Quantifying Risk Factors for Osteochondritis Dissecans in Children: A Propensity-Matched Retrospective Cohort Study.

Abstract

Background: Osteochondritis dissecans (OCD) is a developmental orthopaedic condition in pediatric patients characterized by disruption of epiphyseal cartilage vascular supply leading to secondary subchondral bone changes and potential joint degeneration. While repetitive trauma is implicated, emerging evidence suggests a contributing role of biological and hereditary risk factors.

Purpose: To quantify the relative risk (RR) of OCD with specific biological comorbidities and athletic participation in a large representative pediatric and adolescent population.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: We queried the TriNetX US Collaborative Network for patients aged ≤25 years between 2017 and 2024. Using International Classification of Diseases (ICD-10) diagnosis codes, we identified patients with potentially associated medical conditions (eg, hypopituitarism, vitamin D deficiency, coagulopathies, obesity, and nicotine dependence) and participation in common youth sports. The RR of OCD development for each condition and sport was calculated after propensity matching on age and sex. Annual incidence and prevalence were also assessed.

Results: We identified 18,493 patients with OCD (mean age at first ICD diagnosis: 13.4 ± 3.45 years; 59% male). The most common OCD location was the knee (49%). From 2017 to 2024, the annual incidence rose from 15 to 23 per 100,000. Gymnastics (RR, 4.96; [95% CI, 3.14-7.83]), volleyball (RR, 2.96 [95% CI, 1.84-4.74]), and cheerleading (RR, 2.83 [95% CI, 1.47-5.47]) were associated with the highest OCD risk among included sports. Among medical comorbidities, primary thrombophilia (RR, 3.20 [95% CI, 1.57-6.51]), von Willebrand Factor deficiency (RR, 2.90 [95% CI, 1.41-5.95]), and Factor V Leiden (RR, 2.70 [95% CI, 1.31-5.58]) carried the highest risk. Hypopituitarism (RR, 1.71 [95% CI, 1.21-2.41]) and body mass index ≥35kg/m² (RR, 1.14 [95% CI, 1.01-1.29]) were also significantly associated. Nicotine dependence was associated with decreased risk (RR, 0.72 [95% CI, 0.57-0.91]).

Conclusion: This large-scale analysis provides updated epidemiologic trends and quantifies risk factors associated with pediatric OCD. Age, sex, specific medical conditions, and athletic participation were linked to increased OCD risk, and novel associations between OCD and coagulopathies were identified.