. DOI: 10.17816/vto202027379-86

[9] Vorotnikov AA, Airapetov GA, Vasyukov VA, et al. Modern aspects of the treatment of Koenig’s disease in children. N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):79–86. (In Russ.) DOI: 10.17816/vto202027379-86

[10] Dipaola J, Nelson D, Colville M. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy. 1991;7(1):101–104. DOI: 10.1016/0749-8063(91)90087-e

[11] Dipaola J., Nelson D., Colville M. Characterizing osteochondral lesions by magnetic resonance imaging // Arthroscopy. 1991. Vol. 7. No. 1. P. 101–104. DOI: 10.1016/0749-8063(91)90087-e

[12] Dipaola J, Nelson D, Colville M. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy. 1991;7(1):101–104. DOI: 10.1016/0749-8063(91)90087-e

[13] Antipov AV. Artroskopicheskoe zameshchenie defektov sustavnoi poverkhnosti kostno-khryashchevymi transplantatami pri rassekayushchem osteokhondrite kolennogo sustava: [abstract dissertation]. Moscow; 2003. (In Russ.)

[14] Антипов А.В. Артроскопическое замещение дефектов суставной поверхности костно-хрящевыми трансплантатами при рассекающем остеохондрите коленного сустава: дис. ... канд. психол. наук. Москва, 2003.

[15] Antipov AV. Artroskopicheskoe zameshchenie defektov sustavnoi poverkhnosti kostno-khryashchevymi transplantatami pri rassekayushchem osteokhondrite kolennogo sustava: [abstract dissertation]. Moscow; 2003. (In Russ.)

[16] Egiazaryan KA, Lazishvili GD Hramenkova IV, et al. Knee osteochondritis desiccans: surgery algorithm. Bulletin of RSMU: Biomedical journal of Pirogov university. 2018;2:77–83. (In Russ.) DOI: 10.24075/vrgmu.2018.020

[17] Егиазарян К.А., Лазилашвили Г.Д., Храменкова И.В., и др. Алгоритм хирургического лечения больных с рассекающим остеохондритом коленного сустава // Вестник Российского государственного медицинского университета. 2018. № 2. С. 77–83. DOI: 10.24075/vrgmu.2018.020

[18] Egiazaryan KA, Lazishvili GD Hramenkova IV, et al. Knee osteochondritis desiccans: surgery algorithm. Bulletin of RSMU: Biomedical journal of Pirogov university. 2018;2:77–83. (In Russ.) DOI: 10.24075/vrgmu.2018.020

[19] Krappel FA, Bauer E, Harland U. Are bone bruises a possible cause of osteochondritisdissecans of the capitellum? A case report and review of the literature. Arch Orthop Traums Surg. 2005;125(8):545–549. DOI: 10.1007/s00402-005-0018-0

[20] Krappel F.A., Bauer E., Harland U. Are bone bruises a possible cause of osteochondritisdissecans of the capitellum? A case report and review of the literature // Arch. Orthop. Traums. Surg. 2005. Vol. 125. № 8. P. 545–549. DOI: 10.1007/s00402-005-0018-0

[21] Krappel FA, Bauer E, Harland U. Are bone bruises a possible cause of osteochondritisdissecans of the capitellum? A case report and review of the literature. Arch Orthop Traums Surg. 2005;125(8):545–549. DOI: 10.1007/s00402-005-0018-0

[22] Shea K, Jacobs JC, et al. Osteohondritis dissecans development after bone contusion of the knee in the skeletally immature: a case series. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):403–407. DOI: 10.1007/s00167-012-1983-9

[23] Shea K., Jacobs J.C., et al. Osteohondritis dissecans development after bone contusion of the knee in the skeletally immature: a case series // Knee Surg. Sports Traumatol. Arthrosc. 2013. Vol. 21. No. 2. P. 403–407. DOI: 10.1007/s00167-012-1983-9

[24] Shea K, Jacobs JC, et al. Osteohondritis dissecans development after bone contusion of the knee in the skeletally immature: a case series. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):403–407. DOI: 10.1007/s00167-012-1983-9

[25] Merkulov VN, El’tsin AG, Avakyan AP, et al. Modern tactics of treatment of Koenig’s disease in children and adolescents. In: Sbornik tezisov 9-go s”ezda travmatologii i ortopedii. Saratov; 2010. Vol. 3. P. 931–932. (In Russ.)

