Pediatric orthopaedic surgeons around the country remain baffled by a rare condition called osteochondritis dissecans (OCD), a degenerative cartilage disorder that strikes the knees of active, athletic teenagers. The surgeons teleconference frequently and meet several times a year to share information about their rare cases to better understand a condition with no known cause, and no proven best treatment.
Their collaborative team, Research in OsteoChondritis of the Knee (ROCK) Group, has cleared one hurdle by reaching baseline agreement on the key anatomical features that mark the condition. Results of the team’s first Cincinnati-led, multi-center study appear in the February 15 issue of The American Journal of Sports Medicine.
In the ROCK study, seven orthopaedic specialists rated X-rays of 45 different knees for nine or more specific OCD characteristics. The study showed highly reliable agreement among the doctors on features such as growth plate maturity, condylar width and lesion size, and the ability to differentiate medial and lateral lesions in the knee. Other characteristics were less reliable for identifying OCD.
“We all hate osteochondritis dissecans because it’s so nebulous and so debilitating,” according to Eric Wall, MD, study coordinator and director of Orthopaedic Sports Medicine. Aided by new data, doctors will now focus on how specific OCD features correlate to treatment outcomes, Wall says.
With treatment failure rates of 30 percent, some OCD-diagnosed adolescents must drastically reduce physical activities for up to two years as cartilage recovers, and others can develop early onset degenerative arthritis. Affected knee tissue, Wall says, “looks like a Cincinnati road after a hard winter, with a big deep pothole in the knee cartilage. But asking a 10-year-old to rest for up to two years – that’s a lot of time out of a young life. Our goal is to cure it in the next decade.”