Childhood cancer survivors: an at-risk cohort for ankle osteonecrosis

We aimed to determine if the ankle is at risk for corticosteroid-induced osteonecrosis as a cause of pain in a cohort of childhood cancer survivors. We retrospectively reviewed magnetic resonance imaging scans of the ankle in patients treated at our institution between 1993 and 2003. Among the 15 patients who met study criteria, 20 of 30 (67%) ankles were involved. Older children had the highest incidence of the disease. The tibial metaphysis, epiphysis, and talus were the most frequent sites of osteonecrotic lesions. Ten patients were symptomatic with extended weightbearing activity. Surgery was required in four with continued amelioration of pain at last followup (17-44 months). As early detection and intervention lead to prevention of ankle morbidity, childhood cancer survivors would benefit from a prospective multi-institutional study that would provide understanding of ankle osteonecrosis and development of effective interventions.

Prognostic study, Level II-1 (retrospective study).