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- Title
Juvenile osteochondritis dissecans of the talus: predictors of conservative treatment failure.
- Authors
Heyse, Thomas; Schüttler, Karl; Schweitzer, Annette; Timmesfeld, Nina; Efe, Turgay; Paletta, Jürgen; Fuchs-Winkelmann, Susanne; Fernandez, Francisco; Heyse, Thomas J; Schüttler, Karl F; Paletta, Jürgen R; Fernandez, Francisco Fernandez
- Abstract
<bold>Background: </bold>The ideal treatment for juvenile osteochondritis dissecans of the talus (ODT) is still unclear. To determine predictors of failure of conservative treatment, children admitted for ODT were retrospectively analyzed.<bold>Methods: </bold>Patient files were analyzed to search for children treated for an ODT between 2000 and 2011. X-rays and MRI at baseline were evaluated for grading of lesions and the patient history was obtained. Final follow-up evaluation was performed via questionnaire and complementary telephone interview. Outcome was measured using the AOFAS and the Olerud/Molander scores. Conservative treatment consisted of out of sports and modification of activity under full weight-bearing. In case of persisting pain, full load removal on crutches was initiated. For further analysis, two groups were formed: (1) successful conservative treatment; (2) converted to surgical therapy. A logistic regression was used to determine potential predictors of conservative treatment failure.<bold>Results: </bold>Seventy-seven lesions in 67 children with a mean age of 11.4 years (range 4-15 years) at the time of diagnosis were identified. Every patient received conservative treatment as a first-line treatment after diagnosis of ODT except for one single patient with a grade IV lesion at time of diagnosis who received operative treatment directly after diagnosis. Sixty-one percent of the lesions failed conservative treatment. A higher age as well as a grade III lesion at time of diagnosis was predictive for failure of the conservative treatment (p = 0.03 and p = 0.02, respectively). Regarding the functional outcome, a higher grade lesion in general was predictive for an inferior outcome as measured by clinical score.<bold>Conclusion: </bold>Grade III ODT especially in older children leads significantly more often to treatment failure when treated non-surgically. No other predictors for treatment failure could be identified.<bold>Level Of Evidence: </bold>Level III (retrospective comparative study).
- Subjects
OSTEOCHONDRITIS; ANKLEBONE; MEDICAL applications of x-rays; MAGNETIC resonance imaging; JUVENILE diseases; SURGICAL therapeutics; DISEASES; THERAPEUTICS; ANKLEBONE surgery; EXERCISE therapy; FOOT diseases; ORTHOPEDIC surgery; OSTEOCHONDROSIS; PROGNOSIS; TREATMENT effectiveness; RETROSPECTIVE studies; DIAGNOSIS
- Publication
Archives of Orthopaedic & Trauma Surgery, 2015, Vol 135, Issue 10, p1337
- ISSN
0936-8051
- Publication type
journal article
- DOI
10.1007/s00402-015-2260-4