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Foot & Ankle International Dec 2019
Review
Topics: Diagnosis, Differential; Diagnostic Imaging; Foot Diseases; Humans; Osteochondritis; Osteonecrosis; Tarsal Bones
PubMed: 31538823
DOI: 10.1177/1071100719877000 -
Arthroscopy : the Journal of... May 2021Fresh osteochondral allograft transplantation has been my preferred procedure for chondral and osteochondral lesions for many decades. This is particularly true for...
Fresh osteochondral allograft transplantation has been my preferred procedure for chondral and osteochondral lesions for many decades. This is particularly true for patients younger than 18 years of age, where diagnoses such as osteochondritis dissecans, osteochondral fractures, and osteonecrosis predominate, rendering the situation as much a "bone problem" as a "cartilage problem." In the universe of cartilage-repair techniques, osteochondral allografts are particularly useful when bone defects must be managed. Furthermore, allografts have stood the test of time for safety, efficacy, and durability, even in a young, active population. For me, I don't think twice about using fresh allografts in young patients. I might even have to admit that an osteochondral allograft transplantation procedure for an osteochondritis dissecans lesion in a patient younger than 18 years old is my favorite surgery!
Topics: Adolescent; Allografts; Bone Transplantation; Cartilage; Humans; Knee Joint; Osteochondritis Dissecans; Transplantation, Homologous
PubMed: 33896511
DOI: 10.1016/j.arthro.2021.02.027 -
American Family Physician Jul 2017
Review
Topics: Adolescent; Calcaneus; Child; Humans; Orthotic Devices; Osteochondritis; Pain Measurement; Shoes
PubMed: 28762709
DOI: No ID Found -
Journal of Paediatrics and Child Health Nov 2017Growing children are susceptible to a number of disorders to their lower extremities of varying degrees of severity. The diagnosis and management of these conditions can... (Review)
Review
Growing children are susceptible to a number of disorders to their lower extremities of varying degrees of severity. The diagnosis and management of these conditions can be challenging. With musculoskeletal symptoms being one of the leading reasons for visits to general practitioners, a working knowledge of the basics of these disorders can help in the appropriate diagnosis, treatment, counselling, and specialist referral. This review covers common disorders affecting the hip, the knee and the foot. The aim is to assist general practitioners in recognising developmental norms and differentiating physiological from pathological conditions and to identify when a specialist referral is necessary.
Topics: Child; Foot Deformities, Congenital; Genu Valgum; Genu Varum; Hip Dislocation, Congenital; Humans; Legg-Calve-Perthes Disease; Lower Extremity Deformities, Congenital; Osteochondritis Dissecans; Osteochondrosis; Slipped Capital Femoral Epiphyses
PubMed: 29148202
DOI: 10.1111/jpc.13756 -
Journal of Orthopaedic Science :... Mar 2018Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. However, its etiology remains unknown.... (Review)
Review
Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. However, its etiology remains unknown. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. A plain anteroposterior radiograph with the elbow in 45° of flexion is essential for the diagnosis of an OCD lesion. The stability of OCD lesions is evaluated on plain radiographs, computed tomography, and magnetic resonance imaging (MRI). Imaging features of the unstable lesions are an epiphyseal closure of the capitellum or a lateral epicondyle, a displaced fragment, or irregular contours of the articular surface and a high signal interface on T2-weighted MRI. A stable lesion has the potential to be healed with conservative treatment. By contrast, surgical treatment should be considered if there is no radiographic improvement within 3 months. In addition, surgery should be performed for the lesions that cause pain during daily activities, have a locking phenomenon, or which are assessed by imaging as obviously unstable. Arthroscopic debridement/loose body removal can be performed for small lesions (≤12 mm in diameter). For large lesions (>12 mm), preservation and/or reconstruction of the articular surface should be selected, such as bone-peg fixation of the lateral part of the fragment and osteochondral autograft transplantation (OAT) from the knee. In the future directions, there is no comparative study of OAT from the knee and rib. In addition, little is known about its long-term outcome, or resulting osteoarthritis. A recent meta-analysis showed that grafts harvested from the knee may lead to donor site morbidity (7.8%). Thus, a novel cartilage tissue engineering approach is anticipated.
Topics: Adult; Arthralgia; Arthroscopy; Athletic Injuries; Conservative Treatment; Debridement; Elbow Joint; Female; Humans; Humeral Head; Magnetic Resonance Imaging; Male; Osteochondritis Dissecans; Prognosis; Recovery of Function; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 29276039
DOI: 10.1016/j.jos.2017.11.013 -
Bulletin of the Hospital For Joint... Mar 2016Osteochondritis dissecans (OCD) of the capitellum is an articular cartilage lesion commonly affecting young adolescents. The exact mechanism for the development of these... (Review)
Review
Osteochondritis dissecans (OCD) of the capitellum is an articular cartilage lesion commonly affecting young adolescents. The exact mechanism for the development of these lesions is still uncertain; however, both traumatic and vascular etiologies have been described. Careful physical examination in conjunction with appropriate diagnostic studies helps the surgeon to classify these lesions as stable or unstable and leads to proper management. There is a diverse array of treatments available for OCD lesions of the capitellum, including fragment excision or fixation, bone marrow stimulation, and osteochondral autograft transplantation. This review helps the orthopaedic surgeon understand the diagnosis and management options available for OCD lesions of the capitellum.
Topics: Athletic Injuries; Cumulative Trauma Disorders; Diagnostic Imaging; Elbow Joint; Humans; Osteochondritis Dissecans; Risk Factors
PubMed: 26977547
DOI: No ID Found -
Knee Surgery, Sports Traumatology,... Sep 2021The current systematic review and meta-analysis aim to pool together the incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knee. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The current systematic review and meta-analysis aim to pool together the incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knee.
