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The Healing Potential of Stable Juvenile Osteochondritis Dissecans Knee Lesions

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

Journal of Bone & Joint Surgery - American Volume: 01 December 2008 - Volume 90 - Issue 12 - p 2655–2664
doi: 10.2106/JBJS.G.01103
Scientific Articles

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.

1Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229. E-mail address for G.D. Myer: greg.myer@cchmc.org

Copyright 2008 by The Journal of Bone and Joint Surgery, Incorporated
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