Magnolia Livingston, Sylvia Culpepper, R Carter Clement
{"title":"等待还是操练?青少年稳定性膝夹层性骨软骨炎的共同决策。","authors":"Magnolia Livingston, Sylvia Culpepper, R Carter Clement","doi":"10.1097/BPO.0000000000002989","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of stable juvenile osteochondritis dissecans (OCD) of the knee in adolescents is controversial. Traditionally, initial management has been nonoperative. However, early subchondral drilling is also a consideration to potentially reduce the recovery time because ∼50% of stable OCD lesions eventually require surgery after a period of failed nonoperative care. This study uses choice-based conjoint (CBC) analysis to explore patient and family preferences regarding initial nonoperative treatment versus early drilling.</p><p><strong>Methods: </strong>This study used a CBC survey using Sawtooth Software (Lighthouse Studio version 9.2.0) to collect demographic information and preferences on surgical scenarios. Anonymous participants were recruited through the Prolific crowdsourcing platform. Eligible participants were US residents over 18 years of age with children aged 12 to 17. Data were analyzed using Hierarchical Bayes and logistic regression to determine the importance of each attribute and correlate preferences with demographic variables.</p><p><strong>Results: </strong>Of the 474 participants, the highest importance was placed on minimizing treatment failure (46.3%), followed by the likelihood of needing surgery (22.4%), cost (11.8%), time on crutches (10.8%), and return to normal activities (8.7%). Simulation of surgical decision-making showed a strong preference for early surgery (90.8%) over conservative treatment (9.2%). Preferences varied slightly by demographics, with female participants valuing recovery time more and male participants prioritizing cost.</p><p><strong>Discussion: </strong>Our findings indicate a significant preference for early surgical intervention driven by concerns over treatment failure and the need for a future surgery with a second recovery period. Despite some demographic differences in attribute importance, no specific patient characteristic significantly influenced the overall treatment preference.</p><p><strong>Conclusion: </strong>Early drilling of stable OCD lesions of the knee is favored by most parents of adolescents, primarily to reduce the risk of future surgery/recovery. This preference underscores the importance of personalized treatment discussions and highlights the need for shared decision-making tools that incorporate individual patient values.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"451-457"},"PeriodicalIF":1.5000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Wait or Drill? Shared Decision-making in Adolescents With Stable Osteochondritis Dissecans of the Knee.\",\"authors\":\"Magnolia Livingston, Sylvia Culpepper, R Carter Clement\",\"doi\":\"10.1097/BPO.0000000000002989\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Treatment of stable juvenile osteochondritis dissecans (OCD) of the knee in adolescents is controversial. Traditionally, initial management has been nonoperative. However, early subchondral drilling is also a consideration to potentially reduce the recovery time because ∼50% of stable OCD lesions eventually require surgery after a period of failed nonoperative care. This study uses choice-based conjoint (CBC) analysis to explore patient and family preferences regarding initial nonoperative treatment versus early drilling.</p><p><strong>Methods: </strong>This study used a CBC survey using Sawtooth Software (Lighthouse Studio version 9.2.0) to collect demographic information and preferences on surgical scenarios. Anonymous participants were recruited through the Prolific crowdsourcing platform. Eligible participants were US residents over 18 years of age with children aged 12 to 17. Data were analyzed using Hierarchical Bayes and logistic regression to determine the importance of each attribute and correlate preferences with demographic variables.</p><p><strong>Results: </strong>Of the 474 participants, the highest importance was placed on minimizing treatment failure (46.3%), followed by the likelihood of needing surgery (22.4%), cost (11.8%), time on crutches (10.8%), and return to normal activities (8.7%). Simulation of surgical decision-making showed a strong preference for early surgery (90.8%) over conservative treatment (9.2%). Preferences varied slightly by demographics, with female participants valuing recovery time more and male participants prioritizing cost.