Abstract
BACKGROUND: Previous studies have reported disparities in medical and surgical care along the lines of race and socioeconomic status. The purpose of this study is to evaluate the impact of these factors on successful or unsuccessful healing of juvenile osteochondritis dissecans (OCD) lesions in the knee. METHODS: We retrospectively reviewed patients younger than 18 years that were treated for a knee OCD lesion at our urban, tertiary children’s hospital between 2006 and 2017. Demographic data included patient-reported race, median household income for the patient’s zip code, and insurance status. We also collected information regarding clinical history, imaging, treatment course, and post-treatment outcomes. The primary outcome of interest was healing of the OCD lesion based on radiographic and clinical examination. Univariate analysis was followed by purposeful entry multivariate regression to control for confounders. RESULTS: A total of 205 children with mean follow-up of 15.8 ± 6.5 months were included in the analysis. The mean age was 12.4 ± 2.8 years and 145 (71%) were male. At their most recent follow-up, 28 subjects (13.7%) did not show radiographic or clinical evidence of healing. In univariate analysis, non-healing lesions were found in 25% of black children compared to 9.4% of white children (p=0.02). There was no difference in insurance status or median household income between patients who successfully and unsuccessfully healed their OCD lesion. After controlling for age, sex, sports participation, lesion size and stability, skeletal maturity, and operative vs. non-operative treatment in a multivariate model, black children had 6.7 times higher odds of unsuccessful healing compared to their white counterparts (95% CI 1.1, 41.7; p=0.04). CONCLUSION: In this study, black children with OCD of the knee were less likely to heal than white patients even when accounting for socioeconomic and other factors in a multivariate model.
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