A Simple Clinical Predictive Model for Arthroscopic Mobility of Osteochondritis Dissecans Lesions of the Knee.,The American Journal of Sports Medicine

当前位置： X-MOL 学术 › Am. J. Sports Med. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

A Simple Clinical Predictive Model for Arthroscopic Mobility of Osteochondritis Dissecans Lesions of the Knee.
The American Journal of Sports Medicine ( IF 4.2 ) Pub Date : 2024-11-25 , DOI: 10.1177/03635465241296133
Matthew D Milewski,Patricia E Miller,Emma C Gossman,Ryan P Coene,Marc A Tompkins,Christian N Anderson,Kathryn Bauer,Michael T Busch,James L Carey,Sasha Carsen,Henry G Chambers,Ryan P Coene,Eric W Edmonds,Jutta Ellermann,Henry B Ellis,John Erickson,Peter D Fabricant,Theodore J Ganley,Emma C Gossman,Daniel W Green,Benton E Heyworth,James Hoi Po Hui,Mininder S Kocher,Aaron J Krych,Kevin Latz,Roger M Lyon,Stephanie Mayer,Matthew D Milewski,Patricia E Miller,Bradley J Nelson,Jeffrey J Nepple,Jie C Nguyen,Carl W Nissen,James Lee Pace,Mark V Paterno,Andrew T Pennock,Crystal Perkins,John D Polousky,Paul Saluan,Kevin G Shea,Marc A Tompkins,Eric J Wall,Jennifer M Weiss,Clifton Willimon,Philip Wilson,Rick W Wright,Andy Zbojniewicz,Gregory D Myer

BACKGROUND Osteochondritis dissecans (OCD) of the knee is a focal idiopathic alteration of subchondral bone and/or its precursor with risk for instability and disruption of adjacent cartilage. Treatment options focused on preventing premature osteoarthritis vary depending on multiple patient and lesion characteristics, including lesion mobility. PURPOSE To differentiate lesion mobility before arthroscopy using a multivariable model that includes patient demographic characteristics and physical examination findings. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS Demographic, preoperative physical examination, and radiographic data were collected from a multicenter national prospective cohort of patients with OCD of the knee. Inclusion criteria included patients <19 years of age and patients with arthroscopically confirmed mobility status based on the Research on Osteochondritis Dissecans of the Knee arthroscopy classification. Multivariable logistic regression analysis using stepwise model selection was used to determine factors associated with the likelihood of a mobile versus an immobile lesion. A 75% partition of the data was used for model training, and 25% was used as a validation cohort. Quantitative model fit statistics were computed using the holdout data, including sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC), along with the corresponding 95% CI. RESULTS A total of 407 patients in the prospective cohort met inclusion criteria, and 62% were male. The mean ± SD age was 13.7 ± 2.2 years, height 161.8 ± 5.3 cm, and weight 59.2 ± 42.2 kg. Arthroscopic evaluation yielded 235 immobile and 172 mobile lesions. Multivariable analysis determined that the best model to predict lesion mobility included chronologic age ≥14 years (P < .001), effusion on physical examination (P < .001), and any loss of range of motion on physical examination (P = .07), while controlling for male sex (P = .38) and weight >54.4 kg (P = .12). In the 25% holdout validation sample (n = 102), a sensitivity of 83%, a specificity of 82%, and an AUC of 0.89 (95% CI, 0.82-0.95) were achieved with these predictive factors. CONCLUSION Age, effusion, and loss of motion can predict knee OCD lesion mobility at the time of arthroscopy. Education about lesion mobility can help with surgical planning and patient and family counseling.

更新日期：2024-11-25

点击分享查看原文

点击收藏

阅读更多本刊新发论文