Siegall Evan, Faust John R, Herzog Mackenzie M, Marshall Kelley W, Willimon S Clifton, Busch Michael T
Children's Healthcare of Atlanta at Scottish Rite.
Children's Orthopaedics of Atlanta.
J Pediatr Orthop. 2018 Mar;38(3):176-180. doi: 10.1097/BPO.0000000000000796.
The purpose of this study was to determine if patient age could accurately identify disrupted articular cartilage overlying an osteochondritis dissecans (OCD) lesion of the femoral condyle in adolescents. This could have important implications for imaging and treatment decisions.
All patients from 2001 to 2014 who were arthroscopically treated for a femoral condyle OCD were included in this Institutional Review Board-approved study. Exclusion criteria were trochlear and patellar OCD lesions, idiopathic arthritis, and traumatic osteochondral injuries. Arthroscopy was performed to visualize and probe the articular surface. Arthroscopic and magnetic resonance imaging (MRI) findings were recorded as "intact" or "disrupted" cartilage. Extra-articular drilling was performed when the articular cartilage was intact.
There were 119 patients (81 male, 68%) with 139 OCD lesions in 136 knees. The mean age at time of surgery was 13.0 years (range, 7.2 to 19.3 y). At arthroscopy, 115 knees had intact cartilage and 24 had disrupted cartilage. There was a significant difference in age between patients with intact versus disrupted cartilage at arthroscopy (12.5 vs. 15.3 y; P<0.0001). Eighty-eight OCD lesions had MRIs preoperatively, showing 69 as intact and 19 (24%) disrupted. MRI reading for cartilage status had 94% sensitivity and 97% specificity. Multivariable regression analysis revealed that age (P<0.01) and MRI status (P<0.0001) were strong predictors of cartilage status. Sixteen years was the critical age in which both sensitivity was maximized and false positive probability was minimized. Over the age of 17 years, 7 of 7 (100%) had disrupted cartilage. Age alone was 100% sensitive for children below the age of 10, and 96% sensitive below the age of 13.
Age was a good predictor of cartilage status in both younger (<13 y) and older (≥17 y) patients in this study. For patients in the mid-range group (13 through 16 y), age alone is not an adequate predictor of cartilage status, but adding MRI increased accuracy.
Age can be used to stratify patients and thereby influence diagnostic and treatment strategies.
Level IV.
本研究的目的是确定患者年龄能否准确识别青少年股骨髁剥脱性骨软骨炎（OCD）病变上方的关节软骨是否破裂。这可能对影像学和治疗决策具有重要意义。
2001年至2014年所有接受关节镜治疗股骨髁OCD的患者均纳入本机构审查委员会批准的研究。排除标准为滑车和髌骨OCD病变、特发性关节炎和创伤性骨软骨损伤。进行关节镜检查以观察和探查关节表面。关节镜和磁共振成像（MRI）结果记录为软骨“完整”或“破裂”。当关节软骨完整时进行关节外钻孔。
119例患者（81例男性，占68%），136个膝关节中有139处OCD病变。手术时的平均年龄为13.0岁（范围7.2至19.3岁）。关节镜检查时，115个膝关节软骨完整，24个膝关节软骨破裂。关节镜检查时软骨完整与破裂的患者年龄存在显著差异（12.5岁对15.3岁；P<0.0001）。88处OCD病变术前行MRI检查，69处显示完整，19处（24%）破裂。MRI对软骨状态的诊断敏感性为94%，特异性为97%。多变量回归分析显示，年龄（P<0.01）和MRI状态（P<0.0001）是软骨状态的强预测因素。16岁是敏感性最大化且假阳性概率最小化的临界年龄。17岁以上，7例中有7例（100%）软骨破裂。单独年龄对10岁以下儿童的敏感性为100%，对13岁以下儿童的敏感性为96%。
在本研究中，年龄是较年轻（<13岁）和较年长（≥17岁）患者软骨状态的良好预测指标。对于年龄在中间范围（13至16岁）的患者，单独年龄不是软骨状态的充分预测指标，但增加MRI可提高准确性。
年龄可用于对患者进行分层，从而影响诊断和治疗策略。
四级。
