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Results of Surgical Management of Osteochondritis Dissecans of the Ankle in the Pediatric and Adolescent Population

Kramer, Dennis E. MD; Glotzbecker, Michael P. MD; Shore, Benjamin J. MD, MPH, FRCSC; Zurakowski, David PhD; Yen, Yi-Meng MD, PhD; Kocher, Mininder S. MD, MPH; Micheli, Lyle J. MD

doi: 10.1097/BPO.0000000000000352
Foot and Ankle
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Background: There is a paucity of published literature on operative management of osteochondritis dissecans (OCD) in the ankle in adolescents. This study seeks to elucidate patient and lesion characteristics associated with surgical success and failure as well as reporting functional outcomes.

Methods: Retrospective chart review identified all patients aged 18 years old or younger surgically treated for OCD of the ankle at our institution from 2001 to 2010. This included 109 ankles in 100 patients (75 female, 25 male), mean age 14.3±2.3 years (range, 7 to 18 y), with a median follow-up of 3.3 years (range, 1 to 10.8 y). Patient and lesion data, surgical procedure, clinical results, and complications were recorded. Postoperative radiographs were reviewed in 80 ankles. A return to sport survey and a Foot and Ankle Outcome Score (FAOS) was sent to all patients. Multivariate statistical analysis evaluated predictors of reoperation rate, Berndt and Harty clinical grade, and FAOS scores. Kaplan-Meier analysis was applied to determine freedom from reoperation.

Results: The OCD lesion was most commonly found on the medial talus (80, 73%). The most common procedures performed included transarticular drilling (59, 54%), fixation (22, 20%), and excision microfracture (27, 26%). The overall rate of reoperation was 27% (29/109). Berndt and Harty clinical grade was poor (33, 30%), fair (23, 21%), and good (53, 49%). Reoperation rates were significantly higher for OCD lesions in which postoperative radiographs had no change or looked worse (10/16, 63%) (P=0.002). Thirty-six of 44 survey respondents (82%) were satisfied and 37 (84%) returned to sports at a median time of 6 months. Average FAOS score was 77±18. Multiple linear regression confirmed that female sex and elevated body mass index were significant negative predictors for FAOS score.

Conclusions: The reoperation rate following surgical intervention for OCD of the ankle is high. Females and those with a higher body mass index may have worse subjective functional ankle outcomes.

Level of Evidence: Level IV—retrospective case series.

Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA

The authors declare no conflicts of interest.

Reprints: Dennis E. Kramer, MD, Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115. E-mail: dennis.kramer@childrens.harvard.edu.

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