Norbert M. Meenen, Orthopaedic Department, Pediatric Sports Medicine, Altona Children's Hospital, University Medical Center Hamburg-Eppendorf, Bleickenallee 38, 22763 Hamburg, Germany.
Am J Sports Med. 2013 Oct;41(10):2384-91. doi: 10.1177/0363546513496049. Epub 2013 Jul 22.
Nonoperative treatment of stable juvenile osteochondritis dissecans (JOCD) lesions of the knee fails in up to 50% of cases. Healing predictors are needed to identify potential failures and thus determine treatment options.
A predictive model for healing potential after 6 and 12 months of nonoperative treatment of stable JOCD lesions based on sensitive magnetic resonance imagining (MRI) follow-up measurements was developed.
Cohort study (diagnosis); Level of evidence, 2.
A retrospective cross-sectional study was conducted to analyze 62 white patients (76 stable JOCD lesions) who were initially treated by restriction of activity until they were free of pain. The primary end point was healing investigated on MRI with follow-up measurements after 6 and 12 months of nonoperative treatment. Multivariate logistic regression was used to determine the influence of age, sex, JOCD lesion size, clinical symptoms, and the occurrence of cystlike lesions (CLLs) on healing potential. Additionally, optimal prognostic cutoffs were defined to differentiate failures from nonfailures.
After 6 months of nonoperative treatment, 51 (67%) of 76 stable JOCD lesions showed no progression toward healing or showed signs of instability. Normalized lesion width and area and CLL occurrence differed significantly between failures and nonfailures (P < .05). A multivariate logistic regression best-predictors model that included age, CLL size, and normalized lesion width best predicted healing after 6 months and resulted in an area under the curve (AUC) of 0.779 (P < .001). A cutoff at 48% healing probability, as predicted by a nomogram based on age, normalized lesion width, and CLL size, differentiated failures from nonfailures (sensitivity, 60.0%; specificity, 83.7%). After 12 months, 37 lesions (49%) had progressed toward healing, and the sole observation of CLL size had the highest predictive validity (AUC, 0.766). The optimal cutoff was a healing probability of 61% (lesion size, 1.3 mm; sensitivity, 70.3%; specificity, 74.1%).
A 6-month period of nonoperative treatment with or without casting might be appropriate if the healing potential is >48%. A 12-month period of nonoperative treatment may be successful if the CLL is <1.3 mm in length as assessed on MRI.
对于膝关节稳定型青少年骺软骨病（JOCD）病变，非手术治疗失败率高达 50%。需要有愈合预测指标来识别潜在的失败病例，从而确定治疗方案。
基于敏感磁共振成像（MRI）随访测量，建立一个用于预测稳定型 JOCD 病变非手术治疗 6 个月和 12 个月后愈合潜能的预测模型。
队列研究（诊断）；证据水平，2 级。
对 62 名白人患者（76 个稳定型 JOCD 病变）进行回顾性横断面研究，这些患者最初通过限制活动进行治疗，直到他们无疼痛为止。主要终点是在非手术治疗 6 个月和 12 个月后通过 MRI 随访测量来评估愈合情况。使用多变量逻辑回归来确定年龄、性别、JOCD 病变大小、临床症状和囊样病变（CLL）发生对愈合潜能的影响。此外，还定义了最佳预后截断值，以区分失败和非失败病例。
在非手术治疗 6 个月后，76 个稳定型 JOCD 病变中有 51 个（67%）病变未出现愈合进展或出现不稳定迹象。失败病例与非失败病例之间的病变宽度和面积的归一化值以及 CLL 的发生差异有统计学意义（P <.05）。包括年龄、CLL 大小和病变宽度的归一化值的多变量逻辑回归最佳预测模型可以预测 6 个月后的愈合情况，其曲线下面积（AUC）为 0.779（P <.001）。基于年龄、病变宽度的归一化值和 CLL 大小的预测概率，以概率为 48%为截定点的列线图可以区分失败和非失败病例（敏感性，60.0%；特异性，83.7%）。12 个月后，37 个病变（49%）向愈合方向进展，CLL 大小的唯一观察结果具有最高的预测有效性（AUC，0.766）。最佳截定点为愈合概率为 61%（病变大小为 1.3 mm），其敏感性为 70.3%，特异性为 74.1%。
如果愈合潜能>48%，则可能需要 6 个月的非手术治疗（或不使用石膏固定）。如果 MRI 上 CLL 的长度<1.3 mm，则 12 个月的非手术治疗可能会成功。
