{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:30:38Z","timestamp":1770751838073,"version":"3.50.0"},"reference-count":45,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cImage Biopsy Lab GmbH\u201d"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Juvenile osteochondritis dissecans (JOCD) of the knee is commonly treated using conservative or joint-preserving surgical techniques. While clinical outcomes are generally favorable, the risk of early cartilage degeneration remains unclear. Joint space width (JSW) on weight-bearing radiographs serves as an indirect marker of cartilage health. Artificial intelligence (AI)-based JSW assessment may enable sensitive and reproducible detection of early degenerative changes. Methods: This cross-sectional feasibility study included 21 skeletally immature patients treated for JOCD of the distal femur between 2002 and 2017. Treatment modalities comprised conservative management, retrograde drilling, and fragment refixation. Fully automated JSW measurements were performed on standardized anteroposterior knee radiographs using a validated AI-based software IB Lab KOALA\u2122, Version 2.4. JSW of the affected compartment was compared with the contralateral knee and between treatment groups. Clinical outcomes were assessed using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score. Additionally, a systematic review of the literature on post-treatment degenerative changes following OCD therapy was conducted according to PRISMA guidelines. Results: Compared with manually reviewing images, the software IB Lab KOALA\u2122, Version 2.4 as easy to implement. AI-based analysis revealed no significant differences in JSW between the affected and contralateral knees, nor between treatment modalities. Average JSW exceeded 6 mm in all groups after a median follow-up of 64 (min. 27, max. 177) months. Clinical scores were high and comparable across treatments. A moderate positive correlation was observed between the JSW and Lysholm score, while increasing age and longer follow-up were associated with a reduced JSW. The systematic review identified ten relevant studies, reporting generally favorable long-term clinical outcomes with a low but present risk of osteoarthritis progression. Conclusions: Our AI-based analysis showed no differences in JSW between conservative and joint-preserving surgical treatments of JOCD in the follow-up. This technology can provide a valuable tool for standardized and sensitive radiographic monitoring in young patients.<\/jats:p>","DOI":"10.3390\/jcm15041384","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:16:38Z","timestamp":1770722198000},"page":"1384","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Automated Joint Space Width Assessment in Patients Treated for Juvenile Osteochondritis Dissecans of the Distal Femur: A Cross-Sectional Study and Systematic Review of the Literature"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9509-8244","authenticated-orcid":false,"given":"Matthias","family":"Pallamar","sequence":"first","affiliation":[{"name":"Department of Paediatric Orthopaedics and Foot Surgery, Orthopaedic Hospital Speising, Speisinger Stra\u00dfe 109, 1130 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaveh","family":"Same","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Speisinger Stra\u00dfe 109, 1130 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5465-3459","authenticated-orcid":false,"given":"Jennyfer Angel","family":"Mitterer","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Speisinger Stra\u00dfe 109, 1130 Vienna, Austria"},{"name":"Center for Anatomy and Cell Biology, Medical University Vienna, W\u00e4hringer Stra\u00dfe 13, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1420-4648","authenticated-orcid":false,"given":"Sebastian","family":"Simon","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Speisinger Stra\u00dfe 109, 1130 Vienna, Austria"},{"name":"Center for Anatomy and Cell Biology, Medical University Vienna, W\u00e4hringer Stra\u00dfe 13, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6073-8384","authenticated-orcid":false,"given":"Jan Philipp","family":"Nolte","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Vienna, W\u00e4hringer G\u00fcrtel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3250-2593","authenticated-orcid":false,"given":"Sebastian","family":"Farr","sequence":"additional","affiliation":[{"name":"Department of Paediatric Orthopaedics and Foot Surgery, Orthopaedic Hospital Speising, Speisinger Stra\u00dfe 109, 1130 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Hofstaetter","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Speisinger Stra\u00dfe 109, 1130 Vienna, Austria"},{"name":"2nd Department, Orthopaedic Hospital Speising, Speisinger Stra\u00dfe 109, 1130 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catharina","family":"Chiari","sequence":"additional","affiliation":[{"name":"Department of Paediatric Orthopaedics and Foot Surgery, Orthopaedic Hospital Speising, Speisinger Stra\u00dfe 109, 1130 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1177\/18632521221149063","article-title":"Osteochondritis dissecans of the knee: Epidemiology, etiology, and natural history","volume":"17","author":"Turati","year":"2023","journal-title":"J. Child. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1016\/j.joca.2018.06.019","article-title":"Juvenile osteochondritis dissecans of the knee is a result of failure of the blood supply to growth cartilage and osteochondrosis","volume":"26","author":"Olstad","year":"2018","journal-title":"Osteoarthr. Cartil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1213","DOI":"10.3928\/01477447-20130821-27","article-title":"Matching osteochondritis dissecans lesions in identical twin brothers","volume":"36","author":"Richie","year":"2013","journal-title":"Orthopedics"},{"key":"ref_4","first-page":"231","article-title":"Osteochondritis Dissecans: A Multicenter Study of the European Pediatric Orthopedic Society","volume":"8","author":"Hefti","year":"1999","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/01241398-200407000-00015","article-title":"Osteochondritis Dissecans of the Knee","volume":"24","author":"Flynn","year":"2004","journal-title":"J. Pediatr. