Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Iowa Orthop J. 2022 Jun;42(1):193-199.
Avascular necrosis (AVN) is a rare albeit serious condition that has a high risk for long term morbidity given the risk of chronic pain and arthroplasty after diagnoses. The recent rise in sports participation in the pediatric population demonstrates the importance of evaluating functional limitations after AVN treatment. Return to sport (RTS) rates after treatment for AVN have not been evaluated in pediatric or adolescent populations.It is necessary to evaluate all joints impacted by AVN due to heterogenous nature of the disease and the variety of sports that could be impacted by disease specific activity restrictions. Thus, this present study aimed to characterize RTS rate after AVN treatment, determine if there was a difference in RTS rates after operative versus nonoperative management, and identify demographic and treatment factors associated with RTS rates.
This retrospective cohort study evaluated patients ages eight to twenty years old who were treated for symptomatic AVN of any joint between January 2005 and August 2021. Patient records were reviewed for demographic, disease, and treatment variables. Standard descriptive statistics and bivariate analyses were performed to describe and compare groups who did and did not RTS. A generalized estimating model was used to determine variables that were associated with better RTS rates.
A total of 144 patients and 190 lesions were evaluated in the study, 60 patients (43%) were female with a mean age of 14.36+/-3.24 years. The overall RTS rate after AVN treatment was 67% (64/96). Roughly 8% of patients (5/64) were able to return to multiple sports, however of those that returned to sports, 6% (4/64) reported playing at a lower level of competition. There was not a significant difference between the RTS rate for those who underwent operative versus nonoperative management (70% versus 62%, p=0.38). Males were almost 2.5 times more likely to return to sport than females (OR: 2.46, p=0.018).
The ability to return to sports after AVN treatment has largely remained unknown in the pediatric and adolescent populations. Our data suggests that a majority of patients are able to RTS in the short term follow up with males being twice as likely to RTS compared to females. Physicians should maintain awareness of the long-term morbidity of AVN and understand the unique patient and disease characteristics that optimize functional outcomes in this population. .
骨坏死（AVN）是一种罕见但严重的疾病，如果在诊断后出现慢性疼痛和关节置换的风险，其长期发病率很高。最近，儿童和青少年参与体育运动的人数增加，这表明评估 AVN 治疗后的功能障碍很重要。尚未在儿科或青少年人群中评估 AVN 治疗后的重返运动（RTS）率。由于疾病的异质性和受疾病特异性活动限制影响的各种运动，有必要评估受 AVN 影响的所有关节。因此，本研究旨在评估 AVN 治疗后的 RTS 率，确定手术与非手术治疗后的 RTS 率是否存在差异，并确定与 RTS 率相关的人口统计学和治疗因素。
本回顾性队列研究评估了 2005 年 1 月至 2021 年 8 月期间因任何关节症状性 AVN 接受治疗的 8 至 20 岁患者。对患者的病历进行了人口统计学、疾病和治疗变量的回顾性分析。采用标准描述性统计和双变量分析对 RTS 组和非 RTS 组进行描述和比较。使用广义估计模型来确定与更好的 RTS 率相关的变量。
该研究共评估了 144 名患者和 190 个病变，其中 60 名患者（43%）为女性，平均年龄为 14.36+/-3.24 岁。AVN 治疗后总的 RTS 率为 67%（64/96）。大约 8%的患者（5/64）能够重返多项运动，但在重返运动的患者中，有 6%（4/64）报告运动水平较低。手术与非手术治疗的 RTS 率无显著差异（70%对 62%，p=0.38）。男性重返运动的可能性几乎是女性的 2.5 倍（OR：2.46，p=0.018）。
在儿科和青少年人群中，AVN 治疗后重返运动的能力在很大程度上仍然未知。我们的数据表明，大多数患者在短期随访中能够重返运动，而男性重返运动的可能性是女性的两倍。医生应始终意识到 AVN 的长期发病率，并了解在该人群中优化功能结局的独特患者和疾病特征。