[26] Меркулов В.Н., Ельцин А.Г., Авакян А.П., и др. Современная тактика лечения болезни Кенига у детей и подростков // Сборник тезисов 9-го съезда травматологии и ортопедии. Т. 3. Саратов, 2010. C. 931–932.

[27] Merkulov VN, El’tsin AG, Avakyan AP, et al. Modern tactics of treatment of Koenig’s disease in children and adolescents. In: Sbornik tezisov 9-go s”ezda travmatologii i ortopedii. Saratov; 2010. Vol. 3. P. 931–932. (In Russ.)

[28] Han J., Gao F., Li Y. et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: a systematic review. Biomed Res Int. 2020. DOI: 10.1155/2020/ 2642439

[29] Han J., Gao F., Li Y., et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: a systematic review // Biomed. Res. Int. 2020. DOI: 10.1155/2020/2642439

[30] Han J., Gao F., Li Y. et al. The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: a systematic review. Biomed Res Int. 2020. DOI: 10.1155/2020/ 2642439

[31] Malanin DA, Tregubov AS, Demeshchenko MV, et al. PRP-terapiya pri osteoartrite krupnykh sustavov: metodicheskie rekomendatsii. Volgograd; 2018. (In Russ.)

[32] Маланин Д.А., Трегубов А.С., Демещенко М.В., и др. PRP-терапия при остеоартрите крупных суставов: методические рекомендации. Волгоград, 2018.

[33] Malanin DA, Tregubov AS, Demeshchenko MV, et al. PRP-terapiya pri osteoartrite krupnykh sustavov: metodicheskie rekomendatsii. Volgograd; 2018. (In Russ.)

[34] Song JS, Hong KT, Kim NM, et al. Allogenic umbilical cord blood-derived meneschymal stem cell implantation for the treatment of juventle osteochondritis dissecans of the knee. J Clin Orthop Trauma. 2019;10(Suppl 1);S20–S25. DOI: 10.4252/wjsc.v12.i6.514

[35] Song J.S., Hong K.T., Kim N.M., et al. Allogenic umbilical cord blood-derived meneschymal stem cell implantation for the treatment of juventle osteochondritis dissecans of the knee // J. Clin. Orthop. Trauma. 2019. Vol. 10 (Suppl. 1). P. S20–S25. DOI: 10.4252/wjsc.v12.i6.514

[36] Song JS, Hong KT, Kim NM, et al. Allogenic umbilical cord blood-derived meneschymal stem cell implantation for the treatment of juventle osteochondritis dissecans of the knee. J Clin Orthop Trauma. 2019;10(Suppl 1);S20–S25. DOI: 10.4252/wjsc.v12.i6.514

[37] Beck JJ, Sugimoto D, Micheli L. Sustained results in long-term follow-up of autologous chondrocyte implantation (ACI) for distal femur juvenile osteochondritis dissecans (JOCD). Adv Orthop. 2018;2018. DOI: 10.1155/2018/7912975

[38] Beck J.J., Sugimoto D., Micheli L. Sustained results in long-term follow-up of autologous chondrocyte implantation (ACI) for distal femur juvenile osteochondritis dissecans (JOCD) // Adv. Orthoped. 2018. Vol. 2018. DOI: 10.1155/2018/7912975

[39] Beck JJ, Sugimoto D, Micheli L. Sustained results in long-term follow-up of autologous chondrocyte implantation (ACI) for distal femur juvenile osteochondritis dissecans (JOCD). Adv Orthop. 2018;2018. DOI: 10.1155/2018/7912975

[40] Chang K-V, Hung Ch-Y, Aliwarga F, et al. Comparative effectiveness of platelet-rich plasma injection for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2014;95(3):562–575.

[41] Chang K-V., Hung Ch-Y., Aliwarga F., et al. Comparative effectiveness of platelet-rich plasma injection for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis // Arch. Phys. Med. Rehabil. 2014. Vol. 95. Vol. 3. P. 562–575. DOI: 10.1016/j.apmr.2013.11.006

[42] Chang K-V, Hung Ch-Y, Aliwarga F, et al. Comparative effectiveness of platelet-rich plasma injection for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2014;95(3):562–575.

