1. Juvenile osteochondritis dissecans: a 5-year review of the natural history using clinical and MRI evaluation.
- Author
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Hughes, Jacqueline A., Cook, Jane V., Churchill, Mark A., and Warren, Mary E.
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OSTEOCHONDROSIS , *BONE diseases , *MAGNETIC resonance imaging , *DIAGNOSTIC imaging , *MEDICAL imaging systems , *PROGNOSIS , *ARTHROSCOPY , *COMPARATIVE studies , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *EVALUATION research , *TREATMENT effectiveness , *RETROSPECTIVE studies , *SEVERITY of illness index , *DIAGNOSIS - Abstract
Background: Although MRI prognostic features for juvenile osteochondritis dissecans (JOCD) have been determined, the natural history of JOCD on serial MRI has not been fully documented.Objectives: To document the natural history of JOCD on serial MRI and to correlate this with arthroscopy and clinical outcome over a 5-year follow-up.Materials and Methods: Twenty-one knees in 19 patients (15 boys, 4 girls; age range 5-15 years) with JOCD underwent MRI and clinical follow-up over 5 years. Lesions were classified as stable or unstable on MRI and compared with clinical and arthroscopic data.Results: On 5-year follow-up, 17 of 19 patients were asymptomatic and 2 of 19 had minimal pain. Fourteen arthroscopies were performed on 11/21 knees. One of twenty-one had fragment fixation. On initial MRI, eight knees had marked fragmentation, high signal at the fragment/bone interface and incomplete defects in the hyaline cartilage (MRI stage III-stable), but no tear. Of these, five had arthroscopy, all confirming intact cartilage. One of twenty-one knees was unstable (MRI stage IVb) with a detached osteochondral fragment, requiring surgery.Conclusions: Despite extensive subchondral bone changes on MRI, all cases with intact cartilage (95%) improved with conservative treatment. Early MRI allows prompt diagnosis and institution of conservative treatment. This results in healing and avoidance of surgery in most patients. [ABSTRACT FROM AUTHOR]- Published
- 2003
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