(From the March 2015 Issue of PediatricsOnline)
According to a prospective clinical research study, all children presenting with juvenile osteochondritis dissecans should be radiographically evaluated for bilateral lesions. The study, conducted by orthopedic specialists at Nationwide Children’s Hospital, is the first to identify risk factors for and the prevalence of bilateral JOCD.
In order to estimate the prevalence of JOCD present in both knees, 108 consecutive patients presenting with a lesion in one knee were evaluated radiographically for lesions in the other knee. Demographics and OCD factors were compared between groups presenting with only one affected knee and those in whom both knees were impacted.
“We discovered JOCD in the contralateral knee in 29 percent of patients initially presenting with OCD in a single, symptomatic knee,” says Kevin E. Klingele, MD, chief of Orthopedics at Nationwide Children’s and senior author on the study, which was published in the Journal of Pediatric Orthopedics. “In 39 percent of those cases, the second knee was asymptomatic, and 94 percent of the lesions were considered weight-bearing lesions.”
The study also examined differences in the prevalence of bilateral JOCD based on gender and age. Female patients and younger children were statistically more likely to have a lesion in both knees than males or children presenting with OCD at a more advanced age. No statistically significant difference in bilateral JOCD prevalence was noted based on lesion location, stability or pain.
“Our findings indicate that bilateral JOCD is highly prevalent among children presenting with OCD of a single knee,” says Dr. Klingele, who also is an adjunct assistant professor of Surgery at The Ohio State University College of Medicine. “Females and younger patients with OCD in a single knee are at the highest risk, but all children presenting with OCD should have the contralateral knee radiographically evaluated for bilateral JOCD.”
Bilateral, radiographic evaluation of patients with OCD is now standard of care at Nationwide Children’s.
Cooper T, Samora W, Klingele KE. Prevalence of bilateral JOCD of the knee and associated risk factors. Journal of Pediatric Orthopedics. 2014 Oct 6. [Epub ahead of print]