Study On The Consistency Of Preoperative Diagnosis,Treatment And Prognosis Of Children With Osteochondral Injury Of Knee Joint

Objective The incidence of osteochondral injuries of the knee joint is not common in children with sports injuries.The complex structure of the knee joint and the inability of cartilage to develop on X-ray make it difficult to diagnose in clinic.At the same time,the consistency of imaging diagnosis of osteochondral injury by different doctors needs to be explored.The purpose of the research is to study the osteochondral injury of children's knee joint from three aspects of preoperative imaging diagnosis consistency,treatment and prognosis evaluation.Method To retrospectively analyze clinical data of 28 cases of osteochondral injury of the knee joint from January 2010 to June 2018 to our department,and the age of injury,the time from injury to treatment and the mode of injury were calculated.Collecting intraoperative data of all children,and recording the size of intraoperative visible cartilage fracture slices,specific fracture sites and surgical methods.Colleting the positive and lateral X-ray data of the knee joint in the last postoperative follow-up of all children,measuring the femoral tibial Angle,LDFA and MPTA.Meanwhile,Colleting preoperative and postoperative knee MRI imaging data of 15 children,and measuring the thickness of lateral femoral condyle,medial femoral condyle and patella articular surface cartilage of 15 children.In the last postoperative review,measuring the flexion-extension degree of all the limbs,and observing the gait,knee joint appearance of the children.At the same time,examing the anterior and posterior cruciate ligaments,medial and lateral collateral ligaments and other auxiliary structures of the knee joint.Lysholm knee movement level score was performed for all the children's healthy and affected knee joints,and Marx activity level score was performed preoperatively and postoperatively to evaluate the basic function of the knee joints and postoperative basic activity ability.In the aspect of imaging diagnosis consistency,2 senior experts were invited to read the imaging data of 15 children for diagnosis.According to the gold standard of intraoperativeknee arthroscopy or the site of cartilage fracture seen in the open knee joint,analyzing the diagnosis results of the two experts.Result In this study,The mean age of the injured children was 11.93±2.64 years.The types of injuries included: 1 case injured in a car accident,15 cases injured in walking,playing or daily activities,11 cases injured in sports,and 1 case injured in a fall from a height(<1 meter).The mean time from injury to treatment was 8.31±6.90 days,and the mean time from postoperative to the last follow-up was 19.24±10.31 months.6 patients underwent arthroscopy of the knee,and taken out fracture pieces.16 patients underwent arthroscopy of the knee,and the size of cartilage fracture pieces under the knee arthroscopy was larger than 5mm,and fixation of cartilage fracture piece.6 patients underwent direct reduction and fixation and all the cartilage fracture slices were larger than 5mm.In terms of diagnostic consistency,the Cohen's kappa coefficient of X-ray results of the two experts was-0.5,P=0.03,indicating poor consistency.The Cohen's kappa coefficient of MRI results of the 2 experts was 0.24,P=0.01,with a general consistency.During the last follow-up,the following indexes of the anterior and lateral X-ray of the knee were measured: femoral tibial angle,LDFA and MPTA.By measuring the cartilage thickness of LFC,MFC and patella surface in preoperative and postoperative knee MRI of 15 children,and it was found that there was no statistical difference in the cartilage thickness between preoperative and postoperative.The flexion and extension of knee joint on the uninjured side were measured,and the flexion on the uninjured side was 2.75°±2.25° lower than that on the uninjured side.The loss of elongation on the affected side was 6.39°±9.32°.In the last follow-up,Lysholm knee movement level score was performed on the uninjured knee,and the affected knee decreased by 7.79±4.40 compared with the uninjured knee.Preoperative and postoperative Marx activity level scores showed a decrease of 4.25±1.46 compared with preoperative scores.Conclusion The consistency of diagnosis of osteochondral injury of knee joint in children is poor.If children's knee joint osteochondral injury is diagnosed in time,fracture reduction and internal fixation can achieve good healing.Although short-term knee joint function is slightly lost,the overall impact on joint function is not significant.