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/0363546513510390","article-title":"The Demographics and Epidemiology of Osteochondritis Dissecans of the Knee in Children and Adolescents","volume":"42","author":"Kessler","year":"2014","journal-title":"Am. J. Sports Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2384","DOI":"10.1177\/0363546513496049","article-title":"Healing Predictors of Stable Juvenile Osteochondritis Dissecans Knee Lesions After 6 and 12 Months of Nonoperative Treatment","volume":"41","author":"Krause","year":"2013","journal-title":"Am. J. Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1007\/s11999-011-2237-8","article-title":"Drilling Juvenile Osteochondritis Dissecans: Retro- or Transarticular?","volume":"471","author":"Gunton","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.arthro.2020.09.020","article-title":"Cost-Effectiveness Analysis of Nonoperative Management Versus Early Drilling for Stable Osteochondritis Dissecans Lesions of the Knee in Skeletally Immature Patients","volume":"37","author":"LeBrun","year":"2021","journal-title":"Arthrosc. J. Arthrosc. Relat. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/BPO.0000000000000696","article-title":"The Surgical Management of Osteochondritis Dissecans of the Knee in the Skeletally Immature","volume":"37","author":"Yellin","year":"2017","journal-title":"J. Pediatr. Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/BPO.0b013e3181c6318c","article-title":"Fixation of Juvenile Osteochondritis Dissecans Lesions of the Knee Using Poly 96L\/4D-Lactide Copolymer Bioabsorbable Implants","volume":"30","author":"Tabaddor","year":"2010","journal-title":"J. Pediatr. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1177\/0363546518783737","article-title":"Internal Fixation of Unstable Osteochondritis Dissecans: Do Open Growth Plates Improve Healing Rate?","volume":"46","author":"Wu","year":"2018","journal-title":"Am. J. Sports Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"57","DOI":"10.4055\/cios.2016.8.1.57","article-title":"Arthroscopic Bioabsorbable Screw Fixation of Unstable Osteochondritis Dissecans in Adolescents: Clinical Results, Magnetic Resonance Imaging, and Second-Look Arthroscopic Findings","volume":"8","author":"Chun","year":"2015","journal-title":"Clin. Orthop. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/0749-8063(91)90087-E","article-title":"Characterizing Osteochondral Lesions by Magnetic Resonance Imaging","volume":"7","author":"Dipaola","year":"1991","journal-title":"Arthrosc. J. Arthrosc. Relat. Surg."},{"key":"ref_15","first-page":"21","article-title":"Development and Evaluation of a German Version of the Tegner Activity Scale for Measuring Outcome after Anterior Cruciate Ligament Injury","volume":"27","author":"Wirth","year":"2013","journal-title":"Sportverletz. Sportschaden Organ Ges. Orthop. Traumatol. Sportmed."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s41687-018-0058-1","article-title":"Measurement Properties of the German Version of the IKDC Subjective Knee Form (IKDC-SKF)","volume":"2","author":"Preiss","year":"2018","journal-title":"J. Patient-Rep. Outcomes"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/j.joca.2020.04.003","article-title":"A Novel Quantitative Metric for Joint Space Width: Data from the Osteoarthritis Initiative (OAI)","volume":"28","author":"Paixao","year":"2020","journal-title":"Osteoarthr. Cartil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2325967120S00530","DOI":"10.1177\/2325967120S00530","article-title":"Machine Learning Predicts Rate of Cartilage Loss: Data from the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis (Most) Studies","volume":"8","author":"DiFranco","year":"2020","journal-title":"Orthop. J. Sports Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1007\/s00167-022-07220-y","article-title":"Artificial Intelligence-Based Computer-Aided System for Knee Osteoarthritis Assessment Increases Experienced Orthopaedic Surgeons\u2019 Agreement Rate and Accuracy","volume":"31","author":"Smolle","year":"2023","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Neubauer, M., Moser, L., Neugebauer, J., Raudner, M., Wondrasch, B., F\u00fchrer, M., Emprechtinger, R., Dammerer, D., Ljuhar, R., and Salzlechner, C. (2023). Artificial-Intelligence-Aided Radiographic Diagnostic of Knee Osteoarthritis Leads to a Higher Association of Clinical Findings with Diagnostic Ratings. J. Clin. Med., 12.","DOI":"10.3390\/jcm12030744"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a Web and Mobile App for Systematic Reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A Tool for Assessing Risk of Bias in Non-Randomised Studies of Interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_24","unstructured":"(2025, September 09). Study Quality Assessment Tools, Available online: https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (Robvis): An R Package and Shiny Web App for Visualizing Risk-of-bias Assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res. Synth. Methods"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.knee.2018.02.005","article-title":"Epidemiology and Patient-Reported Outcome after Juvenile Osteochondritis Dissecans in the