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Quantifying Risk Factors for Osteochondritis Dissecans in Children: A Propensity-Matched Retrospective Cohort Study
Joseph A Magoline1, Daniel F Wagner2, David C Kaelber3
1Department of Orthopedics, Akron Children's Hospital, Akron, Ohio, USA.
Insights
This study found that certain sports like gymnastics and medical conditions such as thrombophilia significantly increase the risk of osteochondritis dissecans (OCD) in young patients. Understanding these risk factors is crucial for prevention and early intervention in pediatric orthopaedics.
Area of Science:
- Pediatric Orthopaedics
- Epidemiology
- Sports Medicine
Background:
- Osteochondritis dissecans (OCD) is a developmental pediatric orthopedic condition affecting cartilage vascular supply, leading to joint degeneration.
- While repetitive trauma is a known factor, biological and hereditary predispositions are increasingly recognized.
- Understanding these factors is key to managing OCD in young populations.
Purpose of the Study:
- To quantify the relative risk (RR) of developing OCD in relation to specific biological comorbidities and athletic activities.
- To analyze a large, representative population of pediatric and adolescent patients.
- To update epidemiologic trends and identify novel risk associations for OCD.
Main Methods:
- A cross-sectional study utilizing the TriNetX US Collaborative Network (2017-2024) for patients aged 25 years and under.
- International Classification of Diseases (ICD-10) codes identified patients with OCD and associated conditions (e.g., hypopituitarism, coagulopathies, obesity).
- Propensity matching was used to calculate the relative risk (RR) of OCD associated with specific medical conditions and sports participation.
Main Results:
- 18,493 patients with OCD were identified; the knee was the most common site (49%).
- Annual OCD incidence increased from 15 to 23 per 100,000 between 2017 and 2024.
- High-risk sports included gymnastics (RR 4.96), volleyball (RR 2.96), and cheerleading (RR 2.83). Significant medical risk factors included primary thrombophilia (RR 3.20), von Willebrand Factor deficiency (RR 2.90), and Factor V Leiden (RR 2.70).
Conclusions:
- This large-scale analysis confirms associations between OCD and specific medical conditions and athletic participation in pediatric and adolescent populations.
- Novel links between OCD and coagulopathies (e.g., thrombophilia, von Willebrand Factor deficiency, Factor V Leiden) were identified.
- Updated epidemiologic data and quantified risk factors provide valuable insights for managing pediatric OCD.
Background:
Osteochondritis dissecans (OCD) is a developmental orthopaedic condition in pediatric patients characterized by disruption of epiphyseal cartilage vascular supply leading to secondary subchondral bone changes and potential joint degeneration. While repetitive trauma is implicated, emerging evidence suggests a contributing role of biological and hereditary risk factors.
Purpose:
To quantify the relative risk (RR) of OCD with specific biological comorbidities and athletic participation in a large representative pediatric and adolescent population.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
We queried the TriNetX US Collaborative Network for patients aged ≤25 years between 2017 and 2024. Using International Classification of Diseases (ICD-10) diagnosis codes, we identified patients with potentially associated medical conditions (eg, hypopituitarism, vitamin D deficiency, coagulopathies, obesity, and nicotine dependence) and participation in common youth sports. The RR of OCD development for each condition and sport was calculated after propensity matching on age and sex. Annual incidence and prevalence were also assessed.
Results:
We identified 18,493 patients with OCD (mean age at first ICD diagnosis: 13.4 ± 3.45 years; 59% male). The most common OCD location was the knee (49%). From 2017 to 2024, the annual incidence rose from 15 to 23 per 100,000. Gymnastics (RR, 4.96; [95% CI, 3.14-7.83]), volleyball (RR, 2.96 [95% CI, 1.84-4.74]), and cheerleading (RR, 2.83 [95% CI, 1.47-5.47]) were associated with the highest OCD risk among included sports. Among medical comorbidities, primary thrombophilia (RR, 3.20 [95% CI, 1.57-6.51]), von Willebrand Factor deficiency (RR, 2.90 [95% CI, 1.41-5.95]), and Factor V Leiden (RR, 2.70 [95% CI, 1.31-5.58]) carried the highest risk. Hypopituitarism (RR, 1.71 [95% CI, 1.21-2.41]) and body mass index ≥35kg/m2 (RR, 1.14 [95% CI, 1.01-1.29]) were also significantly associated. Nicotine dependence was associated with decreased risk (RR, 0.72 [95% CI, 0.57-0.91]).
Conclusion:
This large-scale analysis provides updated epidemiologic trends and quantifies risk factors associated with pediatric OCD. Age, sex, specific medical conditions, and athletic participation were linked to increased OCD risk, and novel associations between OCD and coagulopathies were identified.