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Juvenile osteochondritis dissecans of the knee: perifocal sclerotic rim as a prognostic factor of healing.
Journal of Pediatric Orthopedics 2010 March
BACKGROUND: Management of osteochondritis dissecans of the femoral condyle in children remains uncertain. The aim of this study was to determine the presence of a perilesional sclerotic ring in radiologic examination and to establish its value for prognosis.
METHODS: We retrospectively reviewed 85 patients diagnosed with osteochondritis dissecans. The population was distributed according to the grade of perilesional radiologic sclerosis: stage 0, patients who did not show a sclerotic rim in the anteroposterior and the lateral views; stage I, patients with marginal sclerosis only in 1 radiologic view; stage II, patients with sclerosis in both views. Patients were also distributed in different age groups: group 1, children under 12 years of age; group 2, children between 12 and 15 years of age; and group 3, children more than 15 years of age. These groups were correlated with the stage of perilesional sclerosis. Radiologic results were analyzed according to the Hughston scale after conservative or surgical treatment of the lesion.
RESULTS: Lesions without perilesional sclerosis (stage 0) were cured in all the cases, with good results by means of conservative treatment (P<0.05). In patients with stage I or II perilesional sclerosis, the percentage of healing was smaller; in these cases, surgical treatment improved the results compared with those in which conservative treatment was used (P<0.05). Children under 12 years of age showed less perilesional sclerosis and more tendencies to spontaneous healing than those more than 15 years of age. In these patients, radiologic sclerosis is greater (P<0.05).
CONCLUSIONS: The presence of a sclerotic rim in the osteochondritis dissecans lesions of the knees in children is considered a prognostic indicator of the process. Lesions without sclerosis show a tendency toward spontaneous recovery with conservative treatment. Lesions with perilesional sclerosis show worse evolution, and treatment with perforations is still essential for enhancement of healing.
LEVEL OF EVIDENCE: Prognostic study, Level II (retrospective study).
METHODS: We retrospectively reviewed 85 patients diagnosed with osteochondritis dissecans. The population was distributed according to the grade of perilesional radiologic sclerosis: stage 0, patients who did not show a sclerotic rim in the anteroposterior and the lateral views; stage I, patients with marginal sclerosis only in 1 radiologic view; stage II, patients with sclerosis in both views. Patients were also distributed in different age groups: group 1, children under 12 years of age; group 2, children between 12 and 15 years of age; and group 3, children more than 15 years of age. These groups were correlated with the stage of perilesional sclerosis. Radiologic results were analyzed according to the Hughston scale after conservative or surgical treatment of the lesion.
RESULTS: Lesions without perilesional sclerosis (stage 0) were cured in all the cases, with good results by means of conservative treatment (P<0.05). In patients with stage I or II perilesional sclerosis, the percentage of healing was smaller; in these cases, surgical treatment improved the results compared with those in which conservative treatment was used (P<0.05). Children under 12 years of age showed less perilesional sclerosis and more tendencies to spontaneous healing than those more than 15 years of age. In these patients, radiologic sclerosis is greater (P<0.05).
CONCLUSIONS: The presence of a sclerotic rim in the osteochondritis dissecans lesions of the knees in children is considered a prognostic indicator of the process. Lesions without sclerosis show a tendency toward spontaneous recovery with conservative treatment. Lesions with perilesional sclerosis show worse evolution, and treatment with perforations is still essential for enhancement of healing.
LEVEL OF EVIDENCE: Prognostic study, Level II (retrospective study).
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