Knee","volume":"25","author":"Ananthaharan","year":"2018","journal-title":"Knee"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bangert, Y., Zarembowicz, P., Engelleiter, K., Gkarilas, E., Schmitt, H., Renkawitz, T., and Jaber, A. (2023). Long-Term Outcome and Athletic Level Following Operative Treatment for Osteochondritis Dissecans of the Knee in Pediatric and Adolescent Patients. J. Clin. Med., 12.","DOI":"10.3390\/jcm12124140"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1177\/03635465231164410","article-title":"Internal Fixation of Unstable Osteochondritis Dissecans of the Knee: Long-Term Outcomes in Skeletally Immature and Mature Patients","volume":"51","author":"Husen","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1177\/1947603518786545","article-title":"Osteochondritis Dissecans in the Knee of Skeletally Immature Patients: Rates of Persistent Pain, Osteoarthritis, and Arthroplasty at Mean 14-Years\u2019 Follow-Up","volume":"11","author":"Hevesi","year":"2020","journal-title":"Cartilage"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Perelli, S., Romoli, A.R.M., Costa-Paz, M., Erquicia, J.I., Gelber, P.E., and Monllau, J.C. (2019). Internal Fixation of Osteochondritis Dissecans of the Knee Leads to Good Long-Term Outcomes and High Degree of Healing without Differences between Fixation Devices. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111934"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0968-0160(99)00037-X","article-title":"Operative Treatment of Osteochondritis Dissecans of the Knee: A Retrospective Comparison of Fixation with Autologous Bone Pegs vs. Bioabsorbable Rods","volume":"7","author":"Tuompo","year":"2000","journal-title":"Knee"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1177\/03635465231165290","article-title":"Transarticular Versus Retroarticular Drilling of Stable Osteochondritis Dissecans of the Knee: A Prospective Multicenter Randomized Controlled Trial by the ROCK Group","volume":"51","author":"Heyworth","year":"2023","journal-title":"Am. J. Sports Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3863","DOI":"10.1007\/s00402-022-04638-4","article-title":"Increased Lesion Depth, Higher Body Mass Index and Older Age Are Risk Factors for Osteoarthritis during Long-Term Follow-up in Patients with Osteochondritis Dissecans of the Knee","volume":"143","author":"Ekman","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1007\/s00167-008-0490-5","article-title":"Longitudinal Long-term Results of Surgical Treatment in Patients with Osteochondritis Dissecans of the Femoral Condyles","volume":"16","author":"Bruns","year":"2008","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological Assessment of Osteo-Arthrosis","volume":"16","author":"Kellgren","year":"1957","journal-title":"Ann. Rheum. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/j.joca.2021.04.018","article-title":"Imaging in Osteoarthritis","volume":"30","author":"Roemer","year":"2022","journal-title":"Osteoarthr. Cartil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.1016\/j.joca.2006.11.009","article-title":"Atlas of Individual Radiographic Features in Osteoarthritis, Revised","volume":"15","author":"Altman","year":"2007","journal-title":"Osteoarthr. Cartil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.joca.2011.02.018","article-title":"Summary and Recommendations of the OARSI FDA Osteoarthritis Assessment of Structural Change Working Group","volume":"19","author":"Conaghan","year":"2011","journal-title":"Osteoarthr. Cartil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.joca.2007.12.004","article-title":"Joint Space Narrowing and Kellgren\u2013Lawrence Progression in Knee Osteoarthritis: An Analytic Literature Synthesis","volume":"16","author":"Emrani","year":"2008","journal-title":"Osteoarthr. Cartil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1118\/1.598897","article-title":"Trainable rule-based algorithm for the measurement of joint space width in digital radiographic images of the knee","volume":"27","author":"Duryea","year":"2000","journal-title":"Med. Phys."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.joca.2008.11.001","article-title":"Location specific radiographic joint space width for osteoarthritis progression","volume":"17","author":"Neumann","year":"2009","journal-title":"Osteoarthr. Cartil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/S0895-4356(99)00109-2","article-title":"Chastang Cl Assessing Smallest Detectable Change over Time in Continuous Structural Outcome Measures Application to Radiological Change in Knee Osteoarthritis","volume":"52","author":"Auleley","year":"1999","journal-title":"J. Clin. Epidemiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.joca.2009.01.007","article-title":"OARSI\u2013OMERACT definition of relevant radiological progression in hip\/knee osteoarthritis","volume":"17","author":"Ornetti","year":"2009","journal-title":"Osteoarthr. Cartil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2325967117704644","DOI":"10.1177\/2325967117704644","article-title":"Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-Up","volume":"5","author":"Sanders","year":"2017","journal-title":"Orthop. J. Sports Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1177\/0363546517699846","article-title":"High Rate of Osteoarthritis After Osteochondritis Dissecans Fragment Excision Compared with Surgical Restoration at a Mean 16-Year Follow-Up","volume":"45","author":"Sanders","year":"2017","journal-title":"Am. J. Sports Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1384\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:49:24Z","timestamp":1770724164000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":45,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041384"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041384","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]}}}