Presentation Abstract

Session: 46-Pediatrics IV
Date/Time: Friday, Feb 10, 2012, 11:06 AM -11:12 AM
Presentation Number: 681
Title: Osteochondritis Dissecans (OCD) of the Knee: Does the Presence of Bone in the Lesion Improve Healing Rates?
Classification: Pediatrics
Keywords: Knee; MRI / Imaging
Author(s): Sean Waldron, MD, New Orleans, Louisiana, United States
Eric Wall, MD, Cincinnati, Ohio, United States
Chris Pomeroy, MD, Cincinnati, Ohio, United States
Shital Parikh, MD, Cincinnati, Ohio, United States
Gregory D. Myer, PhD, Cincinnati, Ohio, United States
Abstract: INTRODUCTIONOsteochondritis dissecans (OCD) of the knee often entails prolonged treatment. Prognostic data for healing following non-operative and operative treatment is lacking. We sought to determine if the presence of bone in an OCD lesion as depicted on a pre-treatment magnetic resonance imaging (MRI) scan of the knee was a significant predictor of healing.
We analyzed 111 MRI scans of pediatric patients treated for OCD of the knee. Patients with closed physes and those that lacked at least six months of radiographic follow up were excluded. Pre-treatment MRI scans were evaluated for the presence of bone in the OCD lesions on the spoiled gradient echo (SPGR) sequence. We classified the lesions according to the presence (see figure 1) or absence of bone (see figure 2) and the treatment utilized, operative or non-operative. We analyzed the follow-up knee radiographs for complete healing of the OCD lesions.

There were 93 patients included in the final analysis, 69 with bone in the lesion and 24 without bone. Of the patients with bone in the lesion, 60 (87%) demonstrated complete radiographic healing, compared to 16 (67%) without bone in the lesion (p=0.024). Twenty-four (89%) of the patients with bone in the lesion treated non-operatively healed completely, compared to seven (64%) without bone in the lesion (p=0.090). Thirty-six (86%) of the patients with bone in the lesion treated operatively healed completely, compared to nine (69%) without bone in the lesion (p=0.128).

OCD lesions with the presence of bone on pre-treatment MRI scans had significantly increased rates of healing compared to those without bone. This information will help the treating physician to counsel patients as well as to guide treatment of this condition. It should improve the accuracy of multi-variate OCD healing predictive nomograms.

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