The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy: A prospective study

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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)

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Osteochondritis dissecans of the femoral condyles.

J C Hughston, B G Courtenay, P Hergenroeder (1984)

Because the results of treatment of osteochondritis dissecans of the femoral condyles are still not consistently satisfactory, we reviewed the cases of eighty-three patients (ninety-five knees) with osteochondritis dissecans who were followed for two to thirty-one years to identify factors that may influence treatment and long-term prognosis. Of the eighty-three patients, sixteen had only non-surgical treatment, sixty-five had only surgical treatment, and two had non-surgical treatment of one knee and surgical treatment of the other. Of the twenty-two knees (eighteen patients) that were treated non-surgically, fifteen were treated before and seven were treated after distal femoral epiphyseal closure. Of the seventy-three knees (in sixty-seven patients) that were treated surgically because of persisting symptoms, twenty-three were treated before epiphyseal closure and fifty, after closure. At follow-up, each knee was given a rating of excellent, good, fair, poor, or failure, and a corresponding point score. Seventy-seven per cent of the knees in the surgical group and 82 per cent of those in the conservatively treated group were rated either excellent or good. The average scores in both groups were higher in knees in which the osteochondritic defect was small and was treated before epiphyseal closure, and in knees in which the fragment healed as compared with the ones from which the fragment was removed. We found that knees with osteochondritis dissecans of the femoral condyles that had no other abnormal physical findings or functional disability responded well to conservative treatment before epiphyseal closure.(ABSTRACT TRUNCATED AT 250 WORDS)

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The incidence of osteochondritis dissecans in the condyles of the femur.

B Lindén (1976)

The incidence of osteochondritis dissecans in the condyles of the femur was studied in a defined population and was found to be twice as common in men as in women; the maximum incidence in both sexes being between the ages of 10 and 20. The site of the lesion in the condyles did not differ between age groups. The indicence of diagnosied cases has increased somewhat in recent years but only in men. The incidence in the population is less than has been suggested in the past.