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Nonoperative treatment of stable juvenile osteochondritis dissecans of the knee

effectiveness of unloader bracing

Tepolt, Frances A.a; Kalish, Leslie A.b,,d; Heyworth, Benton E.a,,c; Kocher, Mininder S.a,,c

Journal of Pediatric Orthopaedics B: January 2020 - Volume 29 - Issue 1 - p 81–89
doi: 10.1097/BPB.0000000000000617
Knee
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The purpose of this study was to compare the treatment outcomes of stable juvenile osteochondritis dissecans (JOCD) of the knee in a large cohort treated nonoperatively with unloader bracing versus other nonoperative treatment modalities without unloader bracing. This retrospective study assessed the clinical course of skeletally immature patients who underwent a minimum of 3 months nonoperative treatment for stable JOCD of the femoral condyle at a single institution (2001–2014). Treatment was based on physician preference. Unloader bracing was compared with other ‘non-unloader’ modalities, with successful nonoperative treatment defined as the avoidance of subsequent surgical intervention. Two hundred ninety-eight patients were included, 219 (73%) of whom were male. The mean ± SD age at diagnosis was 11.5 ± 1.6 years. Thirty-five patients were diagnosed with bilateral OCD, resulting in 333 knees in total. One hundred eighty-seven (56%) knees were treated with unloader bracing for a minimum of 3 months, whereas 146 (44%) were treated with other nonoperative modalities. All patients were treated with activity restrictions. Weight-bearing restrictions were applied for a total of 83 (25%) cases, for durations ranging from 19 to 196 days (median: 46 days) and at similar rates across groups. Nonoperative treatment was successful in 189 (57%) knees with a median follow-up of 9.5 months (interquartile range: 5.9–15.7 months). Surgical intervention was required in 144 (43%) knees at a median time of 6.0 months (interquartile range: 4.1–10.5 months). The unloader bracing group more often required surgical intervention when compared with the nonunloader group [93/187 (50%) vs. 51/146 (35%) knees, respectively; P = 0.02]. Male sex (P = 0.05) and Hefti stage I (P = 0.05) showed possible associations with nonoperative treatment success. Nonoperative treatment for stable JOCD of the knee leads to the avoidance of subsequent surgical intervention in 57% of cases. Unloader bracing is not associated with significantly improved outcomes when compared with other nonoperative modalities. Level of Evidence: III Retrospective Comparative Case Series.

aDepartment of Orthopaedic Surgery

bInstitutional Centers for Clinical and Translational Research, Boston Children’s Hospital

cDepartment of Orthopaedic Surgery

dDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

The study was presented at the American Orthopaedic Society for Sports Medicine (AOSSM) Annual Meeting 2016 and at the Pediatric Research in Sports Medicine (PRiSM) Annual Meeting 2016 (both podium presentations). The study was also presented as an electronic poster at the Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting 2017 and as a poster at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting 2018.

Correspondence to Mininder S. Kocher, MD, MPH, Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115, USA Tel: + 1 617 355 8423; fax: + 1 617 730 0321; e-mail: mininder.kocher@childrens.harvard.edu

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