Abstract
Objectives:
The goal of treatment of osteochondritis dissecans (OCD) is most commonly to preserve the native chondral surface to avoid long term development of osteoarthritis. However, some OCD lesions are not considered amenable to fixation and therefore deemed unsalvageable. Little is known about the OCD subpopulation presenting with such lesions or the detailed characteristics of unsalvageable lesions and their treatment. The purpose of this study is to investigate the characteristics of lesions and their treatment in a large volume of patients with OCD lesions that were determined to be unsalvageable upon presentation.
Methods:
A review of the ROCK (Research in Osteochondritis of the Knee) study group’s prospective cohort database from 2014 to 2022 was performed to identify condylar lesions in patients <20 years old that were deemed unsalvageable, based on a cartilage resurfacing technique being preliminary treatment performed. Demographic data, radiographic descriptors, intraoperative lesion findings, and treatments performed were analyzed. Treatments for lesions considered unsalvageable were categorized as marrow stimulation (e.g. microfracture, McFx), osteochondral autograft transplantation surgery (e.g. OATS), osteochondral allograft transplantation (OCA), and cultured chondrocyte/cell-based therapy (e.g. MACI). Comparative analysis was performed between the cohort with unsalvageable lesions and those who underwent lesion preservation techniques associated with unstable lesions (ie fixation).
Results:
A total of 590 out of 1291 (45.7%) surgically treated OCDs (mean age 13.7 years old, 2:1 male: female) were included with 10.8% considered unsalvageable. The distribution of techniques for unsalvageable lesions was McFx (4.4%), OCA (2.9%), and MACI (2.0%). Compared to the lesion preservation cohort, the unsalvageable was older (15.9 vs. 14.6; p=-0.006), had a higher body mass index (24.2 vs. 22.7; p<0.001), and was more likely to have had prior surgery (33.3% vs. 10.3%; p<0.001). The presence of bone in the progeny, a linear signal on MRI, and bone edema were less common in unsalvageable lesions (p<0.05 for all). A multivariate analysis model resulted in significant associated in unsalvageable OCD lesions with prior surgery (p<0.001, OR 1.97, CI 2.736-19.929).
Conclusions:
OCD patients with unsalvageable lesions are more likely to be identified in those that have undergone prior surgical procedure, but MRI signs of instability still undergo preservation techniques. Given the implications of long-term joint health, comparative analyses of outcomes of the different cartilage resurfacing techniques for such lesions is of critical importance for future study.