Operative Management of Osteochondritis Dissecans: Progression to Osteoarthritis and Arthroplasty in a Population Based Cohort

OBJECTIVES: Osteochondritis dissecans (OCD) is a disorder of subchondral bone that causes adverse effects on the overlying cartilage and commonly affects the knee. The purpose of this study is to (1) evaluate the rate of arthritis and knee arthroplasty in a population-based cohort of patients with OCD lesions treated operatively and (2) evaluate factors that may predispose patients to knee osteoarthritis and arthroplasty. METHODS: 221 patients (mean age 26.1 ± 13.6 years) with OCD lesions treated operatively were identified between 1976 and 2014 and followed for a mean of 16.3 (±11.4) years from diagnosis. Information related to the diagnosis, laterality of lesion, details of treatment, and progression to arthritis was obtained from the medical record. Surgical treatment was classified as palliative (fragment excision) or restorative (lesion drilling, fragment fixation, osteochondral allograft or autograft). Factors predictive of arthritis and arthroplasty were examined. RESULTS: In the palliative group, the cumulative incidence of arthritis was 12.0% at 5 years, 17.0% at 10 years, 26.0% at 15 years, 39.0% at 20 years, and 70% at 30 years. The cumulative incidence of arthroplasty was 2.0% at 5 years, 4.0% at 10 years, 4.0% at 15 years, 10.0% at 20 years, and 32.0% at 30 years. In the restorative group, the cumulative incidence of arthritis was 3.0% at 5 years, 7.0% at 10 years, 16.0% at 15 years, 25.0% at 20 years, and 51% at 30 years. The cumulative incidence of arthroplasty was 0.0% at 5 years, 0.0% at 10 years, 3.0% at 15 years, 6.0% at 20 years, and 11.0% at 30 years. BMI greater than 25 kg/m(2) (HR 3.3, 95% CI: 1.6, 7.0), older age at diagnosis (HR 4.9, 95% CI: 1.8, 17.3) and fragment excision (HR 2.3, 95% CI: 1.2, 4.6) were predictive of arthritis. CONCLUSION: OCD patients treated with fragment excision have a high rate of arthritis and knee arthroplasty at long-term follow-up. In contrast, patients treated with fragment repair or osteochondral restoration have lower rates of arthritis and arthroplasty. BMI greater than 25 kg/m(2), older age at diagnosis, and fragment excision were predictive of arthritis.