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Orthop J Sports MedOrthop J Sports MedOJSspojsOrthopaedic Journal of Sports Medicine2325-9671SAGE Publications Sage CA: Los Angeles, CA 10.1177/2325967118S0012410.1177_2325967118S00124ArticleOperative And Non-operative Management Of Osteochondritis Dissecans
In The Knee Of Skeletally Immature Patients: Rates Of Persistent Knee Pain,
Osteoarthritis, And Arthroplasty At Mean 14- Years Follow-up Hevesi Mario MD1Sanders Thomas L. MD1Pareek Ayoosh MD1Milbrandt Todd MD1Levy Bruce A. MD1Saris Daniël B. MD, PhD2Krych Aaron John MD11 Mayo Clinic, Rochester, MN, USA2 University Medical Center Utrecht,
Utrecht, Netherlands27 7 2018 7 2018 6 7 suppl4 2018 AOSSM Annual Meeting Abstracts2325967118S00124© The Author(s) 20182018SAGE PublicationsThis open-access article is published and distributed under the
Creative Commons Attribution - NonCommercial - No Derivatives License
(http://creativecommons.org/licenses/by-nc-nd/4.0/), which
permits the noncommercial use, distribution, and reproduction of the article
in any medium, provided the original author and source are credited. You may
not alter, transform, or build upon this article without the permission of
the Author(s). For article reuse guidelines, please visit SAGE’s website at
http://www.sagepub.com/journals-permissions.Objectives:
The purpose of this study was to report long-term follow-up of skeletally
immature OCD lesions treated operatively and non-operatively and determine
risk factors for persistent knee pain at final follow-up.

Methods:
A large, geographic database of over 500,000 patients was reviewed in this
case series to identify and confirm patients with OCD of the knee.
Presenting radiographs and MRI were reviewed. Clinical course including
operative management, persistent knee pain, and conversion to TKA were
obtained and analyzed through review of clinical and operative notes.

Results:
95 skeletally immature patients (70 males, 25 females) with OCD lesions
diagnosed at a mean age of 13 years (range: 7-16) were followed for a mean
of 14 years (range: 2-40). 53 patients (56%) were treated operatively and 42
patients (44%) were treated non-operatively. At final follow up, 13 patients
with a mean age of 30 years noted persistent knee pain, 8 (15%) treated
operatively versus 5 (12%) treated non-operatively. Risk factors for knee
pain were female gender, patellar lesion location, and unstable lesions
(Table 1). Four patients (8%) treated operatively and two (5%) treated
non-operatively developed symptomatic osteoarthritis at a mean of 28.6 years
following diagnosis. One patient treated operatively and two treated
non-operatively converted to TKA at a mean of 37 years following diagnosis.
Mean age at TKA was 52 years, significantly younger than that observed for
primary TKA at our institution (p = 0.004).

Conclusion:
Patients with skeletally immature OCD lesions have an estimated 14% rate of
persistent knee pain, 6% risk of symptomatic osteoarthritis, and 3% risk of
conversion to TKA at a mean of 14 years following time of diagnosis. Female
patients, patellar lesions, and unstable lesions demonstrated increased risk
of persistent knee pain at final follow-up. Patients with OCD of the knee
convert to TKA at a significantly younger age than that of the general
primary TKA population.

Table 1. Risk factors for penistent ;met pain at the time of final
follow-up


Variable
	
HR (95% Confidence Interval)
	
p-value
	
Treatment	
 Non-Operative	Reference	
 Operative	1.16(0.35 - 3.83)	0.81	
Age at diagnosis	
 <10	Reference	
 ≥10	10.3(0.11-9.63)	0.98	
Gender	
 Female	Reference	
 Male	0.24(0.07-0.81)	
0.02
	
Location	
 MFC	Reference	
 LFC	2.91(0.57-14.97)	0.2	
 Patella	5.30(1.37-20.48)	
0.02
	
 Trochlea	0.00(0.00-0.00)a
	
<0.01a
	
AP Radiograph Lesion Width	
 <20mm	Reference	
 ≥20mm	1.74(0.23-12.97)	0.59	
AP Radiograph Lesion Depth	
 <5mm	Reference	
 ≥5mm	0.68(0.08-6.00)	0.73	
Lateral Radiograph Lesion Width	
 <20mm	Reference	
 ≥20mm	1.75(0.31-10.01)	0.53	
Lateral Radiograph Lesion Depth	
 <5mm	Reference	
 ≥5mm	2.14(0.38-11.95)	0.38	
Lesion Contour	
 Concave	Reference	
 Convex	0.45(0.08-2.54)	0.37	
Disruption of subchondral bone	
 No	Reference	
 Yes	0.73(0.15-3.54)	0.7	
Intra-articular displace fragment	
 No	Reference	
 Yes	0.85(0.10-7.48)	0.88	
Adjacent Focal Articular Cartilage
Defects	
 No	Reference	
 Yes	0.85(0.10-7.48)	0.88	
Stability	
 Stable	Reference	
 Unstable	10.58(1.26-88.63)	
0.03
	

aOf then =2 lesions present on the trochlea, none
developed symptomatic Knee pain

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