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Physeal fusion status and lesion size are more important than patient age for healing of juvenile osteochodritis dessicans lesions of the distal femur

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the study was to evaluate the effect of skeletal age and lesion size, location, and grade on the success of nonoperative treatment for juvenile osteochondritis dissecans (OCD). It is hypothesized that skeletal maturity, including a combination of maturation phenotypes, correlates with nonoperative lesion healing.

Methods

The clinical and radiographic data on 52 patients aged 7–20 years treated for OCD of the distal femur between 2010 and 2019 were retrospectively reviewed. Knee radiographs were assessed for number of lesions present and lesion location, size, and stage. Assessments of skeletal maturation were performed on all antero-posterior knee radiographs using the Roche, Wainer, and Thissen (RWT) method. Patients were categorized as healed if they demonstrated no pain on clinical examination. The relationship between skeletal maturity and nonoperative lesion healing was determined using Spearman rank correlations on available variables.

Results

Neither chronological nor skeletal age was associated with surgical status (Rho = 0.03, n.s., and Rho = 0.13, n.s., respectively) or the healing status of nonoperatively treated OCD lesions (Rho = 0.44, n.s., and Rho = 0.03, n.s., respectively). Epiphyseal fusion status of the distal femoral physis was moderately correlated with nonoperative healing, but was not statistically significant (lateral femoral physis: Rho = 0.43, p = 0.05; medial femoral physis: Rho = 0.43, n.s.). Lesion length correlated with surgical status (Rho = − 0.38, p = 0.009).

Conclusion

The extent of fusion of the distal femoral physis (multi-stage grading) may be more strongly correlated with nonoperative healing than other markers of skeletal maturity or chronological age. Clinicians can use this as an additional radiographic sign when considering nonoperative treatment for juvenile OCD lesions in the distal femur. OCD lesion length and physeal fusion status appear to be more important for healing than patient age.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the University of Missouri’s Orthopaedic Association Resident Research Grant for their financial support. We would also like to thank Christina Holzhauser for assistance with RWT assessments, Vicki Jones and Maria Luisa Suzzarini for acquiring the initial medical record data for the patients screened and subsequently assessed in this study, as well as to Laura Ellenberger and Dr. Ennio Rizzo Esposito for their efforts in developing the data entry database.

Funding

For this study was provided by the University of MIssouri Orthopaedic Association Resident Research Grant ($2,500).

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Author notes

  1. Dana L. Duren and Sumit K. Gupta are co-senior authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65201, USA

    Olubusola Brimmo, Melanie E. Boeyer, Daniel G. Hoernschemeyer, Aaron Gray, Dana L. Duren & Sumit K. Gupta

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  1. Olubusola Brimmo
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Contributions

Conceptualization: OB, DGH, AG, DLD, SKG; Methodology: OB, MEB, DGH, AG, DLD, SKG. Formal analysis and investigation: OB, MEB, DLD, SKG. Writing—original draft preparation: OB, MEB, DLD, SKG. Writing—review and editing: OB, MEB, DGH, AG, DLD, SKG. Funding acquisition: OB. Resources: DGH, DLD, SKG. Supervision: DLD, SKG.

Corresponding author

Correspondence to Sumit K. Gupta.

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Conflict of interest

Dr. Hoernschemeyer is a paid presenter or speaker and receives research support from Biomarin and IP royalties, is a paid consultant and has stock or stock options from Orthopediatrics. Dr. Gupta is a board or committee member for the AAOS and a board or committee member for the Pediatric Orthopaedic Society of North America.

Ethical approval

The study was approved by the Institutional review board of the University of Missouri (IRB#2,014,076).

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Brimmo, O., Boeyer, M.E., Hoernschemeyer, D.G. et al. Physeal fusion status and lesion size are more important than patient age for healing of juvenile osteochodritis dessicans lesions of the distal femur. Knee Surg Sports Traumatol Arthrosc 31, 2936–2943 (2023). https://doi.org/10.1007/s00167-022-07284-w

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