METHODS
The systematic review was conducted according to PRISMA guidelines. A search was conducted using PubMed and Cochrane Library with the keywords being "knee" and "osteochondritis dissecans" or "osteochondral lesion". All original human studies that reported the incidence or risk factors of osteoarthritis following osteochondritis dissecans of the knee were included.
RESULTS
Nine studies with 496 patients were included. The incidence of osteoarthritis following osteochondritis dissecans is 0.39 (95% CI 0.19-0.59). Patients with a body mass index greater than 25 kg/m had a significantly increased risk of osteoarthritis. Fragment excision had an increased relative risk of 1.89 (95% CI 1.19-3.01) of osteoarthritis as compared to fragment preservation. Significant heterogeneity was identified when comparing between juvenile and adult osteochondritis dissecans. The size of the lesions moderated the between-study heterogeneity with regards to the incidence of osteoarthritis, with the relative risk of osteoarthritis in lesions bigger than 4 cm being 2.29 (95% CI 1.24-4.23). No other risk factors, including gender of the patient, location of osteochondritis dissecans, stability of osteochondritis dissecans, and surgical versus non-surgical management were significant risk factors.
CONCLUSION
Significant risk factors for osteoarthritis were increased body mass index and fragment excision. Probable but inconclusive risk factors were the age of the patients and the size of the osteochondritis dissecans. The gender of the patient, location of osteochondritis dissecans, the stability of osteochondritis dissecans, and surgical versus non-surgical management of osteochondritis dissecans when appropriate were not significant risk factors.
Topics: Adult; Humans; Incidence; Knee Joint; Osteoarthritis, Knee; Osteochondritis Dissecans; Risk Factors
PubMed: 33211214
DOI: 10.1007/s00167-020-06365-y -
Current Opinion in Pediatrics Feb 2016Juvenile osteochondritis dissecans (JOCD) knee lesions are common abnormalities in adolescents and children, and have higher rates of spontaneous healing with... (Review)
Review
PURPOSE OF REVIEW
Juvenile osteochondritis dissecans (JOCD) knee lesions are common abnormalities in adolescents and children, and have higher rates of spontaneous healing with nonoperative management compared to adult osteochondritis dissecans (OCD) lesions. Multiple classification and assessment systems have been established in order to help clinicians determine which lesions are amenable to nonoperative management. However, these assessments often use adult OCD classification systems of lesion stability, which have poor reliability in JOCD lesions. The purpose of this review is to assess these various classification systems proposed for JOCD lesions.
RECENT FINDINGS
Although arthroscopy remains the gold standard for the definitive assessment of lesion stability, recent evidence suggests that MRI characteristics indicative of instability in adult OCD lesions are not applicable in determining JOCD lesion instability. In addition, the correlation between arthroscopic and MRI indications of instability is highly varied in these younger patients.
SUMMARY
In order for the pediatric orthopedic surgeon to more accurately predict treatment outcomes in patients with JOCD knee lesions, further investigation into the radiographic characteristics specific to JOCD lesion instability and healing is warranted.
Topics: Arthroscopy; Child; Humans; Knee Joint; Magnetic Resonance Imaging; Osteochondritis Dissecans; Radiography; Severity of Illness Index
PubMed: 26709687
DOI: 10.1097/MOP.0000000000000308 -
The Orthopedic Clinics of North America Oct 2014High valgus and extension loads imparted to the athlete's elbow during repetitive overhead throwing can lead to acute and chronic pathology. Over time, normal soft... (Review)
Review
High valgus and extension loads imparted to the athlete's elbow during repetitive overhead throwing can lead to acute and chronic pathology. Over time, normal soft tissue and bony stabilizing structures of the elbow undergo progressive structural changes and can succumb to injury. Modern diagnostic modalities, including plain radiographs, computed tomography, and magnetic resonance imaging, in addition to arthroscopy, can aid in diagnosis. Although nonoperative management is often successful, surgical intervention may be necessary before allowing return to play.
Topics: Adolescent; Arthralgia; Arthroscopy; Athletic Injuries; Baseball; Biomechanical Phenomena; Cumulative Trauma Disorders; Diagnostic Imaging; Elbow; Electrodiagnosis; Humans; Ligaments, Articular; Medical History Taking; Olecranon Process; Osteochondritis Dissecans; Physical Examination; Tennis Elbow; Ulnar Neuropathies; Elbow Injuries
PubMed: 25199426
DOI: 10.1016/j.ocl.2014.06.012 -
The Journal of Medical Investigation :... 2020Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association... (Review)
Review
Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association of player position with capitellar OCD. Elbow pain and a longer playing history might be related to progression of capitellar OCD but do not in themselves increase the risk of development of the condition. The cause of capitellar OCD is likely to include a combination of repetitive microtrauma and internal factors, such as ischemia and genetic predisposition. A combination of radiography, computed tomography, magnetic resonance imaging, and ultrasonography have aided our understanding of the pathology of capitellar OCD. Screening using ultrasonography enables early detection and provides an opportunity for successful conservative treatment. Treatment has conventionally included both operative and nonoperative measures based on the stage and size of the lesion, skeletal maturity, subjective symptoms, and structural integrity of the cartilage. Early-stage lesions respond better to nonoperative treatment than those in more advanced stages. Operative indications include persistent symptoms despite nonoperative treatment, symptomatic loose bodies, and displacement or detachment of fragments. J. Med. Invest. 67 : 217-221, August, 2020.
Topics: Humans; Osteochondritis Dissecans
PubMed: 33148891
DOI: 10.2152/jmi.67.217