The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents

Abstract

Background:The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described.Purpose:To assess the frequency of pediatric OCD lesions that progress to surgery based on sex, joint involvement, and age.Study Design:Descriptive epidemiology study.Methods:A retrospective chart review (2007-2011) was performed on OCD. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years. Exclusion criteria included traumatic osteochondral fractures or coexistence of non-OCD intra-articular lesions. Differences in progression toward surgery were compared between age groups, sex, and joint location. Logistical regression analysis was performed by sex, age, and ethnicity.Results:Overall, 317 patients with a total of 334 OCD lesions were found. The majority of lesions (61.7%) were in the knee, with ankle, elbow, shoulder, and foot lesions representing 25.4%, 12.0%, 0.6%, and 0.3% of all lesions, respectively. The majority of joints needing surgery were in the knee (58.5%), with ankle and elbow lesions representing 22.9% and 18.6% of surgeries performed, respectively. The percentage of all OCD lesions progressing to surgery was 35.3%; surgical progression for knee, ankle, and elbow joints was 33.5%, 31.8%, and 55.0%, respectively. Logistic regression analysis found no statistically significant different risk of progressing to surgery for OCD of the knee, elbow, and ankle between sexes. Patients aged 12 to 19 years had a 7.4-times greater risk of progression to surgery for knee OCD lesions than 6- to 11-year-olds. Patients aged 12 to 19 years were 8.2 times more likely to progress to surgery for all OCD lesions than patients aged 6 to 11 years. Progression to surgery of ankle OCD did not significantly differ based on location. Three of 4 trochlear lesions progressed to surgery, along with 1 of 1 tibial, 1 of 3 patellar, 40.3% of lateral femoral condylar, and 28.2% of medial femoral condylar lesions.Conclusion:In this large cohort study of pediatric OCD patients, 35% progressed to surgery. Progression to surgery did not differ significantly between sexes with OCD of any joint. Progression to surgery for OCD of the knee, elbow, and ankle strongly correlated with patient age at the time of diagnosis.Clinical Relevance:The knowledge of likelihood of progression to surgery of OCD by location, sex, and age is useful in counseling patients and in planning treatment. This study confirms a worse prognosis in the nonoperative treatment of older patients with OCD.

Osteochondritis Dissecans Lesions in Family Members: Does a Positive Family History Impact Phenotypic Potency?

“…Although a large majority of our cohort was treated surgically (75 of 103 [73%]), this may be indicative of the stronger relationship patients develop with their surgeon after being managed operatively and followed postoperatively, making these patients more likely to respond to a mailed survey and/or phone call. Furthermore, our findings were within the range of previous studies describing operative frequency in pediatric OCD of (34%-74% [2,7,26]). Although we did not have a ''normal'' population to compare our frequency of positive family history to, a number of previous studies have described the general incidence of OCD in the broader pediatric population, including Kessler et al's robust epidemiologic study of an integrated health system with more than 1 million patients [10].…”

Incidence of symptomatic osteochondritis dissecans lesions of the knee: a population-based study in Olmsted County

“…(1, 5, 28, 29) In a cross-sectional study sampling from over 2100 patients, male athletes had a larger percentage of injuries attributed to traumatic injuries when compared with female athletes. (30) Although not clearly understood, the study concluded that males were more likely to participate in team and collision sports compared to females and this put them at an increased risk for injuries that were traumatic and bony in nature.…”

“…(7, 11, 31, 32) Another study reported that younger males may have higher activity levels when compared to similar age females and this puts them at an increased risk of shoulder and knee injuries. 28, 29 (33, 34) Both increased activity in males combined with the possibility of increased traumatic events can result in repetitive loading and micro-trauma, which have been shown to be a risk factor for OCD lesions. (5, 6, 8, 9) Lastly, emerging studies have revealed genetics to be an important component and may also contribute to the increased risk in males compared to females.…”

Evaluation of the Suitability of Miniature Pigs as an Animal Model of Juvenile Osteochondritis Dissecans

“…Juvenile osteochondritis dissecans (JOCD) is an orthopedic disease characterized by intra-articular formation of osteo-cartilaginous flaps and fragments in pediatric and adolescent patients. 1 Nearly 62% of all JOCD lesions involve the distal femur, with the ankle, elbow, and shoulder joints affected at decreasing frequencies. 2 To delay progression toward early onset osteoarthritis, clinically apparent JOCD lesions are treated using either conservative or surgical techniques.…”

“…2 To delay progression toward early onset osteoarthritis, clinically apparent JOCD lesions are treated using either conservative or surgical techniques. 1 Unfortunately, evidence-based treatment guidelines for JOCD are lacking 3 because the low incidence of the disease limits the opportunity to conduct large-scale studies. Animal models represent an alternative approach to provide data that are critically needed to inform clinical decision making.…”