title: Surgical management of osteochondritis dissecans lesions of the patella and trochlea in the pediatric and adolescent population.
abstract: BACKGROUND
  There is a paucity of published data regarding the management of osteochondritis dissecans (OCD) lesions of the patellofemoral joint in children and adolescents.
  
  
  OBJECTIVE
  To evaluate the functional outcomes of surgical management of OCD lesions of the patella and trochlea in children and adolescents. Secondary aims included elucidating predictors for higher functional outcomes and determining complication rates, surgical satisfaction, and ability to return to sports.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Patients aged 18 years and younger who were surgically treated for OCD of the patella or trochlea were identified. Charts were queried to record patient/lesion data, surgical procedure, results, and complications. Pre- and postoperative imaging was reviewed. Patients were asked to complete a follow-up athletic questionnaire and a Pediatric International Knee Documentation Committee (Pedi-IKDC) questionnaire. Statistical analysis was conducted to look for predictors for reoperation, residual pain, ability to return to sports, and lower Pedi-IKDC scores.
  
  
  RESULTS
  A total of 26 children (9 females, 17 males, 3 with bilateral lesions; thus, 29 lesions) were identified. The mean age was 14.7 years (range, 9-18, years), 21 of the 29 knees with lesions (72%) had open physes, and median follow-up was 3.8 years (range, 1-9 years). The most common location was the trochlea (17/29 lesions; 59%). Twenty-two lesions (76%) underwent transarticular drilling (n = 14) or drilling with fixation (n = 8), while 7 underwent excision and marrow stimulation. Four patients (14%) required unplanned reoperation. Internal fixation was predictive of reoperation (odds ratio [OR] = 8.7; 95% CI, 2.8-26.9; P = .04). At final follow-up, 14 knees (48%) were pain free, and 14 (48%) had mild residual pain. Female sex was predictive of residual pain (OR, 9; 95% CI, 2-56; P = .02). Twenty-two patients (85%) returned to sports. Longer duration of preoperative pain negatively affected return to sports (OR, 0.32; 95% CI, 0.05-0.97; P = .04). On postoperative MRI, the lesion appeared completely healed in 2 cases (18%) and partially healed in 9 cases (82%). All 15 survey respondents were satisfied with surgery. The mean Pedi-IKDC score was 82.4 ± 17.8 (range, 40.2-100).
  
  
  CONCLUSIONS
  Surgical treatment of patellofemoral OCD in children and adolescents produces a high rate of satisfaction and return to sports. Female sex, prolonged duration of symptoms, and internal fixation may be associated with worse outcomes.
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA Dennis.kramer@childrens.harvard.edu.
authors.forename: Dennis E
authors.initials: DE
authors.lastname: Kramer
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Yi-Meng
authors.initials: YM
authors.lastname: Yen
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Simoni
authors.affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Miller
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Micheli
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Mininder S
authors.initials: MS
authors.lastname: Kocher
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Benton E
authors.initials: BE
authors.lastname: Heyworth
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000209:etiology; D054544:Arthroplasty, Subchondral; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008279:Magnetic Resonance Imaging; D008297:Male; D010008:Osteochondritis Dissecans / Q000150:complications / Q000601:surgery*; D010329:Patella / Q000601:surgery*; D057071:Patellofemoral Joint / Q000601:surgery*; D017060:Patient Satisfaction; D011184:Postoperative Period; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013177:Sports; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: OCD; knee; patellofemoral