Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65201, USA.
Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2936-2943. doi: 10.1007/s00167-022-07284-w. Epub 2022 Dec 20.
The purpose of the study was to evaluate the effect of skeletal age and lesion size, location, and grade on the success of nonoperative treatment for juvenile osteochondritis dissecans (OCD). It is hypothesized that skeletal maturity, including a combination of maturation phenotypes, correlates with nonoperative lesion healing.
The clinical and radiographic data on 52 patients aged 7-20 years treated for OCD of the distal femur between 2010 and 2019 were retrospectively reviewed. Knee radiographs were assessed for number of lesions present and lesion location, size, and stage. Assessments of skeletal maturation were performed on all antero-posterior knee radiographs using the Roche, Wainer, and Thissen (RWT) method. Patients were categorized as healed if they demonstrated no pain on clinical examination. The relationship between skeletal maturity and nonoperative lesion healing was determined using Spearman rank correlations on available variables.
Neither chronological nor skeletal age was associated with surgical status (Rho = 0.03, n.s., and Rho = 0.13, n.s., respectively) or the healing status of nonoperatively treated OCD lesions (Rho = 0.44, n.s., and Rho = 0.03, n.s., respectively). Epiphyseal fusion status of the distal femoral physis was moderately correlated with nonoperative healing, but was not statistically significant (lateral femoral physis: Rho = 0.43, p = 0.05; medial femoral physis: Rho = 0.43, n.s.). Lesion length correlated with surgical status (Rho = - 0.38, p = 0.009).
The extent of fusion of the distal femoral physis (multi-stage grading) may be more strongly correlated with nonoperative healing than other markers of skeletal maturity or chronological age. Clinicians can use this as an additional radiographic sign when considering nonoperative treatment for juvenile OCD lesions in the distal femur. OCD lesion length and physeal fusion status appear to be more important for healing than patient age.
本研究旨在评估骺骨龄、病变大小、位置和分级对青少年骺骨软骨病（OCD）非手术治疗效果的影响。本研究假设骺骨成熟度，包括成熟表型的组合，与非手术性病变愈合相关。
回顾性分析 2010 年至 2019 年间接受股骨远端 OCD 治疗的 52 例 7-20 岁患者的临床和影像学资料。评估膝关节正位片上病变的数量、病变位置、大小和分期。采用 Roche、Wainer 和 Thissen（RWT）法对所有膝关节前后位 X 线片进行骺骨成熟度评估。如果患者临床检查无疼痛，则认为其为愈合。对可用变量进行 Spearman 秩相关分析，以确定骺骨成熟度与非手术性病变愈合的关系。
无论是实际年龄还是骺骨年龄，均与手术状态（Rho = 0.03，n.s. 和 Rho = 0.13，n.s.）或非手术治疗 OCD 病变的愈合状态（Rho = 0.44，n.s. 和 Rho = 0.03，n.s.）无关。股骨远端骺板融合状态与非手术性愈合呈中度相关，但无统计学意义（外侧股骨骺板：Rho = 0.43，p = 0.05；内侧股骨骺板：Rho = 0.43，n.s.）。病变长度与手术状态相关（Rho = -0.38，p = 0.009）。
股骨远端骺板融合程度（多阶段分级）可能与非手术治疗的愈合比其他骺骨成熟度或实际年龄标志物更相关。临床医生在考虑股骨远端青少年 OCD 病变的非手术治疗时，可以将其作为额外的影像学征象。病变长度和骺板融合状态似乎比患者年龄对愈合更为重要。
