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Males and Females Exhibit Comparable Outcomes Following Treatment of OCD Lesions of the Knee: A Systematic Review

      Purpose

      The purpose of this study was to evaluate the impact of patient sex on outcomes after treatment of osteochondritis dissecans (OCD) lesions of the knee through a systematic review of current evidence.

      Methods

      This review was conducted according to the PRISMA guidelines using the PubMed, PubMed Central, Embase, Ovid Medline, Cochrane Libraries, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Relevant outcomes included functional (e.g., International Knee Documentation Committee and Subjective Knee Evaluation, Lysholm Knee Score) and clinical outcomes (e.g., symptom/pain resolution, reoperation rates) for males and females after operative or nonoperative treatment of knee OCD lesions.

      Results

      Ten articles with a total of 691 (73%) males and 260 (27%) females were included. Mean age ranged from 11.3 ± 2.1 years to 34.5 ± 10.3 years, and follow-up ranged from 6 months to 16.3 years. In four studies reporting functional outcomes, no significant differences were found between males and females in any metric assessed (all P > .05). Seven studies reported clinical outcomes after treatment of knee OCD lesions. One study determined males were more likely to have a successful nonoperative outcome than females (OR: 1.85, 95% CI: 1.00-3.40). Another study found males had a lower risk of developing symptomatic knee pain following operative or nonoperative treatment at a mean 14-year follow-up (HR: 0.24; 95% CI: 0.07-0.81). The remaining 5 studies reported statistically comparable clinical outcomes between males and females (all P > .05).

      Conclusion

      The present systematic review found mostly comparable clinical and functional outcomes between males and females following treatment of knee OCD lesions. Despite sex-related differences in the prevalence of these lesions and limited evidence of differences in clinical outcomes, these data suggest that sex does not independently predict outcomes after treatment.

      Level of Evidence

      III, systematic review of Level II and III studies.
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      References

