Osteochondritis Dissecans in the Knee of Skeletally Immature Patients: Rates of Persistent Pain, Osteoarthritis, and Arthroplasty at Mean 14-Years’ Follow-Up
Hevesi, Mario; Sanders, Thomas L.; Pareek, Ayoosh; Milbrandt, Todd A.; Levy, Bruce A.; Stuart, Michael J.; Saris, Daniel B.F.; Krych, Aaron J.
(2020) Cartilage, volume 11, issue 3, pp. 291 - 299
(Article)
Abstract
Objective: Osteochondritis dissecans (OCD) is a knee disorder of predominately pediatric populations. Because of low incidence, it has traditionally been difficult to study OCD. The purpose of this study was to report long-term outcomes of skeletally immature OCD lesions and determine risk factors for persistent knee pain at final follow-up.
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Design: A geographic database of more than 500,000 patients was reviewed to identify patients with knee OCD. Clinical course including operative management, persistent knee pain, and total knee arthroplasty (TKA) were analyzed through review of radiographs, magnetic resonance images, and physician notes. Results: A total of 95 skeletally immature patients (70 male, 25 female, mean age 12.5 ± 2.0 years) were followed for a mean of 14 years (range, 2-40 years). Fifty-three patients were treated operatively and 42 were treated nonoperatively. At final follow-up, 13 patients noted persistent knee pain, 8 treated operatively versus 5 treated nonoperatively. Risk factors for knee pain were female gender, patellar lesions, and unstable lesions. Four patients (8%) treated operatively and 2 patients (5%) treated nonoperatively developed symptomatic osteoarthritis at a mean of 28.6 years following diagnosis. Three patients underwent TKA at a mean age of 52 years, significantly younger than that observed for primary TKA at our institution (P = 0.004). Conclusions: Skeletally immature OCD patients have promising histories, with an estimated 14% risk of persistent knee pain, 6% symptomatic osteoarthritis, and 3% conversion to TKA at 14 years’ mean follow-up. Females, patellar lesions, and unstable lesions demonstrated increased persistent knee pain risk. Patients with OCD undergo TKA at a significantly younger age than the general population.
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Keywords: articular cartilage, knee, nonsurgical therapy, osteoarthritis, procedures, Physical Therapy, Sports Therapy and Rehabilitation, Biomedical Engineering, Immunology and Allergy, Journal Article, Research Support, N.I.H., Extramural
ISSN: 1947-6035
Publisher: SAGE Publications Inc.
Note: Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was made possible by the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under award number R01AG034676. Publisher Copyright: © The Author(s) 2018. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
(Peer reviewed)