The incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knees: a systematic review a
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The incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knees: a systematic review and meta‑analysis Si Heng Sharon Tan1 · Beverly Shu Wen Tan1 · Wei Yang Wilson Tham1 · Andrew Kean Seng Lim1 · James Hoipo Hui1 Received: 31 July 2020 / Accepted: 4 November 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose The current systematic review and meta-analysis aim to pool together the incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knee. Methods The systematic review was conducted according to PRISMA guidelines. A search was conducted using PubMed and Cochrane Library with the keywords being “knee” and “osteochondritis dissecans” or “osteochondral lesion”. All original human studies that reported the incidence or risk factors of osteoarthritis following osteochondritis dissecans of the knee were included. Results Nine studies with 496 patients were included. The incidence of osteoarthritis following osteochondritis dissecans is 0.39 (95% CI 0.19–0.59). Patients with a body mass index greater than 25 kg/m2 had a significantly increased risk of osteoarthritis. Fragment excision had an increased relative risk of 1.89 (95% CI 1.19–3.01) of osteoarthritis as compared to fragment preservation. Significant heterogeneity was identified when comparing between juvenile and adult osteochondritis dissecans. The size of the lesions moderated the between-study heterogeneity with regards to the incidence of osteoarthritis, with the relative risk of osteoarthritis in lesions bigger than 4 cm2 being 2.29 (95% CI 1.24–4.23). No other risk factors, including gender of the patient, location of osteochondritis dissecans, stability of osteochondritis dissecans, and surgical versus non-surgical management were significant risk factors. Conclusion Significant risk factors for osteoarthritis were increased body mass index and fragment excision. Probable but inconclusive risk factors were the age of the patients and the size of the osteochondritis dissecans. The gender of the patient, location of osteochondritis dissecans, the stability of osteochondritis dissecans, and surgical versus non-surgical management of osteochondritis dissecans when appropriate were not significant risk factors. Keywords Osteochondritis dissecans · Osteoarthritis · Incidence · Risk factors
Introduction The aim of treatment of osteochondritis dissecans of the knee is to obtain healing, to prevent persistent knee pain and osteoarthritis [1]. This is because osteochondritis dissecans of the knee predominantly affects children and adolescents between 6 and 21 years; therefore, long-term treatment outcomes of the condition are of paramount importance [1, 4, * Si Heng Sharon Tan [email protected] 1
16]. Many studies have, therefore, attempted to investigate the incidence and risk factors of osteoarthritis following treatment of osteochondritis dissecans, though the best available evidence to date is still limited to small r
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