Surgical management of juvenile osteochondritis dissecans of the knee

Purpose: Operative management of osteochondritis dissecans (OCD) in the juvenile knee is generally indicated upon failure of conservative treatment, in unstable lesions, and in lesions nearing physeal closure. We hypothesized that juvenile OCD lesions have improved clinical and radiographic outcomes with surgical treatment following failed non-surgical management, in unstable lesions, and in lesions nearing physeal closure. Methods: Multiple medical databases were searched for Levels I-IV evidence with specific study inclusion and exclusion criteria. Length of mean follow-up was minimum 2 years. Studies were included if an analysis of clinical outcomes following surgical treatment of juvenile OCD was performed. All surgical techniques and defect classifications were potentially inclusive. Results: Thirty studies (29 Level IV evidence) were included for analysis (783 subjects, 862 knees). Mean post-operative follow-up was 77 months. Nearly all studies within this review demonstrated significant clinical and radiographic improvements in outcomes in surgically treated juvenile OCD at short-, mid-, and long-term follow-up. Isolated excision of weight-bearing OCD lesions led to poorer clinical and radiographic results than other surgical techniques. Outcomes were significantly better with juvenile OCD versus adult OCD. Conclusions: Surgical treatment of juvenile OCD has significantly improved clinical and radiographic outcomes at short-, mid-, and long-term follow-up. No difference in clinical or radiographic outcome was demonstrated in comparing different surgical techniques, with the exception of poorer results with isolated fragment excision. Level of evidence: IV.