The Management of Osteochondritis Dissecans of the Femoral Condyle Appropriate Use Criteria Adopted by: The American Academy of Orthopaedic Surgeons Board of Directors December 4, 2015 Disclaimer Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment. Disclosure Requirement In accordance with American Academy of Orthopaedic Surgeons policy, all individuals whose names appear as authors or contributors to this document filed a disclosure statement as part of the submission process. All authors provided full disclosure of potential conflicts of interest prior to participation in the development of these Appropriate Use Criteria. Disclosure information for all panel members can be found in Appendix B. Funding Source The American Academy of Orthopaedic Surgeons exclusively funded development of these Appropriate Use Criteria. The American Academy of Orthopaedic Surgeons received no funding from outside commercial sources to support the development of these Appropriate Use Criteria. FDA Clearance Some drugs or medical devices referenced or described in this document may not have been cleared by the Food and Drug Administration (FDA) or may have been cleared for a specific use only. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice. Copyright All rights reserved. Reproduction, storage in a retrieval system, or transmission, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, of any part of this document, requires prior written permission from the American Academy of Orthopaedic Surgeons. Published 2015 by the American Academy of Orthopaedic Surgeons 9400 West Higgins Road Rosemont, IL 60018 First Edition Copyright 2015 by the American Academy of Orthopaedic Surgeons For a more user-friendly version of this AUC, or to view additional AUCs, please visit the AAOS AUC web-based app at: www.OrthoGuidelines.org/auc Table of Contents Writing Panel ............................................................................................................................... i Voting Panel................................................................................................................................. i Voting Panel Round Two Discussion Moderator ...................................................................... iii AUC Section Leader, AAOS Committee on Evidence-Based Quality and Value .................... iii Chair, AAOS Committee on Evidence-Based Quality and Value ............................................. iii Chair, AAOS Council on Research and Quality ........................................................................ iii AAOS Staff ................................................................................................................................ iii I. INTRODUCTION ...................................................................................................................1 Overview ..................................................................................................................................... 1 ASSUMPTIONS OF THE WRITING PANEL/Voting Panel ................................................... 2 Conditions Not Covered by this AUC ........................................................................................ 3 II. METHODS ..............................................................................................................................4 Developing Criteria ..................................................................................................................... 4 Formulating Indications and Scenarios ................................................................................... 5 Creating Definitions and Assumptions ................................................................................... 6 Literature Review........................................................................................................................ 7 Determining Appropriateness ..................................................................................................... 7 Voting Panel............................................................................................................................ 7 Rating Appropriateness ........................................................................................................... 8 Round One Voting .................................................................................................................. 8 Round Two Voting ................................................................................................................. 9 Final Ratings ........................................................................................................................... 9 Revision Plans ........................................................................................................................... 10 Disseminating Appropriate Use Criteria ................................................................................... 11 III. PATIENT INDICATIONS AND TREATMENTS ...............................................................12 Indications ................................................................................................................................. 12 Treatments................................................................................................................................. 13 IV. RESULTS OF APPROPRIATENESS RATINGS ................................................................14 Appropriate Use Criteria for Treatment of Osteochondritis Dissecans .................................... 19 V. APPENDICES .......................................................................................................................69 Appendix A. Documentation of Approval ................................................................................ 70 Appendix B. Disclosure Information ........................................................................................ 71 Appendix C. References ........................................................................................................... 75 Appendix D – Study Attrition Chart for Guideline Supplemental Literature Search ............... 76 Appendix E – Search Strategy .................................................................................................. 77 Writing Panel Kevin G. Shea, MD American College of Sports Medicine American Academy of Orthopaedic Surgeons John D. Polousky, MD James L. Carey MD, MPH Pediatric Orthopaedic Society of North America American Academy of Orthopaedic Surgeons Kevin H. Latz, MD Carl W. Nissen, MD American Academy of Pediatrics American Orthopaedic Society for Sports Medicine Teri M. McCambridge, MD Thomas R. Carter, MD American Academy of Pediatrics Arthroscopy Association of North America Timothy J. Mosher, MD Theodore J. Ganley, MD American College of Radiology Orthopaedic Trauma Association James Hill, MD, MPH Robert H. Brophy, MD American College of Occupational and Association of Bone and Joint Surgeons Environmental Medicine Feza Korkusuz, MD Mark Paterno, PT, PhD, MBA, ATC, SCS Association of Bone and Joint Surgeons American Physical Therapy Association Paul Manner, MD, FRCSC Leonard Macrina, PT, MSPT, CSCS, SCS Association of Bone and Joint Surgeons American Physical Therapy Association Kent Reinker, MD Ben E. Heyworth, MD Association of Bone and Joint Surgeons American College of Surgeons Richard J. Haynes, MD Aaron J. Krych, MD Association of Bone and Joint Surgeons American Academy of Orthopaedic Surgeons Mark R. Hutchinson, MD, FACSM Voting Panel Edward McDevitt, MD Jutta Ellermann, MD, PhD American Orthopaedic Society for Sports Medicine American Academy of Orthopaedic Surgeons Philip Wilson, MD Alexander Meininger, MD Pediatric Orthopaedic Society of North America American Academy of Orthopaedic Surgeons Eric Wall, MD Pediatric Orthopaedic Society of North America Daryl Osbahr, MD American Academy of Orthopaedic Surgeons Daniel Green, MD American Academy of Pediatrics Dennis Chin, MD American Academy of Orthopaedic Surgeons Danielle Katz, MD American College of Surgeons Andrew Gregory, MD American Academy of Orthopaedic Surgeons Norman Otsuka, MD American College of Surgeons i Voting Panel Round Two Discussion Moderator Gregory A. Brown, MD, PhD AUC Section Leader, AAOS Committee on Evidence-Based Quality and Value Robert H. Quinn, MD Chair, AAOS Committee on Evidence-Based Quality and Value David S. Jevsevar, MD, MBA Chair, AAOS Council on Research and Quality Kevin J. Bozic, MD, MBA AAOS Staff William O. Shaffer, MD Medical Director Deborah S. Cummins, PhD Director, Department of Research and Scientific Affairs Jayson Murray, MA Manager, Evidence-Based Medicine Unit Ryan Pezold, MA Research Analyst, Evidence-Based Medicine Unit Peter Shores, MPH Statistician, Evidence-Based Medicine Kaitlyn Sevarino, MBA Evidence-Based