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AAOS issues guideline for knee disorder that involves cartilage and bone
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The American Academy of Orthopaedic Surgeons has released a clinical practice guideline for treating osteochondritis dissecans of the knee.
Henry Chambers, MD, of San Diego, chaired of the work study group that reviewed evidence for the new osteochondritis dissecans (OCD) guideline. “We were humbled to realize that there are no adequate studies on either the operative or nonoperative treatment of this problem,” he stated in a press release from the American Academy of Orthopaedic Surgeons (AAOS). “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 the disease.”
The guideline was developed after a review of high-quality studies (levels 1 to 3) published between January 1966 and March 2010, according to the release.
The opinion of the AAOS work group pertains to the diagnosis and treatment of OCD both in skeletally immature and skeletally mature patients. According to the press release, the following are the opinions of the work group:
L 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;
L Patients who remain symptomatic after treatment for OCD should have a repeat history and physical examination, X-rays, and/or MRI to assess healing; and
L Patients who receive surgical treatment of OCD should be offered postoperative physical therapy.
“Ultimately, this review process has been a positive step for the AAOS and our patients,” Chambers stated in the release. “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, multicenter controlled studies, which will allow us to come closer to some of these unknowns when treating this challenging condition.”
Reference:
- www.aaos.org/guidelines
The American Academy of Orthopaedic Surgeons’ osteochondritis dissecans (OCD) treatment guideline reflects humility and honesty of current thought leaders regarding this condition. The admission that the treatment recommendations of OCD are based on poor science affirms what most orthopedists already hold to be true: that many contemporary techniques and “pearls” are not founded on valid scientific studies.
The panel’s conclusions pertaining to diagnosis and treatment are self evident. For example, loose or detached lesions should be referred for arthroscopy; yet, they serve as a clinical foundation from which further refinements may emanate. Perhaps the greatest blessing of the panel’s efforts will be the promotion of high-level scientific studies regarding this sometimes stubborn condition.
– John D. Kelly IV, MD
Orthopedics Today Editorial Board member
University of Pennsylvania
Department of Sports Medicine
Philadelphia
Disclosure: He has no relevant financial disclosures.
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