The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy

Abstract

A prospective clinical study used joint scintigraphy to investigate conservative treatment of juvenile osteochondritis dissecans (JOCD) of the femoral condyle. The predictive value of scintigraphic evaluation and various parameters (age at onset, sex, location and size of lesion) were analyzed. Over a 10 year period, the senior author followed 92 knees in 76 patients, 60 of whom were male and 16 female (11 and 5 bilaterals, respectively). All patients were participants in athletics or exercise programs. All patients had orthopaedic assessment, roentgenographic studies (AP, lateral, and tunnel views), 99m-Technetium phosphate compound joint scintigraphy, and instruction in a symptom-free existence (with all athletic activity proscribed). Patients were reevaluated and scanned every 8 weeks. No casts or braces were used, although crutches were sometimes necessary to maintain symptom-free levels. Based on specific indications for failure of conservative treatment, 50% of these patients failed and underwent surgery. Of the 92 knees, 52 were successfully treated conservatively, while 40 failed. Average followup was 4.2 years. Average age at onset was 12.5 years; the success group averaged 12.1 years and the failure group 13.0 years. The average lesion size was 363.2 mm2, with 309.5 mm2 in the success group and 436.0 mm2 in the failure group. Parameters of location, sex, and scan classification were not statistically significant as predictive factors. This study found no predictors for the success or failure of treatment beyond a moderate correlation of larger lesion size with failed conservative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

“…This provides visual access to the common locations for OCD lesions. Furthermore, since Cahill et al [11,23] demonstrated 16 of 76 patients had bilateral knee involvement, we believe it clinically acceptable to obtain contralateral films to evaluate for bilateral involvement.…”

“…After plain film radiology, some authors have recommended the next evaluation should be scintigraphy because it provided information regarding blood flow to the lesion [8,11,50,65]. However, it fails to provide detailed information about the state of affairs concerning the articular cartilage.…”

“…Success is sometimes reported when the clinical symptoms have resolved, but no study to date has defined an outcome measure for OCD lesions. Bearing this in mind, the rates of healing for nonoperative treatment have varied from 50% to 94% [8,9,11,13,26,28,31,32,35,48,49,70,85].…”

Comparison of the stability of various internal fixators used in the treatment of osteochondritis dissecans—a mechanical model

“…3,[8][9][10][11] While no defined mechanism of failure following fixation has been identified, we suspect that subjecting the repair site to loads in shear is a contributing factor. Our results revealed all methods of internal fixation performed significantly better than the control, with the construct using the longest AO screw and threaded washer providing the greatest stability.…”

“…A 4-month trial of protected weightbearing is recommended in this group. 3,[8][9][10][11][12] Surgical treatment is reserved for the patient with JOCD that has failed conservative measures and for those who are skeletally mature at the time of presentation. A variety of fixation methods have been used successfully in achieving fracture healing, including Kirschner wire (K-wire) fixation, 3,9 cannulated screws, 10 Herbert screws, 13 compression screws, 14 biodegradable rods, 15 biologic fixation with autogenous osteochondral plugs, 16 and nonabsorbable sutures.…”