Analysis of risk factors for poor prognosis in conservatively managed juvenile osteochondritis dissecans of the lateral femoral condyle.

BACKGROUND: The purpose of this study was to examine factors affecting the prognosis of conservative treatment for stable juvenile osteochondritis dissecans (OCD) of the lateral femoral condyle based on review of our patient population.

METHODS: A consecutive series of 43 knees in 37 patients with stable OCD of the lateral femoral condyle with open physes undergoing conservative treatment were included in the study. The mean age of the included subjects was 10.7±2.5years (range, seven to 16years) with the mean follow-up period of 33.3±15.1months (range, 12 to 67months). Conservative treatment consisting of prohibition of sports activities and use of a brace locking the knee in full extension was applied to all included patients. Potential prognostic factors examined were the presence of discoid meniscus, radiographic stage, lesion size on radiographs, time period from onset of symptoms to evaluation/consultation, number of hours of sporting activity per week, and age at starting sports activities. Prognosis of a patient was deemed to be poor when an apparent healing response was not detected in follow-up radiographic studies within six months.

RESULTS: The prognosis was defined to be poor for 14 knees (32.6%). The presence of discoid meniscus was identified in 100% of the knees in the poor prognosis group and time-period from onset to consultation of six months or more was shown to be a risk factor with statistical significance.

CONCLUSIONS: A majority of patients with juvenile OCD in the lateral femoral condyle could be managed with conservative treatment. The presence of discoid meniscus and longer time-period from onset to consultation were significantly related with poor prognosis.

LEVEL OF EVIDENCE: IV (case series).