Race Predicts Unsuccessful Healing of Osteochondritis Dissecans in the Pediatric Knee

Abstract

The purpose of this study was to evaluate the effect of race, insurance status, and socioeconomic status on successful or unsuccessful healing of osteochondritis dissecans (OCD) lesions in the pediatric knee. The authors retrospectively reviewed patients younger than 18 years who were treated for a knee OCD lesion between 2006 and 2017. Patients were required to have at least 6 months of clinical and radiographic follow-up to be included, unless complete healing was achieved sooner. The primary outcome of interest was healing of the OCD lesion based on radiographic and clinical examination. A total of 204 OCD lesions in 196 patients with a mean follow-up of 15.8±6.4 months were included. The mean age at initial presentation was 12.4±2.8 years. At most recent follow-up, 28 (13.7%) lesions did not show radiographic or clinical evidence of healing. Nonhealing lesions were found in 25.0% of Black children compared with 9.4% of White children ( P =.02). After controlling for age, sex, sports participation, lesion size and stability, skeletal maturity, and operative vs nonoperative treatment in a multivariate model, Black children had 6.7 times higher odds of unsuccessful healing compared with their White counterparts (95% CI, 1.1–41.7; P =.04). In this study, Black children with OCD of the knee were significantly less likely to heal than were White patients, even when controlling for numerous other factors in a multivariate model. Although the exact etiology of this finding is unclear, future work should focus on the social, economic, and cultural factors that may lead to disparate outcomes. [ Orthopedics . 2021;44(3):e378–e384.]

Evaluating the association between race and complications following pediatric upper extremity surgery

“…In contrast, a few studies have shown racial disparities in orthopedic care for pediatric patients [9,11]. Malyavko et al .…”

“…Similarly, Patel et al . aimed to evaluate whether race influences the healing of osteochondritis dissecans (OCD) lesions in pediatric patients [9]. After multivariate analyses, African American children with OCD were found to have 6.7 times higher odds of unsuccessful healing than Caucasian children [9].…”

Racial Disparities in Outcomes Following Open Treatment of Pediatric Femoral Shaft Fractures

“…A study by Patel et al investigated the healing pattern of osteochondritis dissecans lesions in pediatric knees. They found that black patients had 6.7 times greater odds of unsuccessful healing when compared to the White patient cohort [ 15 ]. Another study by Kulaylat et al looked at factors impacting the transfer of pediatric trauma patients from adult trauma centers to pediatric trauma centers and found that there was an increased rate of interfacility transfer for uninsured pediatric patients and non-White patients [ 16 ].…”

Other Factors that Can Affect Wound Healing With Elective Lumbar Spine Surgery and Perioperative Nutritional Supplementation in Patients

“…Identification of disparities in access, quality, or outcomes of care provides opportunities for intervention on behalf of the populations experiencing dissimilar care or outcomes. There is a statistical significance that, even when adjusting for age, sex, sports participation, lesion size and stability, and surgical versus nonsurgical treatment, impacts the rate of healing 2 . The study design did not mention the difference between these factors, which can affect the data that was received.…”

“…There is a statistical significance that, even when adjusting for age, sex, sports participation, lesion size and stability, and surgical versus nonsurgical treatment, impacts the rate of healing. 2 The study design did not mention the difference between these factors, which can affect the data that was received.…”