</p><p><strong>Discussion: </strong>Our findings indicate a significant preference for early surgical intervention driven by concerns over treatment failure and the need for a future surgery with a second recovery period. Despite some demographic differences in attribute importance, no specific patient characteristic significantly influenced the overall treatment preference.</p><p><strong>Conclusion: </strong>Early drilling of stable OCD lesions of the knee is favored by most parents of adolescents, primarily to reduce the risk of future surgery/recovery. This preference underscores the importance of personalized treatment discussions and highlights the need for shared decision-making tools that incorporate individual patient values.</p>\",\"PeriodicalId\":16945,\"journal\":{\"name\":\"Journal of Pediatric Orthopaedics\",\"volume\":\" \",\"pages\":\"451-457\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Orthopaedics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BPO.0000000000002989\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BPO.0000000000002989","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/22 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
导读:青少年膝关节稳定性青少年性夹层性骨软骨炎(OCD)的治疗存在争议。传统上,最初的治疗是非手术性的。然而,早期软骨下钻孔也是潜在减少恢复时间的一个考虑因素,因为大约50%的稳定OCD病变在一段时间的非手术治疗失败后最终需要手术。本研究使用基于选择的联合(CBC)分析来探讨患者和家庭对初始非手术治疗和早期钻孔治疗的偏好。方法:本研究采用锯齿软件(Lighthouse Studio version 9.2.0)进行CBC调查,收集人口统计信息和对手术方案的偏好。匿名参与者是通过多产众包平台招募的。符合条件的参与者是18岁以上的美国居民,儿童年龄在12至17岁之间。使用分层贝叶斯和逻辑回归分析数据,以确定每个属性的重要性,并将偏好与人口变量关联起来。结果:在474名参与者中,最重要的是最小化治疗失败(46.3%),其次是需要手术的可能性(22.4%)、费用(11.8%)、拄拐时间(10.8%)和恢复正常活动(8.7%)。手术决策模拟显示,早期手术(90.8%)比保守治疗(9.2%)更受青睐。偏好因人口统计而略有不同,女性参与者更看重恢复时间,而男性参与者更看重成本。讨论:我们的研究结果表明,由于担心治疗失败和需要在未来进行第二次恢复期的手术,早期手术干预是一个明显的偏好。尽管在属性重要性上存在一些人口统计学差异,但没有特定的患者特征显著影响总体治疗偏好。结论:大多数青少年家长倾向于对稳定的膝关节OCD病变进行早期钻孔治疗,主要是为了降低未来手术/康复的风险。这种偏好强调了个性化治疗讨论的重要性,并强调了纳入个体患者价值的共享决策工具的必要性。
Wait or Drill? Shared Decision-making in Adolescents With Stable Osteochondritis Dissecans of the Knee.
Introduction: Treatment of stable juvenile osteochondritis dissecans (OCD) of the knee in adolescents is controversial. Traditionally, initial management has been nonoperative. However, early subchondral drilling is also a consideration to potentially reduce the recovery time because ∼50% of stable OCD lesions eventually require surgery after a period of failed nonoperative care. This study uses choice-based conjoint (CBC) analysis to explore patient and family preferences regarding initial nonoperative treatment versus early drilling.
Methods: This study used a CBC survey using Sawtooth Software (Lighthouse Studio version 9.2.0) to collect demographic information and preferences on surgical scenarios. Anonymous participants were recruited through the Prolific crowdsourcing platform. Eligible participants were US residents over 18 years of age with children aged 12 to 17. Data were analyzed using Hierarchical Bayes and logistic regression to determine the importance of each attribute and correlate preferences with demographic variables.
Results: Of the 474 participants, the highest importance was placed on minimizing treatment failure (46.3%), followed by the likelihood of needing surgery (22.4%), cost (11.8%), time on crutches (10.8%), and return to normal activities (8.7%). Simulation of surgical decision-making showed a strong preference for early surgery (90.8%) over conservative treatment (9.2%). Preferences varied slightly by demographics, with female participants valuing recovery time more and male participants prioritizing cost.
Discussion: Our findings indicate a significant preference for early surgical intervention driven by concerns over treatment failure and the need for a future surgery with a second recovery period. Despite some demographic differences in attribute importance, no specific patient characteristic significantly influenced the overall treatment preference.
Conclusion: Early drilling of stable OCD lesions of the knee is favored by most parents of adolescents, primarily to reduce the risk of future surgery/recovery. This preference underscores the importance of personalized treatment discussions and highlights the need for shared decision-making tools that incorporate individual patient values.
期刊介绍:
Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.