A Simple Clinical Predictive Model for Arthroscopic Mobility of Osteochondritis Dissecans Lesions of the Knee.

Document Type

Article

Publication Date

12-2024

Identifier

DOI: 10.1177/03635465241296133

Abstract

BACKGROUND: Osteochondritis dissecans (OCD) of the knee is a focal idiopathic alteration of subchondral bone and/or its precursor with risk for instability and disruption of adjacent cartilage. Treatment options focused on preventing premature osteoarthritis vary depending on multiple patient and lesion characteristics, including lesion mobility.

PURPOSE: To differentiate lesion mobility before arthroscopy using a multivariable model that includes patient demographic characteristics and physical examination findings.

STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 2.

METHODS: Demographic, preoperative physical examination, and radiographic data were collected from a multicenter national prospective cohort of patients with OCD of the knee. Inclusion criteria included patients75% partition of the data was used for model training, and 25% was used as a validation cohort. Quantitative model fit statistics were computed using the holdout data, including sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC), along with the corresponding 95% CI.

RESULTS: A total of 407 patients in the prospective cohort met inclusion criteria, and 62% were male. The mean ± SD age was 13.7 ± 2.2 years, height 161.8 ± 5.3 cm, and weight 59.2 ± 42.2 kg. Arthroscopic evaluation yielded 235 immobile and 172 mobile lesions. Multivariable analysis determined that the best model to predict lesion mobility included chronologic age ≥14 years (P < .001), effusion on physical examination (P < .001), and any loss of range of motion on physical examination (P = .07), while controlling for male sex (P = .38) and weight >54.4 kg (P = .12). In the 25% holdout validation sample (n = 102), a sensitivity of 83%, a specificity of 82%, and an AUC of 0.89 (95% CI, 0.82-0.95) were achieved with these predictive factors.

CONCLUSION: Age, effusion, and loss of motion can predict knee OCD lesion mobility at the time of arthroscopy. Education about lesion mobility can help with surgical planning and patient and family counseling.

Journal Title

The American journal of sports medicine

Volume

52

Issue

14

First Page

3543

Last Page

3550

MeSH Keywords

Humans; Osteochondritis Dissecans; Arthroscopy; Male; Female; Adolescent; Knee Joint; Prospective Studies; Physical Examination; Child

Keywords

OCD; ROCK Group; arthroscopy; knee; osteochondritis dissecans

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