Abstract
Background:
Osteogenesis imperfecta (OI) is a genetic disorder that causes bone fragility, ligamentous laxity, and joint hypermobility, resulting in musculoskeletal injuries and impaired function [1][2]. While recurrent fractures and lower extremity deformities are well-documented in OI, soft tissue pathology—including meniscal tears, ACL tears, and patellar instability—remains an underrecognized contributor to pain and functional limitation [1][2][3][4][5]. Knee arthroscopy (KA) offers a minimally invasive approach to address intra-articular pathology; however, there is no current literature regarding its safety, functional outcomes, and impact on return to sports in children and adolescents with OI. Given the unique challenges of surgical management in pediatric and adolescent OI patients, understanding the role of KA in restoring function and enabling return to activity is critical.
Hypothesis:
Knee arthroscopies can be safe and effective in pediatric and adolescent OI patients. Complication rates, revision surgery rates, return to sport, and time to full range of motion (ROM) may be worse than non-OI pediatric and adolescent patients.
Methods:
This was a multicenter retrospective review. Medical records were searched using ICD-10 and CPT codes to capture patients with OI who underwent KA between January 2004 and March 2025. Demographics, preoperative diagnoses, procedure performed, post-surgical complications using the Clavien-Dindo-Sink Classification (CDSC), time to full ROM, time to return to sport, and rate of revision surgery were collected and analyzed.
Results:
Twenty-one patients who underwent 30 knee arthroscopies were identified, with average age at surgery being 15.5. The most common surgical indications were: meniscus injury (12 surgeries), patellar instability (9 surgeries), and fracture (8 surgeries). The most common arthroscopic procedures were: meniscus repair or debridement (10 surgeries), MPFL reconstruction or repair (7 surgeries), and ACL reconstruction (5 surgeries). The rate of any complication was 50%. 27% of surgeries (33% of patients) required revision surgery. Table 1 shows the rate of revision surgery by surgery type. 81% of patients regained full knee ROM post-operatively. On average, it took 15.4 weeks after surgery to reach full ROM for those that could. 83% of encounters (86% of patients) returned to full pre-operative physical activity level. Table 2 shows the time to full activity by surgery type.
Conclusion:
While most patients with OI who undergo KA can regain full ROM and return to their baseline activities, they should be counseled that the rate of any complication is 50% and the rate of revision surgery is 27%.
