The Demographics And Epidemiology Of Osteochondritis Dissecans Of The Ankle, Elbow, Foot, And Shoulder In Children

OBJECTIVES: To assess the demographics and epidemiology of osteochondritis dissecans (OCD) of the ankle, elbow, foot, and shoulder in patients age 2-19. METHODS: A retrospective chart review was done on OCD between 2007 and 2011. Inclusion criteria included OCD of the ankle, elbow, foot, or shoulder, and patients aged 2-19. Exclusion criteria included the co-existence of any other intra-articular lesions. Joint involvement, laterality, and all patient demographics were recorded. The incidence of OCD in 2010 was determined for the ankle, elbow, and foot. RESULTS: 125 patients with a total of 128 OCD lesions fit the inclusion criteria. 60.2% of lesions were right sided and 39.8% left sided. Males had 53.9% and females 46.1% of all lesions. Lesions of the ankle, elbow, foot, and shoulder represented 66.4%, 31.3%, 0.8%, and 1.6% of all joints, respectively. No OCD lesions were found in the 2-5 year-olds. The incidence of ankle OCD for patients aged 6-19 was 4.7 per 100,000 for all patients, and 3.5, and 6.0 per 100,000 for males and females, respectively. The incidence of elbow OCD was 2.2 per 100,000 for all patients, and 3.8 and 0.6 per 100,000 for males and females, respectively. The incidence of OCD in the foot was 0.15 per 100,000 for all patients. The male/female ratio for elbow OCD was 6.4/1, and 1/1.6 for ankle OCD. In the ankle joint, the vast majority involved the medial talus (71.8%), with most of the rest involving the lateral talus (22.4%). Females had 28.8% of lesions in the lateral talus while males had only 12.1%. Almost all elbow lesions (97.5%) involved the capitellum. In the shoulder, both lesions involved the glenoid, and in the foot, the single lesion involved the metatarsal head. CONCLUSION: In this population-based cohort study of pediatric OCD in nearly 1 million children, males had a greater incidence of OCD and most were right sided. Females had nearly twice the incidence of ankle OCD, while males had over 6 times the incidence of elbow OCD. To our knowledge, this is the largest epidemiologic/demographic study of pediatric OCD of the ankle, elbow, foot, and shoulder reported.