Department of Orthopaedic Surgery, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
University of Turku, Turku, Finland.
Arch Orthop Trauma Surg. 2023 Jul;143(7):3863-3869. doi: 10.1007/s00402-022-04638-4. Epub 2022 Sep 28.
To report on the long-term prognosis of osteochondritis dissecans (OCD) patients regarding radiological and patient-reported outcomes and to analyze possible risk factors.
All patients diagnosed with knee OCD between 2004 and 2014 with radiographic Kellgren-Lawrence (K-L) grades 0-2 at the time of diagnoses, ability to understand the language of the interview, and willingness to participate in the study were retrospectively reviewed. Current knee radiographs and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were prospectively collected between May 2020 and March 2021. The extent of osteoarthritis (OA) and KOOS questionnaire results were evaluated.
90 patients (103 knees) with a mean age of 21 years (range 6-60) were included. The mean follow-up time was 12 years (range 7-20). 24 knees (23%) were treated conservatively, and 79 knees (77%) operatively. At the time of diagnoses, 90% of the patients had K-L grades of 0-1; during the follow-up period, 45% of the patients showed radiological progression of OA. Patient body mass index (BMI) (p = 0.004; 95% CI 0.25-0.29), age (p = 0.003; 95% CI 0.18-0.30), operative treatment (p = 0.0075; 95% CI 0.41-0.65) and lesion depth (p = 0.0007) were statistically significantly connected to K-L grade change. Patients with no progression in joint space narrowing had statistically significantly better overall KOOS scores (p = 0.03; 95% CI 0.77-0.88) than patients whose K-L grades worsened.
During the long-term follow-up of 12 years, patients with knee OCD had good clinical results. Lac of radiological progression of cartilage degeneration was noted in 55% of the patients, regardless of treatment method. Lesion depth, higher BMI and older age were associated with the progression of OA. The progression of OA was related to a worsening of functional scores.
IV.
报告骨软骨病（OCD）患者的长期预后，包括影像学和患者报告的结果，并分析可能的危险因素。
回顾性分析 2004 年至 2014 年间诊断为膝关节 OCD 的所有患者，影像学上的 Kellgren-Lawrence（K-L）分级为 0-2 级，具有理解访谈语言的能力，并且愿意参与研究。在 2020 年 5 月至 2021 年 3 月期间，前瞻性收集了当前的膝关节 X 射线和膝关节损伤和骨关节炎结果评分（KOOS）问卷。评估了骨关节炎（OA）的程度和 KOOS 问卷结果。
共纳入 90 例（103 膝）患者，平均年龄 21 岁（6-60 岁）。平均随访时间为 12 年（7-20 年）。24 例（23%）接受保守治疗，79 例（77%）接受手术治疗。在诊断时，90%的患者 K-L 分级为 0-1 级；在随访期间，45%的患者出现 OA 的影像学进展。患者的体重指数（BMI）（p=0.004；95%CI 0.25-0.29）、年龄（p=0.003；95%CI 0.18-0.30）、手术治疗（p=0.0075；95%CI 0.41-0.65）和病变深度（p=0.0007）与 K-L 分级变化有统计学显著相关性。关节间隙狭窄无进展的患者的整体 KOOS 评分有统计学显著改善（p=0.03；95%CI 0.77-0.88），而 K-L 分级恶化的患者则没有。
在 12 年的长期随访中，膝关节 OCD 患者的临床结果良好。无论治疗方法如何，55%的患者的软骨退变影像学进展均无进展。病变深度、较高的 BMI 和年龄较大与 OA 的进展有关。OA 的进展与功能评分的恶化有关。
IV。
