O3229: Suture Bridge versus Screw Fixation in Pediatric Osteochondral Fractures

Background: Osteochondral fractures (OCF) are rare injuries that affect the pediatric patient. Most commonly occurring in the knee following patellar dislocations, these injuries have the potential to hinder a patient’s function and quality of life and may lead to arthritis later in life. While some may be treated nonoperatively, large and displaced lesions are typically treated with surgical fixation. Various fragment fixation techniques exist including the use of metallic and bioabsorbable implants. More recently, suture bridge constructs have become more popular. Few studies have examined the outcomes of using this technique in a pediatric cohort. The purpose of this study is to compare the functional and radiographic outcomes between bioabsorbable fixation with suture bridge and screw fixation of osteochondral fractures in the knee in an adolescent cohort.

Methods: A retrospective review was conducted identifying OCFs of the knee in pediatric patients ( < 18yo) treated with open repair. Inclusion criteria were patients treated with screw or suture bridge osteochondral fixation (either in isolation or combined with chondral darts) with available preoperative radiographs and surgical notes for review. Exclusion criteria were patients with previous knee surgery or congenital knee diagnoses. Demographic information, injury characteristics, treatments, and outcomes were collected with specific focus on return to sport time and post-operative complications. Univariate analyses were conducted using independent student t-tests, chi-squared, and fisher exact tests as appropriate.

Results: Study criteria identified 35 patients (86% male) with a mean age of 14.2 years (SD=1.8). Twenty-three (66%) patients were injured during sports participation, with basketball and football being the most common causative mechanism. 21 patients (60%) had known patellar dislocation. OCF fixation cohorts consisted of 16 screw and 19 suture bridge patients. Differences approaching significance were seen when comparing return to sport time with suture bridge fixation allowing for a shorter recovery time than screws (8.9 ± 4.8 months vs 12.4 ± 7.4 months respectively, p=0.058). Half of the patients (8/16) treated with screws required return to the operating room (OR) for hardware removal while no suture bridge patients had hardware removed (p < 0.001). Arthrofibrosis requiring operative manipulation occurred in one patient treated with screw fixation. No other patients sustained complications requiring return to the OR. One patient in the screw cohort had incomplete healing 9 months after surgery but decided to forego repeat surgery and chose to avoid high impact activity instead.

Conclusion: Osteochondral fractures in pediatric patients have good overall outcomes and low complication rates regardless of fixation type. However, patients treated with suture bridge fixation were able to return to sport sooner and were less likely to require a secondary operation for hardware removal. Based on these findings, surgeons can consider suture bridge fixation as an option for management of OCF lesions.