Return to Sport After Treatment of Stable Osteochondritis Dissecans Lesions of the Knee in Adolescents: A Systematic Review

Abstract

Background:

Treatment of stable osteochondritis dissecans (OCD) lesions of the knee in young patients poses the challenge of abstaining from competitive sports for months. Outcomes relevant to this patient population additionally include successful return to sport (RTS), return to the same level of sport, and the time needed to achieve both.

Purpose:

To evaluate the adolescent population for RTS outcomes after treatment of stable OCD lesions of the knee and to compare RTS outcomes between patients treated nonoperatively and those who required surgery.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic search of the literature was conducted using the terms “knee,”“return to play,”“return to sport,”“osteochondritis dissecans,”“articular cartilage,”“arthroscopic drilling,”“open drilling,” and “arthroscopic fixation” between inception and May 31, 2023 using PubMed, CINAHL, SPORTDiscus, and Ovid MEDLINE databases. Articles reporting RTS outcomes with a minimum of 6 months’ follow-up were included. Articles were excluded if they were abstracts, editorials, letters, or reviews; were in languages other than English; had <6 months of follow-up, on average; had no data specific to the knee; had no RTS outcomes; consisted of skeletally mature patients; or involved only unstable OCD lesions.

Results:

Available data were collected from 13 articles, consisting of level 3 and 4 evidence, which met inclusion criteria with a total of 710 patients and 783 knees. Ages ranged from 8 to 18 years, and the mean follow-up time ranged from 9.5 to 48 months. Nonoperative treatment consisted of activity modification, bracing, casting, and physical therapy to allow for healing of the subchondral bone. All patients attempted at least 6 weeks of nonoperative treatment. Operative treatment consisted of surgical drilling or internal fixation. The rate of successful nonoperative management for adolescents with stable OCD of the knee ranged from 40.3% to 87.5%. Of those treated successfully with nonoperative treatment, RTS rates ranged from 84.7% to 100%. Patients treated operatively had RTS rates of 100% and rates of return to the same level of sport ranging from 77.8% to 100% at 6 months’ follow-up. Rates of return to the same level of sport varied between operative techniques used. Patients who underwent operative management demonstrated improvements in Lysholm and Tegner scores, and most knees were rated excellent or good according to the Hughston rating scale.

Conclusion:

The current literature demonstrates favorable short-term RTS outcomes after the nonoperative and operative management of stable OCD lesions of the knee in young athletes. When successful, nonoperative management demonstrated high RTS rates, and further research should investigate prognostic factors for successful nonoperative management. The operative management of stable OCD lesions resulted in high rates of RTS and return to the same level of sport, improvements in patient-reported outcomes, and minimal complications, which raises the question of the appropriate duration of nonoperative management in this patient population.