[43] Semenov AV, Koroteev VV, Isaev IN, et al. Maloinvazivnoe lechenie rassekayushchego osteokhondrita u detei s ispol’zovaniem biostimulyatsii. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(5):149. (In Russ.)

[44] Семенов А.В., Коротеев В.В., Исаев И.Н., и др. Малоинвазивное лечение рассекающего остеохондрита у детей с использованием биостимуляции // Российский вестник детской хирургии, анестезиологии и реаниматологии. Т. 10. С. 149.

[45] Semenov AV, Koroteev VV, Isaev IN, et al. Maloinvazivnoe lechenie rassekayushchego osteokhondrita u detei s ispol’zovaniem biostimulyatsii. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2020;10(5):149. (In Russ.)

[46] Pligina EG, Soloshenko MV, Kolyagin DV. Effectiveness of autoplasma application in complex therapy of children with knee cartilage pathology. Russian Bulletin of Pediatric Surgery, Anesthesiology and Critical Care Medicine. 2015;5(3):31–36. (In Russ.)

[47] Плигина Е.Г., Солошенко М.В., Колягин Д.В. Эффективность применения аутоплазмы в комплексной терапии детей с патологией хряща коленного сустава // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2015. Т. 5. № 3. С. 31–36.

[48] Pligina EG, Soloshenko MV, Kolyagin DV. Effectiveness of autoplasma application in complex therapy of children with knee cartilage pathology. Russian Bulletin of Pediatric Surgery, Anesthesiology and Critical Care Medicine. 2015;5(3):31–36. (In Russ.)

[49] Akman B, Guven M, Bildik C, et al. MRI documented improvement in patient with juveline osteochondritis dissecans treated with platelet rich plasma. Journal of Proloyherapy. 2016;(8):966–970.

[50] Akman B., Guven M., Bildik C., et al. MRI documented improvement in patient with juveline osteochondritis dissecans treated with platelet rich plasma // Journal of Prolotherapy. 2016. No. 8. P. 966–970.

[51] Akman B, Guven M, Bildik C, et al. MRI documented improvement in patient with juveline osteochondritis dissecans treated with platelet rich plasma. Journal of Proloyherapy. 2016;(8):966–970.

[52] Gormeli G, Karakaplan M, Gormeli CA. Clinical effects of platelet-rich plasma and hyaluronic acid as an additional therapy for talar osteochondral lasions treated with microfacture surgery: a prospective randomized clinical trial. Foot Ankle Int. 2015;36(8)891–900. DOI: 10.1177/1071100715578435

[53] Gormeli G., Karakaplan M., Gormeli C.A. Clinical effects of platelet-rich plasma and hyaluronic acid as an additional therapy for talar osteochondral lasions treated with microfacture surgery: a prospective randomized clinical trial // Foot Ankle Int. 2015. Vol. 36. No. 8. P. 891–900. DOI: 10.1177/1071100715578435.

[54] Gormeli G, Karakaplan M, Gormeli CA. Clinical effects of platelet-rich plasma and hyaluronic acid as an additional therapy for talar osteochondral lasions treated with microfacture surgery: a prospective randomized clinical trial. Foot Ankle Int. 2015;36(8)891–900. DOI: 10.1177/1071100715578435

[55] Liu J, Song W, Yuan T, et al. A comparison between platelet-rich plasma (PRP) and hyaluronate acid on the healing of cartilage defects. PLoS One. 2014;9(5). DOI: 10/1371/journal/pone/0097293

[56] Liu J., Song W., Yuan T., et al. A comparison between platelet-rich plasma (PRP) and hyaluronate acid on the healing of cartilage defects // PLoS One. 2014. Vol. 9. No. 5. DOI: 10/1371/journal/pone/0097293

[57] Liu J, Song W, Yuan T, et al. A comparison between platelet-rich plasma (PRP) and hyaluronate acid on the healing of cartilage defects. PLoS One. 2014;9(5). DOI: 10/1371/journal/pone/0097293