From the Research
The most common location for osteochondritis dissecans (OCD) lesions in pediatric patients is the lateral aspect of the medial femoral condyle of the knee, accounting for approximately 75-85% of cases. Other frequent sites include the capitellum of the elbow (especially in young athletes involved in throwing sports or gymnastics), the talar dome of the ankle, and less commonly the femoral head, humeral head, and patella. These lesions typically develop in skeletally immature patients during periods of rapid growth, with peak incidence between ages 10-15 years. OCD involves separation of articular cartilage and subchondral bone from the surrounding healthy bone, likely due to repetitive microtrauma, vascular compromise, or genetic factors, as suggested by 1. Boys are affected more frequently than girls, with a ratio of approximately 3:1, though this gender disparity is decreasing as more girls participate in competitive sports. Early identification of these lesions is important as younger patients with open growth plates generally have better healing potential and outcomes compared to adolescents with closing or closed physes. Some key factors that influence the healing of OCD lesions include patient skeletal maturity, lesion location, and the size of the lesion, as noted in 1. Additionally, the presence of certain MRI findings, such as osteochondral defect, intraarticular body, cartilage alteration, and bone plate disruption, can indicate lesion instability, as reported in 2. The assessment of lesion stability by MRI can help guide decision-making regarding arthroscopy versus conservative management for MFC OCD lesions in children, as discussed in 2. Key points to consider when evaluating OCD lesions in pediatric patients include:
- The location and size of the lesion
- The skeletal maturity of the patient
- The presence of MRI findings indicative of lesion instability
- The potential for conservative management versus arthroscopy. It is essential to prioritize the most recent and highest quality study, which in this case is 2, when making decisions regarding the management of OCD lesions in pediatric patients.