        • Weiss J.M.
        • Shea K.G.
        • Jacobs J.C.
        • et al.
        Incidence of osteochondritis dissecans in adults.
        Am J Sports Med. 2018; 46: 1592-1595
        • Bruns J.
        • Werner M.
        • Habermann C.
        Osteochondritis dissecans: Etiology, pathology, and imaging with a special focus on the knee joint.
        Cartilage. 2018; 9: 346-362
        • Accadbled F.
        • Vial J.
        • Sales de Gauzy J.
        Osteochondritis dissecans of the knee.
        Orthop Traumatol Surg Res. 2018; 104: S97-S105
        • McElroy M.J.
        • Riley P.M.
        • Tepolt F.A.
        • Nasreddine A.Y.
        • Kocher M.S.
        Catcher's knee: Posterior femoral condyle juvenile osteochondritis dissecans in children and adolescents.
        J Pediatr Orthop. 2018; 38: 410-417
        • Bauer K.L.
        • Polousky J.D.
        Management of osteochondritis dissecans lesions of the knee, elbow and ankle.
        Clin Sports Med. 2017; 36: 469-487
        • Jones M.H.
        • Williams A.M.
        Osteochondritis dissecans of the knee: A practical guide for surgeons.
        Bone Joint J. 2016; 98-b: 723-729
        • Patel N.M.
        • Helber A.R.
        • Gandhi J.S.
        • Shea K.G.
        • Ganley T.J.
        Race predicts unsuccessful healing of osteochondritis dissecans in the pediatric knee.
        Orthopedics. 2021; 44: e378-e384
        • Hevesi M.
        • Sanders T.L.
        • Pareek A.
        • et al.
        Osteochondritis dissecans in the knee of skeletally immature patients: Rates of persistent pain, osteoarthritis, and arthroplasty at mean 14-Years’ follow-up.
        Cartilage. 2020; 11: 291-299
        • Weiss J.M.
        • Nikizad H.
        • Shea K.G.
        • et al.
        The incidence of surgery in osteochondritis dissecans in children and adolescents.
        Orthop J Sports Med. 2016; 4 (2325967116635515)
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4 (1-1)
        • Wright J.G.
        • Swiontkowski M.F.
        • Heckman J.D.
        Introducing levels of evidence to the journal.
        J Bone Joint Surg Am. 2003; 85: 1-3
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Krause M.
        • Hapfelmeier A.
        • Möller M.
        • Amling M.
        • Bohndorf K.
        • Meenen N.M.
        Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment.
        Am J Sports Med. 2013; 41: 2384-2391
        • Tepolt F.A.
        • Kalish L.A.
        • Heyworth B.E.
        • Kocher M.S.
        Nonoperative treatment of stable juvenile osteochondritis dissecans of the knee: Effectiveness of unloader bracing.
        J Pediatr Orthop B. 2020; 29: 81-89
        • Kocher M.S.
        • Micheli L.J.
        • Yaniv M.
        • Zurakowski D.
        • Ames A.
        • Adrignolo A.A.
        Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling.
        Am J Sports Med. 2001; 29: 562-566
        • Adjei J.
        • Nwachukwu B.U.
        • Zhang Y.
        • et al.
        Health state utilities in children and adolescents with osteochondritis dissecans of the knee.
        Orthop J Sports Med. 2019; 7 (2325967119886591)
        • Sanders T.L.
        • Pareek A.
        • Obey M.R.
        • et al.
        High rate of osteoarthritis after osteochondritis dissecans fragment excision compared with surgical restoration at a mean 16-year follow-up.
        Am J Sports Med. 2017; 45: 1799-1805
        • Wall E.J.
        • Vourazeris J.
        • Myer G.D.
        • et al.
        The healing potential of stable juvenile osteochondritis dissecans knee lesions.
        J Bone Joint Sur Am. 2008; 90: 2655-2664
        • Perelli S.
        • Romoli A.R.M.
        • Costa-Paz M.
        • Erquicia J.I.
        • Gelber P.E.
        • Monllau J.C.
        Internal fixation of osteochondritis dissecans of the knee leads to good long-term outcomes and high degree of healing without differences between fixation devices.
        J Clin Med. 2019; 8: 1934
        • Lee S.
        • Frank R.M.
        • Christian D.R.
        • Cole B.J.
        Analysis of defect size and ratio to condylar size with respect to outcomes after isolated osteochondral allograft transplantation.
        Am J Sports Med. 2019; 47: 1601-1612
        • Beck J.J.
        • Sugimoto D.
        • Micheli L.
        Sustained results in long-term follow-up of autologous chondrocyte implantation (ACI) for distal femur juvenile osteochondritis dissecans (JOCD).
        Adv Orthop. 2018; 2018: 7912975
        • Kessler J.I.
        • Nikizad H.
        • Shea K.G.
        • Jacobs Jr., J.C.
        • Bebchuk J.D.
        • Weiss J.M.
        The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents.
        Am J Sports Med. 2014; 42: 320-326
        • Kessler J.I.
        • Nikizad H.
        • Shea K.G.
        • Jacobs J.C.
        • Ishkhanian R.M.
        • Weiss J.
        The demographics, epidemiology, and incidence of progression to surgery of osteochondritis dissecans of the knee in children and adolescents.
        Orthop J Sports Med. 2013; 1 (2325967113S2325900075)
        • Pareek A.
        • Sanders T.L.
        • Wu I.T.
        • Larson D.R.
        • Saris D.B.F.
        • Krych A.J.
        Incidence of symptomatic osteochondritis dissecans lesions of the knee: a population-based study in Olmsted County.
        Osteoarthritis Cartilage. 2017; 25: 1663-1671
        • Kramer D.E.
        • Yen Y.M.
        • Simoni M.K.
        • et al.
        Surgical management of osteochondritis dissecans lesions of the patella and trochlea in the pediatric and adolescent population.
        Am J of Sports Med. 2015; 43: 654-662
        • De Smet A.A.
        • Ilahi O.A.
        • Graf B.K.
        Untreated osteochondritis dissecans of the femoral condyles: Prediction of patient outcome using radiographic and MR findings.
        Skeletal Radiol. 1997; 26: 463-467
        • Hefti F.
        • Beguiristain J.
        • Krauspe R.
        • et al.
        Osteochondritis dissecans: A multicenter study of the European pediatric orthopedic society.
        J Pediatr Orthop B. 1999; 8: 231-245
        • Sanders T.L.
        • Pareek A.
        • Johnson N.R.
        • et al.
        Nonoperative management of osteochondritis dissecans of the knee: Progression to osteoarthritis and arthroplasty at mean 13-year follow-up.
        Orthop J Sports Med. 2017; 5 (2325967117704644)
        • Tan S.H.S.
        • Tan B.S.W.
        • Tham W.Y.W.
        • Lim A.K.S.
        • Hui J.H.
        The incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knees: A systematic review and meta-analysis.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 3096-3104
        • McNickle A.G.
        • L'Heureux D.R.
        • Yanke A.B.
        • Cole B.J.
        Outcomes of autologous chondrocyte implantation in a diverse patient population.
        Am J Sports Med. 2009; 37: 1344-1350
        • Krishnan S.P.
        • Skinner J.A.
        • Bartlett W.
        • et al.
        Who is the ideal candidate for autologous chondrocyte implantation?.
        J Bone Joint Surg Br. 2006; 88: 61-64
        • Kreuz P.C.
        • Müller S.
        • von Keudell A.
        • et al.
        Influence of sex on the outcome of autologous chondrocyte implantation in chondral defects of the knee.
        Am J Sports Med. 2013; 41: 1541-1548
        • Kreuz P.C.
        • Müller S.
        • Erggelet C.
        • et al.
        Is gender influencing the biomechanical results after autologous chondrocyte implantation?.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 72-79
        • Csintalan R.P.
        • Schulz M.M.
        • Woo J.
        • McMahon P.J.
        • Lee T.Q.
        Gender differences in patellofemoral joint biomechanics.
        Clin Orthop Relat Res. 2002; 402: 260-269
        • Varadarajan K.M.
        • Gill T.J.
        • Freiberg A.A.
        • Rubash H.E.
        • Li G.
        Patellar tendon orientation and patellar tracking in male and female knees.
        J Orthop Res. 2010; 28: 322-328