Nonoperative Management of Juvenile Osteochondritis Dissecans Lesions of the Medial Femoral Condyle: Comparing Cylinder Cast, Hinged Knee Brace Locked Into Extension, and Activity Modification

Abstract

OBJECTIVE: Compare nonoperative treatment options in juvenile osteochondritis dissecans (OCD) lesions of the medial femoral condyle. DESIGN: Descriptive, retrospective cohort study. SETTING: Single academic pediatric tertiary referral center. PATIENTS OR PARTICIPANTS: Male/female patients ages 0 to 18 evaluated in the sports/orthopedic ambulatory setting who were found to have OCD lesions in the medial femoral condyle. INTERVENTIONS OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES: Cast immobilization, hinged knee brace locked into extension, and activity modification. MAIN OUTCOME MEASURES: Nonoperative treatment effectiveness between the 3 groups was evaluated by radiographic healing and symptom resolution, with failure defined as progression to surgery. RESULTS: A total of 148 patients with 168 MFC JOCD lesions of the knee were identified. Median age was 11 years old. Patients were 65.5% male and 77% participated in sports. Sixty-two (37%) lesions were treated in a HKB locked into extension, 55 (32%) were casted in a cylinder cast, and 51 (31%) were treated with activity modification alone. Approximately 19% of HKB locked into extension, 22% of casted MFC JOCD, and 16% of activity-modified MFC JOCD lesions progressed to surgery. At 6 months, 76% of the HKB locked into extension, 71% of the cylinder cast, and 71% of the activity modification group had resolution of clinical symptoms and returned to activity. CONCLUSIONS: MFC JOCD lesions of the knee can be appropriately treated with a HKB brace locked in extension, cast, or activity modification with consistent success rates. CLINICAL RELEVANCE: This study provides practical evidence regarding conservative management of MFC JOCD lesions. LEVEL OF EVIDENCE: III.