Introduction

Osteochondritis dissecans (OCD) is a disease primarily of young adolescents and adults that occurs due to focal, subchondral bone damage that becomes instable or detached from the underlying bone and blood supply. The hypothesized etiologies of OCD lesions are traumatic, ischemic, hereditary, and idiopathic. A multifactorial etiology is most likely. Juvenile OCD lesions favor the etiology of trauma as it is found more frequently in highly active children who are involved in organized sports, as well as found twice more likely in males than females. Epidemiologically, OCD lesions are more common in men with one study finding a 2:1 male to female ratio of incidence. There is a paucity of literature analyzing potential differences in clinical and functional outcomes following treatment of OCD lesions of the knee between males and females. Therefore, the purpose of this study was to perform a systematic review and meta-analysis of sex-related differences in outcomes following treatment of OCD.

Methods

The following databases were searched between October 24-31, 2020: PubMed, PubMed Central, Embase, Ovid Medline, Cochrane Libraries, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The PICO (participants, interventions, comparators, outcomes) framework was used to identify relevant studies. Inclusion criteria were: (1) studies written in the English language, (2) human studies, (3) studies that evaluated at least one sex-related difference in clinical or functional outcomes following treatment of OCD of the knee, (4) studies reporting on patients undergoing treatment for isolated OCD diagnoses, and (5) studies published 2000 to the present.

Results

The initial search yielded 3,766 studies. After removal of duplicate results and screening titles and abstracts, 169 articles underwent full-text review. After full-text review and scanning references of from eligible studies, total of 10 articles met all inclusion criteria and were included in the analysis. Overall, 951 patients (691 [73%] males and 260 [27%] females) were included from the 10 studies. Four studies (40%) reported functional outcomes for males and females separately following treatment of OCD lesions in the knee. Three studies (30%) performed statistical analysis comparing functional outcomes between males and females; however, no significant differences were found in any functional outcome metric assessed across the three studies. Four studies (40%) included an analysis of sex-specific outcomes following exclusively operative or a mix of non-operative and operative management of OCD lesions. Only one of these studies found a significant difference male and female outcomes: Hevesi et al. determined males had lower risk of developing symptomatic knee pain following operative or non-operative treatment at mean 14-year follow-up (HR 0.24; 95% CI, 0.07-0.81).

Conclusion

The present study found comparable clinical and functional outcomes between males and females recovering from OCD lesions of the knee. These results were consistent with the literature in a higher incidence in males and improved outcomes in skeletally immature patients. Although functional outcomes did not vary between males and females, clinical symptoms may be worse in females with a higher incidence of residual knee pain. Further research comparing male and female outcomes after interventions for OCD lesions is warranted.