Matti Vahakari MD, Presenter: Nothing to Disclose

Pekka Kerimaa MD, Abstract Co-Author: Nothing to Disclose

Osmo Tervonen MD, PhD, Abstract Co-Author: Nothing to Disclose

Jussi Korhonen MD, Abstract Co-Author: Nothing to Disclose

Juha Jaakko Sinikumpu MD, Abstract Co-Author: Nothing to Disclose

Risto Ojala MD, PhD, Abstract Co-Author: Nothing to Disclose

Roberto Blanco Sequeiros MD, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to evaluate the feasibility and clinical results of percutaneous high field MRI-guided retrograde drilling for the treatment of juvenile osteochondritis dissecans (JOCD) of the femur.

8 JOCD lesions of the femur in seven patients (figure 1A and 1C), unresponsive to prolonged conservative management (6 months), were treated with MRI-guided percutaneous retrograde drilling (figure 1B) to reduce symptoms and to promote ossification of the subchondral lesion. All lesions were of juvenile type OCD (mean age 13 y). Four lesions were located on the the medial condyle and four lesions were located on the lateral condyle. All the patients had severe limitation of activity due to the OCD related pain. The mean size of the lesion was 15mm x 7mm x 15 mm. An 1.5 T wide bore MRI scanner (Siemens Espree, Erlangen, Germany) was used to percutaneously drill retrograde channels to the JOCD lesions (3 mm cylindrical drill, 1-3 channels). MRI imaging was used to guide instruments. Mean postprocedural clinical follow up time was 14 months (minimum 12 months). All patients had a post-procedural follow up MRI within a year.

All the JOCD lesions were succesfully located and drilled using the MRI scanner without procedural complications. Mean procedural time was 58 minutes. All the patients had pain relief, mean visual analog score of the maximal associated pain (VAS) declined from 7 to 2. Follow up MRI showed ossification in 5 lesions (figure 1C-D). Five patients could return to normal physical activity with no effect on function (Hughston score 4). Two patients were pain free but experienced some symptoms with physical activity (Hughston score 3).

MR-guided retrograde drilling is accurate and feasible method to achieve therapeutic effect in the treatment of the juvenile OCD lesion of the femur.

MRI guided retrograde drilling is potentially a paradigm shifting minimally invasive method to treat JOCD with no associated ionizing radiation, a significant benefit in pediatric population.

Vahakari, M, Kerimaa, P, Tervonen, O, Korhonen, J, Sinikumpu, J, Ojala, R, Blanco Sequeiros, R, Osteochondritis Dissecans of the Knee; MRI Guided Retrograde Drilling at 1.5 T and Clinical Outcomes in Pediatric Patients.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13027080.html