MRI Features That Contribute to Decision-Making for Treatment of Capitellar OCD Lesions: An Expert Consensus Using the Delphi Method.

Background: Most healthcare providers utilize magnetic resonance imaging (MRI) to assist in diagnosing and treating osteochondritis dissecans (OCD) of the capitellum. However, consensus on imaging features that portend clinically relevant information in the care of these lesions has not been determined. Purpose: To conduct a survey on the MRI features of a capitellar OCD that are salient for clinical decision-making using a classic Delphi protocol. Study Design: A consensus statement. Methods: Invitations to participate were sent to 33 healthcare providers identified as capitellar OCD experts. A classic 3-round survey method was used to gather agreement and consensus on the level of importance for clinical decision-making on 33 MRI features. A concise list of features that guide decision-making on the stability of an OCD lesion and the ability of an OCD lesion to heal with nonoperative care was also identified. Agreement and consensus were determined a priori as ≥66%. Results: Of the 33 identified experts, 20 agreed to participate, and 17 (52%) completed all 3 rounds. Of the 33 MRI features evaluated, 17 reached agreement as important for clinical decision-making by the experts. Consensus was reached for a concise list of MRI features that were significant to decision-making (94%), suggestive of a stable lesion (100%), had the potential to heal with nonoperative treatment (94%), were suggestive of an unstable lesion (100%), and had low potential to heal with nonoperative treatment (88%). Conclusion: This 3-round Delphi process produced consensus on clinically relevant MRI features that contribute to clinical decision-making for capitellar OCD. The results of this study will be used as the basis for an interrater reliability assessment of the identified salient features, creating the foundation for developing a reliable MRI assessment tool rooted in clinical experiences. The development of a standardized assessment of capitellar OCD is intended to improve clinical practice and patient outcomes.

Traumatic Patellar Dislocations in Childhood and Adolescents.

Patellar instability and associated patellar dislocation can result in significant pain, disability, and associated injuries in young athletes. The patellofemoral joint is a complex articulation with stabilizing restraints, both medially and laterally, that help guide the patella into the corresponding trochlear groove as the knee cycles through an extension-to-flexion arc. In addition to soft tissue injuries, many osseous aberrancies can contribute to patellar instability in young athletes, including trochlear dysplasia, patella alta, and axial and coronal plane abnormalities. There is a role for nonoperative treatment in these young athletes; however, if recurrent or associated injuries are identified surgical intervention is warranted. Correct diagnosis of the underlying cause of the patellar instability is paramount to developing a surgical plan that will yield the most favorable outcome for these young athletes.