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Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus
Published on: January 23, 2018
Predicting Outcomes of Talar Osteochondritis Dissecans Lesions in Children
Mitchell A Johnson1, Kunbo Park1, Divya Talwar1
1Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Younger patients with lower BMI showed better radiographic healing for talar osteochondritis dissecans (TOCD). Surgical treatment impact on healing was more pronounced in older, higher BMI patients with TOCD.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Limited data exists on radiographic healing rates for talar osteochondritis dissecans (TOCD).
- Few studies characterize treatment outcomes and risk factors for poor outcomes in pediatric TOCD.
Purpose of the Study:
- Identify factors predicting TOCD healing in children.
- Assess treatment outcomes for pediatric TOCD.
- Develop a nomogram to predict TOCD healing.
Main Methods:
- Retrospective review of 92 TOCD lesions in 74 pediatric patients (≤18 years).
- Analysis of surgical vs. non-operative treatments.
- Multivariable logistic regression to identify healing predictors at 1-year follow-up.
Main Results:
- Complete radiographic healing occurred in 47% of lesions.
- Younger age, skeletal immaturity, and lower BMI were associated with complete healing.
- Age, BMI, and initial surgical treatment significantly predicted healing; lesion size did not.
Conclusions:
- TOCD healing is more likely in younger, lower BMI pediatric patients.
- Initial surgical treatment benefits for healing are greater in older, higher BMI patients.
Background:
Reports detailing the rates of radiographic healing after treatment of talar osteochondritis dissecans (TOCD) remain scarce. There is also a paucity of data characterizing treatment outcomes and the risk factors associated with poor outcomes in children with TOCD.
Purpose:
To identify factors associated with healing, assess treatment outcomes, and develop a clinically useful nomogram for predicting healing of TOCD in children.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
This was a retrospective review of all patients ≤18 years of age with TOCD from a single pediatric institution over a 12-year period. Surgical treatment was left to the discretion of the treating surgeon based on standard treatment techniques. Medical records and radiographs were reviewed for patient and clinical data, lesion characteristics, and skeletal maturity. Radiographic healing was evaluated at the 1-year follow-up, and patients with complete versus incomplete healing were compared using multivariable logistic regression models to examine the predictive value of the variables.
Results:
The authors analyzed 92 lesions in 74 patients (mean age, 13.1 ± 2.7 years [range, 7.1-18.0 years]; 61% female). Of these, 58 (63%) lesions were treated surgically (drilling, debridement, microfracture, bone grafting, or loose body removal), and the rest were treated nonoperatively. Complete radiographic healing was seen in 43 (47%) lesions. In bivariate analysis, patients with complete healing were younger (P = .006), were skeletally immature (P = .013), and had a lower body mass index (BMI; P < .001) versus those with incomplete healing. In a multivariate regression model, the factors that correlated significantly with the rate of complete healing were age at diagnosis, BMI, and initial surgical treatment. The lesion dimensions were not significantly associated with the likelihood of healing. A nomogram was developed using the independent variables that correlated significantly with the likelihood of complete radiographic healing.
Conclusion:
Complete radiographic healing of TOCD lesions was more likely in younger patients with a lower BMI. The effect of initial surgical treatment on potential healing rate was greater in older patients with a higher BMI.
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