Impact of Childhood Opportunity Index and Area Deprivation Index on the Time to Presentation and Stability of Osteochondritis Dissecans of the Knee
Presenter Status
Medical Student
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Brian Harvey, DO
Presentation Type
Poster
Start Date
19-5-2026 11:00 AM
End Date
19-5-2026 12:00 PM
Abstract Text
Background: While the cause of osteochondritis dissecans (OCD) lesions of the knee remains unknown, they can limit a child’s participation in activities. The most common site is the lateral aspect of the medial femoral condyle, though lesions also occur in the femoral condyle, trochlea, and patella. Because the clinical course varies, non-operative management is challenging. Clinicians must choose modalities (e.g., bracing or casting), estimate treatment duration, and decide when surgery is indicated. Access and adherence can complicate care, and untreated lesions may have long-term consequences. A 2016 study by Nakayama found that delayed treatment initiation increased risk of progression and prolonged healing, but did not evaluate causes of delayed presentation. Other studies suggest racial disparities in incidence and outcomes.
Despite growing literature on management, data are limited on how socioeconomic status affects time to presentation and lesion severity at diagnosis. Across pediatric care, social determinants of health are often overlooked in assessment and treatment decisions and can influence outcomes, including greater severity at first presentation. Therefore, we will conduct a retrospective study testing whether the Childhood Opportunity Index, a socioeconomic measure, is associated with time to presentation and lesion stability for OCD of the medial femoral condyle. This will clarify whether socioeconomic factors contribute to delays in care and to instability at diagnosis.
Objectives/Goal: To explore the impact of Childhood Opportunity Index (COI)/Area Deprivation Index (ADI) on symptom duration prior to initial clinic presentation and MRI-based lesion stability on presenting MRI in pediatric patients with medial femoral condyle osteochondritis dissecans lesions of the knee.
Methods/Design: Retrospective cohort study in patients aged 5-18 years old with Medial Femoral Condyle (MFC) osteochondritis dissecans (OCD) evaluated from January 2015 to May 2025. Patients were stratified into cohorts based on national COI 2.0 groups and ADI quartiles. Patients were then compared between the groups on their symptoms prior to initial presentation, MRI stability, insurance, and race.
Results: 183 pediatric patients with MFC OCD were stratified by national COI 2.0 and ADI quartiles with low and very low COI quintiles combined. Symptom duration before the initial visit did not differ significantly by COI or ADI (p = 0.24, p = 0.25). The MRI lesion stability also did not differ by COI or ADI (p = 0.66, p = 0.15). In contrast, insurance status and race varied with neighborhood context (p< 0.001). In very high COI areas, 92.8% had private insurance, and 82.9% were White, with 17.2% Black or other race. In low/very low COI areas, private insurance fell to 52.9%, and 55.9% of patients were Black or other race. Private insurance decreased from 97.9% in ADI Quartile 1 to 51.1% in Quartile 4, while Medicaid rose from 2.1% to 48.9%.
Conclusions: COI and ADI were not associated with symptom duration or MRI lesion stability in pediatric MFC OCD but were strongly linked to insurance type and race. High COI/low ADI clustered with privately insured, predominantly White patients. Low COI/high ADI clustered with Medicaid-insured and Black patients. Children from low-COI/high-ADI neighborhoods more often rely on Medicaid and are non-white despite disease severity.
Impact of Childhood Opportunity Index and Area Deprivation Index on the Time to Presentation and Stability of Osteochondritis Dissecans of the Knee
Background: While the cause of osteochondritis dissecans (OCD) lesions of the knee remains unknown, they can limit a child’s participation in activities. The most common site is the lateral aspect of the medial femoral condyle, though lesions also occur in the femoral condyle, trochlea, and patella. Because the clinical course varies, non-operative management is challenging. Clinicians must choose modalities (e.g., bracing or casting), estimate treatment duration, and decide when surgery is indicated. Access and adherence can complicate care, and untreated lesions may have long-term consequences. A 2016 study by Nakayama found that delayed treatment initiation increased risk of progression and prolonged healing, but did not evaluate causes of delayed presentation. Other studies suggest racial disparities in incidence and outcomes.
Despite growing literature on management, data are limited on how socioeconomic status affects time to presentation and lesion severity at diagnosis. Across pediatric care, social determinants of health are often overlooked in assessment and treatment decisions and can influence outcomes, including greater severity at first presentation. Therefore, we will conduct a retrospective study testing whether the Childhood Opportunity Index, a socioeconomic measure, is associated with time to presentation and lesion stability for OCD of the medial femoral condyle. This will clarify whether socioeconomic factors contribute to delays in care and to instability at diagnosis.
Objectives/Goal: To explore the impact of Childhood Opportunity Index (COI)/Area Deprivation Index (ADI) on symptom duration prior to initial clinic presentation and MRI-based lesion stability on presenting MRI in pediatric patients with medial femoral condyle osteochondritis dissecans lesions of the knee.
Methods/Design: Retrospective cohort study in patients aged 5-18 years old with Medial Femoral Condyle (MFC) osteochondritis dissecans (OCD) evaluated from January 2015 to May 2025. Patients were stratified into cohorts based on national COI 2.0 groups and ADI quartiles. Patients were then compared between the groups on their symptoms prior to initial presentation, MRI stability, insurance, and race.
Results: 183 pediatric patients with MFC OCD were stratified by national COI 2.0 and ADI quartiles with low and very low COI quintiles combined. Symptom duration before the initial visit did not differ significantly by COI or ADI (p = 0.24, p = 0.25). The MRI lesion stability also did not differ by COI or ADI (p = 0.66, p = 0.15). In contrast, insurance status and race varied with neighborhood context (p< 0.001). In very high COI areas, 92.8% had private insurance, and 82.9% were White, with 17.2% Black or other race. In low/very low COI areas, private insurance fell to 52.9%, and 55.9% of patients were Black or other race. Private insurance decreased from 97.9% in ADI Quartile 1 to 51.1% in Quartile 4, while Medicaid rose from 2.1% to 48.9%.
Conclusions: COI and ADI were not associated with symptom duration or MRI lesion stability in pediatric MFC OCD but were strongly linked to insurance type and race. High COI/low ADI clustered with privately insured, predominantly White patients. Low COI/high ADI clustered with Medicaid-insured and Black patients. Children from low-COI/high-ADI neighborhoods more often rely on Medicaid and are non-white despite disease severity.
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Poster Board Number: 15