The Healing Potential of Stable Juvenile Osteochondritis Dissecans Knee Lesions

• Published in: Journal of bone and joint surgery. American volume 2008, Vol.90 (12), p.2655-2664
• Main Authors: Wall, Eric J., MD, Vourazeris, Jason, BS, Myer, Gregory D., MS, CSCS, Emery, Kathleen H., MD, Divine, Jon G., MD, Nick, Todd G., PhD, Hewett, Timothy E., PhD
• Format: Article
• Language: English
• Subjects: Orthopedics
• ISSN: 0021-9355
• DOI: 10.1016/S0021-9355(08)72592-X

Background The purpose of the present study was to determine if patient age, lesion size, lesion location, presenting knee symptoms, and sex predict the healing status after six months of a standard protocol of nonoperative treatment for stable juvenile osteochondritis dissecans of the knee. Methods Forty-two skeletally immature patients (forty-seven knees) who presented with a stable osteochondritis dissecans lesion were included in the present study. All patients were managed with temporary immobilization followed by knee bracing and activity restriction. The primary outcome measure of progressive lesion reossification was determined from serial radiographs every six weeks, for up to six months of nonoperative treatment. A multivariable logistic regression model was used to determine potential predictors of healing status from the listed independent variables. Results After six months of nonoperative treatment, sixteen (34%) of forty-seven stable lesions had failed to progress toward healing. The mean surface area (and standard deviation) of the lesions that showed progression toward healing (208.7 ± 135.4 mm2 ) was significantly smaller than that of the lesions that failed to show progression toward healing (288.0 ± 102.6 mm2 ) (p = 0.05). A logistic regression model that included patient age, normalized lesion size (relative to the femoral condyle), and presenting symptoms (giving-way, swelling, locking, or clicking) was predictive of healing status. Age was not a significant contributor to the predictive model (p = 0.25). Conclusions In two-thirds of immature patients, six months of nonoperative treatment that includes activity modification and immobilization results in progressive healing of stable osteochondritis dissecans lesions. Lesions with an increased size and associated swelling and/or mechanical symptoms at presentation are less likely to heal. Level of Evidence Prognostic Level II . See Instructions to Authors for a complete description of levels of evidence.