Ramski David E, Ganley Theodore J, Carey James L
Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Orthop J Sports Med. 2017 Dec 1;5(12):2325967117740846. doi: 10.1177/2325967117740846. eCollection 2017 Dec.
Recent studies have examined radiographic factors associated with healing of osteochondritis dissecans (OCD) lesions of the knee. However, there is still no gold standard in determining the healing status of an OCD lesion.
We examined temporally associated patterns of healing to (1) evaluate the practicality of a classification system and (2) elucidate any associations between healing pattern and patient age, sex, lesion location, treatment type, and physeal patency.
Cohort study (diagnosis); Level of evidence, 3.
We retrospectively screened 489 patients from 2006 to 2010 for a total of 41 consecutive knee OCD lesions that met inclusion criteria, including at least 3 consecutive radiographic series (mean patient age, 12.8 years; range, 7.8-17.1 years; mean follow-up, 75.1 weeks). Radiographs were arranged in sequential order for ratings by 2 orthopaedic sports medicine specialists. Healing patterns were rated as , , , or . Repeat ratings were conducted 3 weeks later.
Patients were most commonly adolescent males aged 13 to 17 years, with a medial femoral condyle lesion that was treated operatively. Interobserver reliability of the healing classification was good (intraclass correlation coefficient, 0.67; 95% CI, 0.55-0.79). Boundary and radiodensity healing was observed for all ages, sexes, lesion locations, treatment types, and physeal patency states.
This study evaluated a valuable radiographic paradigm-boundary resolution, increasing radiodensity of progeny fragment, or combined-for assessment of OCD lesion healing. The proposed system of healing classification demonstrated good inter- and intraobserver reliability. Healing patterns were not significantly associated with any particular age, sex, lesion location, treatment type, or physeal patency status. The development of a classification system for knee OCD may eventually improve clinical assessment and management of OCD lesions.
近期研究已对与膝关节剥脱性骨软骨炎（OCD）损伤愈合相关的影像学因素进行了考察。然而，在确定OCD损伤的愈合状态方面仍不存在金标准。
我们研究了愈合的时间相关模式，以（1）评估一种分类系统的实用性，以及（2）阐明愈合模式与患者年龄、性别、损伤部位、治疗类型和骨骺通畅性之间的任何关联。
队列研究（诊断）；证据等级，3级。
我们回顾性筛查了2006年至2010年期间的489例患者，共纳入41例符合纳入标准的连续性膝关节OCD损伤，包括至少3个连续的影像学系列（患者平均年龄12.8岁；范围7.8 - 17.1岁；平均随访75.1周）。X线片按顺序排列，由2名骨科运动医学专家进行评级。愈合模式被评为 、 、 或 。3周后进行重复评级。
患者最常见为13至17岁的青少年男性，内侧股骨髁损伤，接受手术治疗。愈合分类的观察者间信度良好（组内相关系数，0.67；95%可信区间，0.55 - 0.79）。在所有年龄、性别、损伤部位、治疗类型和骨骺通畅状态中均观察到边界和骨密度愈合。
本研究评估了一种有价值的影像学模式——边界分辨率、子代碎片骨密度增加或两者结合——用于评估OCD损伤的愈合。所提出的愈合分类系统在观察者间和观察者内均显示出良好的信度。愈合模式与任何特定的年龄、性别、损伤部位、治疗类型或骨骺通畅状态均无显著关联。膝关节OCD分类系统的开发最终可能会改善OCD损伤的临床评估和管理。
