2017 ISAKOS Biennial Congress ePoster #1704
Are Basketball and Soccer Risk Factors for Juvenile Osteochondritis Dissecans of the Trochlea? A Cohort Study of 32 Trochlear Lesions
Maria Tuca, MD, Santiago CHILE
Jason Silberman, BS, New York, NY - New York UNITED STATES
Eva Luderowski, BS, New York, NY - New York UNITED STATES
John Arbucci, BS, New York, NY - New York UNITED STATES
Meghan Price, BS, New York, NY UNITED STATES
Daniel W. Green, MD, MS, New York, NY UNITED STATES
Hospital for Special Surgery, NEW YORK, NY - New York, UNITED STATES
FDA Status Not Applicable
JOCD lesions are rarely located in the trochlea. In this study, we examined the largest cohort of patients with lesions in this unique location. They were mainly teenage boys who participated in jumping and cutting sports, such as basketball and/ or soccer. Trochlear JOCD patients tended to have a high surgical rate, with good outcomes following repair and fixation.
To evaluate the clinical characteristics, radiographic findings, and outcomes of patients with juvenile osteochondritis dissecans (JOCD) of the trochlea. To our knowledge, this is the largest cohort reporting JOCD lesions in this unusual location. We hypothesize that trochlear JOCD lesions are associated more with young athletes who play soccer and basketball. We also report that this unique site for JOCD may have better surgical results than previously thought.
This is a retrospective cohort study of 32 trochlear JOCD lesions in 28 patients. Demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from charts. Pre and post-operative radiographic imaging including magnetic resonance images (MRIs) and X-Rays were evaluated.
Our cohort consisted of 32 consecutive trochlear JOCD lesions in 28 patients (24 boys, 4 girls). Average age at diagnosis was 13.8 years (9.64-18.00). 25 (89.3%) patients were active. Of the sports played by this active cohort, soccer and basketball were the most commonly played. 12 of the 25 (48%) active patients played soccer, 13 of 25 (52%) played basketball, and 21 (84%) playing either or both. Three patients had coexisting femoral condyle lesions, three patients had bilateral trochlear lesions, and one patient had coexisting bilateral femoral condyle lesions. The area of the lesions averaged 278 mm2 (17.2-839.56). Nineteen knees (59%) underwent operative treatment. At the time of surgery, all patients had open physes.
Fifteen of the surgical patients underwent repair and fixation with bioabsorbable nails. Ten of the patients who underwent fixation reached clinical and/or radiological follow-up of at least 12 months, with an average follow-up of 21.68 months (12.00-37.34). Average MRI follow-up was 22.00 months (12.00- 37.34). All patients in this surgical cohort who underwent fixation showed radiological and/or clinical indications of healing at last follow-up, defined as either bone incorporation on MRI or the absence of pain. All fixation procedures used 1.6 mm bioabsorbable nails, with an average of 6 nails (4-8). Nine of the patients who underwent fixation were active, and eight of these patients report successful return to sports. In this relatively short term follow up, no revision surgeries were necessary for any of the surgical patients.
JOCD lesions are rarely located in the trochlea. In this study, we examined the largest cohort of patients with lesions in this unique location. Patients with trochlear lesions were mainly teenage boys who participated in jumping and cutting sports which load the patellofemoral joint such as basketball and/ or soccer (84%). Trochlear JOCD patients tended to have a high surgical rate, where over half of the patients underwent operative treatment. Repair and fixation produced good outcomes at short-term follow-up.