Juvenile osteochondritis dissecans of the talus: predictors of conservative treatment failure

• Published in: Archives of orthopaedic and trauma surgery 2015-10, Vol.135 (10), p.1337-1341
• Main Authors: Heyse, Thomas J., Schüttler, Karl F., Schweitzer, Annette, Timmesfeld, Nina, Efe, Turgay, Paletta, Jürgen R., Fuchs-Winkelmann, Susanne, Fernandez, Francisco Fernandez
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Exercise Therapy; Female; Foot Diseases - diagnosis; Foot Diseases - surgery; Humans; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Orthopaedic Surgery; Orthopedic Procedures - methods; Orthopedics; Osteochondritis Dissecans - diagnosis; Osteochondritis Dissecans - surgery; Prognosis; Retrospective Studies; Talus - pathology; Talus - surgery; Treatment Failure
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-015-2260-4

Background The ideal treatment for juvenile osteochondritis dissecans of the talus (ODT) is still unclear. To determine predictors of failure of conservative treatment, children admitted for ODT were retrospectively analyzed. Methods Patient files were analyzed to search for children treated for an ODT between 2000 and 2011. X-rays and MRI at baseline were evaluated for grading of lesions and the patient history was obtained. Final follow-up evaluation was performed via questionnaire and complementary telephone interview. Outcome was measured using the AOFAS and the Olerud/Molander scores. Conservative treatment consisted of out of sports and modification of activity under full weight-bearing. In case of persisting pain, full load removal on crutches was initiated. For further analysis, two groups were formed: (1) successful conservative treatment; (2) converted to surgical therapy. A logistic regression was used to determine potential predictors of conservative treatment failure. Results Seventy-seven lesions in 67 children with a mean age of 11.4 years (range 4–15 years) at the time of diagnosis were identified. Every patient received conservative treatment as a first-line treatment after diagnosis of ODT except for one single patient with a grade IV lesion at time of diagnosis who received operative treatment directly after diagnosis. Sixty-one percent of the lesions failed conservative treatment. A higher age as well as a grade III lesion at time of diagnosis was predictive for failure of the conservative treatment ( p  = 0.03 and p  = 0.02, respectively). Regarding the functional outcome, a higher grade lesion in general was predictive for an inferior outcome as measured by clinical score. Conclusion Grade III ODT especially in older children leads significantly more often to treatment failure when treated non-surgically. No other predictors for treatment failure could be identified. Level of evidence Level III (retrospective comparative study).