The Knee · 2018
Epidemiology and patient-reported outcome after juvenile osteochondritis dissecans in the knee.
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Ananthaharan Archana, Randsborg Per-Henrik
Аннотация
BACKGROUND: This study describes the epidemiology and patient reported outcomes following juvenile osteochondritis dissecans (JOCD) of the knee.
METHODS: Medical records and radiographs of patients aged 10-18years diagnosed with JOCD between 2010 and 2016 were retrospectively reviewed. The lesions were classified according to the International Cartilage Repair Society's classification. The results were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and a Visual Analogue Scale (VAS) for pain.
RESULTS: Seventy patients with 87 JOCDs were identified. The annual incidence was 11.5 (95% confidence interval 10.7-12.2) per 100,000 inhabitants younger than 19years. Fifty-two (74.3%) of the 70 patients returned the questionnaires on average 48months (five to 117) after diagnosis. The median Lysholm score was 84 for patients with grade I-II lesions and 80 for patients with grade III-IV lesions. The median Lysholm score was 84.5 for patients who were treated conservatively and 79.5 for patients who were treated operatively. The median VAS score was 2.0 for all groups, except for patients treated conservatively (median score 1.5). Conservative treatment was successful in 78% of grade I-II lesions. There was a fivefold increased risk of failing conservative treatment with a stage III-IV lesion, compared to stage I-II (Odds ratio=5.5, p=0.02).
CONCLUSIONS: The results following JOCD are good to excellent for the majority of patients. Grade I-II lesions are successfully treated conservatively in 78% of cases. Grade III-IV lesions have a high failure rate.
LEVEL OF EVIDENCE: Level III, retrospective cohort.
METHODS: Medical records and radiographs of patients aged 10-18years diagnosed with JOCD between 2010 and 2016 were retrospectively reviewed. The lesions were classified according to the International Cartilage Repair Society's classification. The results were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and a Visual Analogue Scale (VAS) for pain.
RESULTS: Seventy patients with 87 JOCDs were identified. The annual incidence was 11.5 (95% confidence interval 10.7-12.2) per 100,000 inhabitants younger than 19years. Fifty-two (74.3%) of the 70 patients returned the questionnaires on average 48months (five to 117) after diagnosis. The median Lysholm score was 84 for patients with grade I-II lesions and 80 for patients with grade III-IV lesions. The median Lysholm score was 84.5 for patients who were treated conservatively and 79.5 for patients who were treated operatively. The median VAS score was 2.0 for all groups, except for patients treated conservatively (median score 1.5). Conservative treatment was successful in 78% of grade I-II lesions. There was a fivefold increased risk of failing conservative treatment with a stage III-IV lesion, compared to stage I-II (Odds ratio=5.5, p=0.02).
CONCLUSIONS: The results following JOCD are good to excellent for the majority of patients. Grade I-II lesions are successfully treated conservatively in 78% of cases. Grade III-IV lesions have a high failure rate.
LEVEL OF EVIDENCE: Level III, retrospective cohort.