Significant Geographic Variation in the Epidemiology and Management of Pediatric Osteochondritis Dissecans Exists Between the Asia‐Pacific and North America

Purpose To evaluate regional variations in epidemiology, diagnostic approaches, and surgical interventions for pediatric osteochondritis dissecans (OCD) between Asia‐Pacific (APAC) and North America (NA). Methods A comprehensive search of PubMed, Scopus, and Cochrane Library databases was conducted from database inception until August 2025. Studies on epidemiology and surgical treatment of pediatric OCD were screened independently by 2 reviewers. Data was extracted and collated according to Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines, and risk of bias was assessed using the Methodological Index for Non‐Randomized Studies. Results Sixty‐five studies comprising 2194 patients were analyzed—29 from APAC (803 patients) and 36 from NA (1391 patients). Patients’ age (APAC: 9‐18 years; NA: 6‐19 years) and follow‐up duration (APAC: 8‐184 months; NA: 2‐216 months) were similar. Significant regional differences were observed across multiple domains. Sex distribution was markedly skewed in APAC, where most studies included predominantly male participants (91.9%) without intentional female disaggregation, compared with a more balanced cohort in NA (55.3%). Although the elbow was the most common OCD site overall, knee involvement was significantly higher in NA (36.1%) than APAC (20.7%). Imaging modalities differed—radiographs were the most common imaging tool in both regions, but magnetic resonance imaging was more frequently used in NA (48.9%) compared with APAC (35.8%). Surgical approaches also varied significantly: osteochondral grafting was more common in APAC (41.7%), whereas arthroscopic techniques were favored in NA (73.5%). In situ fixation rates were similar between regions. Standardized reporting and prospective, multicenter registries are essential for enabling patient‐level analysis and guiding region‐specific, evidence‐based care for pediatric OCD. Conclusions There are significant regional variations in epidemiology, imaging modalities, and surgical management for pediatric OCD. The predominantly male bias in the APAC region, greater use of magnetic resonance imaging, and arthroscopic techniques in the NA region reflect underlying biological, cultural, and health care‐related differences. Level of Evidence Level IV, systematic review of Level III and IV studies.