title: The Surgical Management of Osteochondritis Dissecans of the Knee in the Skeletally Immature: A Survey of the Pediatric Orthopaedic Society of North America (POSNA) Membership.
abstract: BACKGROUND
  While the characteristics of osteochondritis dissecans (OCD) of the knee that require surgery to heal have been described, several surgical techniques/procedures exist with no consensus established regarding timing of treatment and specific surgical intervention. In this study, we aim to determine current trends in surgical treatment for OCD lesions in the skeletally immature who have failed 6 months of nonoperative management by surveying a large cohort of orthopaedic surgeons.
  
  
  METHODS
  An electronic survey designed using REDCap to capture surgeon treatment preferences for OCD lesions was distributed to members of the Pediatric Orthopaedic Society of North America (POSNA). The survey inquired about treating physicians' training and demographics. It then offered a series of clinical vignettes alongside imaging describing patients with varying degrees of severity of OCD following nonoperative treatment. Surgeons were prompted to select from a variety of multiple-choice-based options for further patient management. Standard descriptive statistics were used to summarize and compare the responses.
  
  
  RESULTS
  Of the 129 POSNA members completing the pediatric survey, 97.7% were attending level orthopaedic surgeons, the majority identifying with an academic institution and treating mostly skeletally immature patients. In the skeletally immature population, the majority would treat intact, stable OCD lesions with drilling in a retroarticular or transarticular manner. Preferred treatment for unstable, salvageable lesions was screw fixation using bioabsorble materials or metal with variable pitch with no bone graft. The majority of respondents would treat unstable, unsalvageable OCD lesions with chondroplasty and osteochondral transplant/transfer or microfracture/drilling.
  
  
  CONCLUSIONS
  The POSNA membership appears to agree on principle in terms of treatment modalities for various stages of OCD lesions in the skeletally immature, whereas individual techniques of achieving these principles may vary. Members endorse drilling for stable intact lesions; fixation for unstable, salvageable lesions; and "defect fill" for unsalvageable lesions.
  
  
  CONCLUSIONS
  OCD surgical treatment patterns can be used in future studies to determine which techniques are most effective for given indications, with the goal of designing a research-proven optimal treatment regimen for skeletally immature patients.
authors.affiliation: *Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia †Perelman School of Medicine at the University of Pennsylvania §Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, PA ‡Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD ∥Department of Orthopedics, St Luke's Clinics, Boise, ID.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Yellin
authors.forename: Itai
authors.initials: I
authors.lastname: Gans
authors.forename: James L
authors.initials: JL
authors.lastname: Carey
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Shea
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Ganley
mesh_terms: D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009656:North America; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D009985:Orthopedics; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging / Q000601:surgery*; D010818:Practice Patterns, Physicians'; D011859:Radiography; D011795:Surveys and Questionnaires