Nonoperative Management of Juvenile Osteochondritis Dissecans Lesions of the Medial Femoral Condyle: Comparing Cylinder Cast, Hinged Knee Brace Locked Into Extension, and Activity Modification
Brian Harvey, Kennedy Morey, Kennison Adams, El R. Domingo-Johnson, Angie Vanderpool, Natalie Stork, Donna Pacicca, Brian Lee, Melina Varouhakis, Kevin LatzObjective:
Compare nonoperative treatment options in juvenile osteochondritis dissecans (OCD) lesions of the medial femoral condyle.
Design:
Descriptive, retrospective cohort study.
Setting:
Single academic pediatric tertiary referral center.
Patients (or Participants):
Male/female patients ages 0 to 18 evaluated in the sports/orthopedic ambulatory setting who were found to have OCD lesions in the medial femoral condyle.
Interventions (or Assessment of Risk Factors or Independent Variables):
Cast immobilization, hinged knee brace locked into extension, and activity modification.
Main Outcome Measures:
Nonoperative treatment effectiveness between the 3 groups was evaluated by radiographic healing and symptom resolution, with failure defined as progression to surgery.
Results:
A total of 148 patients with 168 MFC JOCD lesions of the knee were identified. Median age was 11 years old. Patients were 65.5% male and 77% participated in sports. Sixty-two (37%) lesions were treated in a HKB locked into extension, 55 (32%) were casted in a cylinder cast, and 51 (31%) were treated with activity modification alone. Approximately 19% of HKB locked into extension, 22% of casted MFC JOCD, and 16% of activity-modified MFC JOCD lesions progressed to surgery. At 6 months, 76% of the HKB locked into extension, 71% of the cylinder cast, and 71% of the activity modification group had resolution of clinical symptoms and returned to activity.
Conclusions:
MFC JOCD lesions of the knee can be appropriately treated with a HKB brace locked in extension, cast, or activity modification with consistent success rates.
Clinical Relevance:
This study provides practical evidence regarding conservative management of MFC JOCD lesions.
Level of Evidence:
III.