1Sepanek L, 2Uqillas C, 1Haselman W, 3Karnyski S
1Cedars-Sinai Kerlan Jobe, Los Angeles, CA, United states; 2Cedar-Sinai Kerlan Jobe, Los Angeles, CA, United states; 3Cedars-sinai Kerlan Jobe, Los Angeles , CA, US
The ideal surgical management of Juvenile Osteochondritis Dissecans (JOCD) is unclear as multiple open and arthroscopic techniques exist. The treating surgeon’s method is dependent on personal experience in clinical practice & prior training. The purposes of this study are to report the surgical techniques used to manage JOCD and the complications associated with these procedures. Additionally, it is evaluating for bias in management between surgeons with backgrounds in Pediatric versus Sports Medicine Orthopaedic Surgery Fellowship and trends in the surgical technique used for JOCD over time.
Pediatric cases from the ABOS database 2010-2019 were searched by diagnosis code(osteochondritis dissecans) and organized by CPT codes. Data was further compiled according to fellowship training of the primary treating physician on the case. Fellowship backgrounds included in this database are sports medicine, pediatric, foot and ankle, adult reconstruction, trauma, hand, shoulder and elbow, oncology or unidentified. Data was collected for the most common complications seen after surgical management of JOCD.
The most commonly used technique for Sports Medicine surgeons was the drilling and screw fixation code (39.4%), Pediatric and dual trained Pediatric/Sports medicine surgeons was isolated drilling code (41.6% and 34.4%, respectively) and other orthopedic specialties was also isolated drilling (33.3%). A significant dependance was found overall between fellowship training & CPT codes reported (p=0.03). Short term complications occurred in 10.4% of cases in this cohort with no reoperations reported. Stiffness/arthrofibrosis was the most common complication.
Surgical management of JOCD is most commonly performed by surgeons with a Sports Medicine and/or Pediatric background amongst ABOS part II candidates and the surgical technique employed is dependent on the type of fellowship completed by the surgeon. These findings support the importance of education & exposure to JOCD in these two fellowship programs. Surgical management of JOCDs has trended upward and cartilage restoration procedures have increased. Overall early complication rate is low with stiffness/arthrofibrosis being the most common complication encountered which provides useful information for patient/parental counseling and for developing post-operative rehabilitation protocols.
