Indications for Surgical Management of Osteochondritis Dissecans of the Knee in the Pediatric Population: A Systematic Review

Abstract

Several case series have been published exploring the surgical management of osteochondritis dissecans (OCD) of the knee in pediatric patients. This systemic review was performed to identify the surgical indications for this condition. A search of the Embase and Ovid Medline databases was performed to identify clinical studies reporting outcomes of surgical management of OCD in the knee in this patient population. A quality assessment of the included articles was conducted independently by two reviewers using a quality assessment tool developed by Yang et al. A total of 25 articles met the eligibility criteria and were reviewed; 40% of studies did not clearly describe their surgical indications. The remainder of the studies had a failure of nonoperative management with or without the concomitant use of imaging as their indication for surgery, or used lesion stability itself as the indication for surgery. This review outlines several surgical indications presented in the literature for the treatment of OCD lesions of the knee in the pediatric population. The most common indication for surgery was a failure of a trial of nonoperative treatment with or without the concomitant use of serial imaging. Although the quality of the case series was high, inconsistencies in reporting radiographic and arthroscopic classification of the OCD lesion were common.

Sustained Results in Long-Term Follow-Up of Autologous Chondrocyte Implantation (ACI) for Distal Femur Juvenile Osteochondritis Dissecans (JOCD)

“…Approximately 30% of patients have bilateral lesions [ 8 ]. Primary surgical intervention of the knee JOCD is indicated for failure of nonoperative management, advanced stage, or advanced age [ 9 ] and consists of microfracture, drilling, or fixation depending on the stage [ 10 ].…”

Juvenile Osteochondritis Dissecans of the Knee: Does Magnetic Resonance Imaging Instability Correlate With the Need for Surgical Intervention?

“…Although surgery for these lesions is minimally invasive, with reported high success rates, 23 the risk/benefit ratio of surgery must always be considered. One of the patients in this study abandoned their first surgery because of bronchospasm.…”

“…The number of OCD lesions was small; however, the sample size is comparable to or larger than many of the published studies of this relatively uncommon condition. 23 The retrospective nature of the study is not as reliable as a prospective review because of incomplete data, such as the nonoperative treatment prescribed and patient compliance. One of the major weaknesses of the study was considering lesions as unstable according to the use of independent MRI findings and not all 3 of the Kijowski criteria combined.…”

“…OCD lesion stability appears to be an important prognostic factor for determining whether a lesion will heal with nonoperative measures or if it will require surgical intervention. 14 , 15 , 22 Salci et al 23 performed a systematic review to document and assess the surgical indications for OCD of the knee in the pediatric population. While many of the authors represented in this review described their surgical treatments based on lesion stability, expressively indicating “stable” or “unstable” lesions, there was a clear lack of consistency for surgical indications for the management of OCD in these young patients.…”

Lower extremity overuse injuries in the skeletally immature athlete

“…44 Unlike stable lesions, unstable lesions are thought to have a low chance of healing on their own and are usually treated operatively. 46,47 Operative treatment is also indicated when the physes are near closure or when nonoperative management has failed. A variety of techniques can be used.…”