Clinical Value of MRI in Assessing the Stability of Osteochondritis Dissecans Lesions: A Systematic Review and Meta-Analysis.

ABSTRACT

OBJECTIVE. The purpose of this study is to perform a systematic review and meta-analysis to estimate the clinical value of MRI in assessing the stability of osteochondritis dissecans (OCD) lesions. MATERIALS AND METHODS. A systematic review of the literature published from January 1995 to July 2018 was performed by two independent reviewers using predefined search terms. The reference standard was established as arthroscopy or open surgery. True- and false-positive results as well as true- and false-negative results were counted. The quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooling of diagnostic accuracy, subgroup analysis, and identification of publication bias were included. RESULTS. Sixteen studies were included in the general data pooling. The pooled sensitivity and specificity were 0.92 (95% CI, 0.87-0.95; I2 = 0.55) and 0.85 (95% CI, 0.64-0.95; I2 = 0.88), respectively. The pooled sensitivity and specificity for juvenile OCD lesions were 0.93 (95% CI, 0.82-0.97) and 0.68 (95% CI, 0.41-0.86), respectively. Subgroup analysis showed that the staging system of Dipaola and colleagues and the criteria of De Smet and colleagues had a significant independent association with sensitivity. There was no evidence of publication bias (p = 0.57). CONCLUSION. The current meta-analysis suggested that MRI has a high diagnostic value for assessing the stability of OCD lesions. However, the MRI criteria applied for adult OCD lesions do not perform well in predicting stability of juvenile OCD lesions. Although some new juvenile OCD-specific MRI criteria yielding a satisfactory outcome have been proposed, further investigations are warranted.