Summary

The conservative treatment of stable knee Osteochondritis Dissecans of the knee often includes the use of an unloader brace but its effectiveness is unknown.

Abstract

Introduction

Stable osteochondritis dissecans (OCD) lesions are primarily treated non-operatively with
a combination of rest and activity restriction. However, little is known about the clinical effectiveness of
different forms of bracing and its influence on OCD healing, return to sport (RTS), and patient-reported
outcomes (PROs). The purpose of this investigation was to evaluate the impact of unloader bracing on
patients with stable medial femoral condyle (MFC) OCD lesions treated non-operatively.

Methods

The Research in Osteochondritis of the Knee (ROCK) database, a prospective, observational
cohort, was queried for MFC lesions with an initial non-operative treatment plan and a minimum of 1-
year clinical follow-up. Patients with previous ipsilateral knee surgery, underwent surgery within 3
months after their baseline visit, or were treated with casting were excluded. Patients were grouped on
the inclusion of valgus unloader bracing as part of their initial treatment plan (VUBG) or no bracing
(NBG). The primary outcomes were transition from non-operative to operative care, RTS clearance, and
PROs.  Non-parametric univariate analyses were used to determine differences between groups. Kaplan-
Meier plots were conducted to visualize the timing of outcomes.

Results

A total of 238 knees (VUBG: 146 knees, 61.3%; NBG: 92 knees, 38.7%) were analyzed (Table 1).
There was no difference in restricted weight-bearing by group (p=0.448). Transition to surgery occurred
in 58 (24.3%) knees, with no statistically significant difference observed by groups (VUBG: n=42, 28.7%,
NBG: n=19, 20.7%, p=0.163). The median time for transition to surgery was 6.8 months (IQR: 4.6-12.9
months), with no differences seen by group (VUBG: 6.7 months [IRQ: 5.0-13.0 months], NGB: 6.9
months [IQR: 3.8-12.6 months], p=0.357) (Figure 1). Of the knees that did not transition to surgical care,
79 (73.8%) in the VUBG and 55 (75.3%) in the NBG received RTP clearance (p=0.687). Median time for
RTP clearance was not statistically different between the VUBG (6.4 months [IQR: 3.3-10.8 months]) and
NBG (8.3 months [IQR: 4.5-12.4 months]) (p=0.084). PRO scores were similar between the two groups at
time of RTP clearance (pedi-IKDC: VUBG–85.5±19.4, NBG–85.8±18.7, p=0.947; KOOS/Sport:
VUBG–92.4±15.5, NBG–88.4±22.3, p=0.475).

Conclusion

This study suggests the clinical effectiveness of non-operative treatment of stable MFC
OCDs may not be enhanced by the use of a valgus unloader brace.

Significance

The clinical impact of other aspects of non-operative treatment needs to be evaluated
more rigorously in a prospective comparative fashion to determine an optimal treatment algorithm
designed to improve the long-term joint health of a young, active sub-population.