02:21pm Thursday 04 June 2020

Guideline Reports a Lack of Quality Research on Treating Orthopaedic Condition

osemont, IL – The American Academy of Orthopaedic Surgeons (AAOS) Board of Directors approved and released a clinical practice guideline for treating osteochondritis dissecans (OCD) of the knee — a rare orthopaedic disorder that affects mostly physically active adolescents and young adults. This puzzling condition occurs when a piece of cartilage and bone detaches, and when severe, gets jammed between the moving parts of the bone, causing considerable pain in the joint. OCD of the knee can also lead to swelling and the inability to continue to play sports.

This clinical practice guideline was developed following a sweeping systematic review of the available high-quality (Level 1-3) literature from January 1966 through March 2010. This document addresses the diagnosis and treatment of of OCD in both children who were still growing (skeletally immature) and teenagers and adults who have completed their growth (skeletally mature).

Henry Chambers, MD, a pediatric orthopaedic surgeon who practices in San Diego, and serves as chair of the AAOS work study group on OCD of the knee, says, “We were humbled to realize that there are no adequate studies on either the operative or non-operative treatment of this problem. Nor are there any adequate studies on the evaluation of OCD by X-ray, MRI, CT scan, or bone scan. There also is a lack of research on which, if any, rehabilitation might alter the natural history of this disorder.”

From the available evidence reviewed for this clinical practice guideline, it is the opinion of the AAOS work group that:

  • Symptomatic skeletally immature patients with loose or completely detached lesions should be offered the option of surgery. There is, however, no support for any particular kind of surgery.
  • Patients who remain symptomatic after treatment for OCD should have a repeat history and physical examination, X-rays, and/or MRI to assess healing.
  • Patients who receive surgical treatment of OCD should be offered post-operative physical therapy.

“Ultimately, this review process has been a positive step for the AAOS and our patients,” says Chambers. “The experience has given us the understanding of specific gaps in our knowledge and the direction future research must take. More importantly, we now have an understanding of how to proceed with prospective, multi-center controlled studies, which will allow us to come closer to some of these unknowns when treating this challenging condition.”

The full guideline along with all supporting documentation and work group disclosures is available on the AAOS website at: http://www.aaos.org/guidelines.

Disclaimer: This Clinical Practice Guideline is not intended to be a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician’s independent medical judgment, given the individual patient’s clinical circumstances.

Editor’s Note: A physician volunteer work group developed this Clinical Practice Guideline, based upon a systematic review of the current scientific and clinical information and accepted approaches to treatment and/or diagnosis. The entire process included a review panel consisting of internal and external committees, pubic commentaries, and final approval by the AAOS Board of Directors.

More information about osteochondritis dissecans is available at: http://orthinfo.org

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