Wait or Drill? Shared Decision-making in Adolescents With Stable Osteochondritis Dissecans of the Knee

Treatment of stable juvenile osteochondritis dissecans (OCD) of the knee in adolescents is controversial. Traditionally, initial management has been nonoperative. However, early subchondral drilling is also a consideration to potentially reduce the recovery time because ∼50% of stable OCD lesions eventually require surgery after a period of failed nonoperative care. This study uses choice-based conjoint (CBC) analysis to explore patient and family preferences regarding initial nonoperative treatment versus early drilling.

This study used a CBC survey using Sawtooth Software (Lighthouse Studio version 9.2.0) to collect demographic information and preferences on surgical scenarios. Anonymous participants were recruited through the Prolific crowdsourcing platform. Eligible participants were US residents over 18 years of age with children aged 12 to 17. Data were analyzed using Hierarchical Bayes and logistic regression to determine the importance of each attribute and correlate preferences with demographic variables.

Of the 474 participants, the highest importance was placed on minimizing treatment failure (46.3%), followed by the likelihood of needing surgery (22.4%), cost (11.8%), time on crutches (10.8%), and return to normal activities (8.7%). Simulation of surgical decision-making showed a strong preference for early surgery (90.8%) over conservative treatment (9.2%). Preferences varied slightly by demographics, with female participants valuing recovery time more and male participants prioritizing cost.

Our findings indicate a significant preference for early surgical intervention driven by concerns over treatment failure and the need for a future surgery with a second recovery period. Despite some demographic differences in attribute importance, no specific patient characteristic significantly influenced the overall treatment preference.

Early drilling of stable OCD lesions of the knee is favored by most parents of adolescents, primarily to reduce the risk of future surgery/recovery. This preference underscores the importance of personalized treatment discussions and highlights the need for shared decision-making tools that incorporate individual patient values.