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The Pan African Medical Journal 2014
Review
Topics: Abnormalities, Multiple; Adolescent; Adult; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Metatarsus; Middle Aged; Morocco; Osteochondritis; Osteonecrosis; Osteotomy; Radiography; Retrospective Studies; Young Adult
PubMed: 25419316
DOI: 10.11604/pamj.2014.18.189.4785 -
Zhongguo Gu Shang = China Journal of... Sep 2014Along with the popularity of youth movement, the incidence of osteochondritis dissecans (OCD) showed a trend of increase, but its pathogenesis is not yet clear. Previous... (Review)
Review
Along with the popularity of youth movement, the incidence of osteochondritis dissecans (OCD) showed a trend of increase, but its pathogenesis is not yet clear. Previous studies suggested that trauma is the main potential cause, but with the emergence of vast family cases, hereditary factor is also gradually taken seriously. Arthroscopy is the "gold standard" for diagnosing OCD, but for the patient with early incomplete joint surface lesions, the diagnositic value of MRI is better than the arthroscopy. For the patients with stable form OCD, nonoperative management should be used such as adjusting activity, fixator and drugs; for the patient with unstable form OCD or failing after conservative treatment, surgery should be generally used such as joint clearing, drilling, microfracture method, fixation and transplantation. With the progress of research, stem cell technology and platelet-rich plasma gradually applied in cartilage repair, which will improve the curative effect of OCD, but still further clinical and experimental research, and also a long-term effective follow-up are needed.
Topics: Humans; Osteochondritis Dissecans
PubMed: 25571667
DOI: No ID Found -
Seminars in Musculoskeletal Radiology Nov 2014Osteochondral lesions are acquired, potentially reversible injuries of the subchondral bone with or without associated articular cartilage involvement. Injury results in... (Review)
Review
Osteochondral lesions are acquired, potentially reversible injuries of the subchondral bone with or without associated articular cartilage involvement. Injury results in delamination and potential sequestration of the affected bone. Although an association with mechanical and traumatic factors has been established, the etiology remains poorly understood. These lesions commonly occur in the knee; articular surfaces of the elbow, ankle, hip, and shoulder are also affected. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Many of these lesions are first diagnosed by plain film. MRI adds value by identifying unstable lesions that require surgical intervention. This review focuses on the clinical and imaging features of osteochondral lesions of the knee, elbow, and ankle. Imaging criteria for staging and management are also reviewed.
Topics: Adolescent; Ankle Injuries; Cartilage, Articular; Child; Diagnostic Imaging; Humans; Knee Injuries; Osteochondritis; Elbow Injuries
PubMed: 25350829
DOI: 10.1055/s-0034-1389268 -
The Journal of Knee Surgery Oct 2016Osteochondritis dissecans (OCD) of the knee remains a relatively common and poorly understood pediatric and adolescent knee condition. Both conservative and surgical... (Review)
Review
Osteochondritis dissecans (OCD) of the knee remains a relatively common and poorly understood pediatric and adolescent knee condition. Both conservative and surgical treatments have major impact on the lives of young active, athletic patients with knee OCD. OCD has been recently redefined as a "focal, idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis." The 2011 American Academy of Orthopedic Surgeons Clinical Practice Guidelines found limited evidence for all aspects of the treatment of knee OCD. The multicenter study group Research in Osteochondritis dissecans of the Knee (ROCK) was formed to advance the understanding and treatment of this condition. This article will review our current understanding of the pathophysiology, treatment options, and outcomes of OCD of the knee, with a focus on the past, present, and future research including the work of the ROCK study group.
Topics: Cohort Studies; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 27532280
DOI: 10.1055/s-0036-1586723 -
The Journal of the American Academy of... May 2017The knee is one of the most commonly injured joints in the body. Its superficial anatomy enables diagnosis of the injury through a thorough history and physical... (Review)
Review
The knee is one of the most commonly injured joints in the body. Its superficial anatomy enables diagnosis of the injury through a thorough history and physical examination. Examination techniques for the knee described decades ago are still useful, as are more recently developed tests. Proper use of these techniques requires understanding of the anatomy and biomechanical principles of the knee as well as the pathophysiology of the injuries, including tears to the menisci and extensor mechanism, patellofemoral conditions, and osteochondritis dissecans. Nevertheless, the clinical validity and accuracy of the diagnostic tests vary. Advanced imaging studies may be useful adjuncts.
Topics: Cartilage; Humans; Knee Injuries; Magnetic Resonance Imaging; Menisci, Tibial; Osteochondritis Dissecans; Physical Examination; Tibial Meniscus Injuries
PubMed: 28406879
DOI: 10.5435/JAAOS-D-15-00464 -
Foot (Edinburgh, Scotland) May 2022Freiberg's osteochondrosis is an uncommon cause of foot pain. Following a national survey circulated by the British Foot and Ankle Society it was found that no...
INTRODUCTION
Freiberg's osteochondrosis is an uncommon cause of foot pain. Following a national survey circulated by the British Foot and Ankle Society it was found that no classification is used to guide surgical treatment. This study aimed to create a simple, reproducible CT based classification to preoperatively plan whether an osteotomy is required.
METHODS
A retrospective review of 24 CT scans of new Freiberg's diseasediagnoses over a 10 year period was conducted. These images were assigned a study number and anonymised. The scans were then reviewed in their entirety by three independent specialists who determined whether an osteotomy would be of benefit. The sagittal CT slice that displayed the widest portion of proximal articular margin of the proximal phalanx was identified and divided the articular surface into 2 zones - plantar and dorsal and this formed the basis for our classification. These sagittal slices were then reviewed independently by two surgeons to determine if patients had disease in one or both zones and re-reviewed two weeks later to assess intra-observer reliability.
RESULTS
All 24 cases involved the second metatarsal. From reviewing the sagittal CT slices, it was felt that 18 patients were suitable for osteotomy and 6 were suitable for debridement +/- arthroplasty alone. The current classification demonstrated that 18 patients had disease confined to zone 1 only and the remaining patients had disease in both zones. Inter-observer reliability assessment had 95.8% agreement (Krippendorff's Alpha 0.897). Intra-observer reliability was 100%. Correlation of those observed to have isolated zone 1 disease and suitability for osteotomy was absolute (Pearson r = 1).
CONCLUSION
Dividing the metatarsal head into two zones on the widest sagittal slice of the CT scan offers an easy reproducible way to preoperatively plan surgical treatment for Freiberg's osteochondrosis. Patients with isolated zone 1 disease should be suitable for an osteotomy.
Topics: Humans; Metatarsal Bones; Metatarsus; Osteochondritis; Osteochondrosis; Reproducibility of Results
PubMed: 35259580
DOI: 10.1016/j.foot.2021.101901 -
Cartilage Oct 2018This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an... (Review)
Review
This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an analysis of and outcomes of the treatments available. OCD is seen in children and adolescents with open growth plates (juvenile OCD) and adults with closed growth plates (adult OCD). The etiology of OCD lesions remains unclear and is characterized by an aseptic necrosis in the subchondral bone area. Mechanical factors seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important. Regarding treatment, a tremendous number of publications exist. Spontaneous healing is expected unless there is an unstable fragment, and treatment involves rest and different degrees of immobilization until healing. Patients with open physes and low-grade lesions have good results with conservative therapy. When surgery is necessary, the procedure depends on the stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable. When the cartilage is damaged, several techniques can be used. While techniques such as drilling and microfracturing produce reparative cartilage, other techniques reconstruct the defect with additional osteochondral grafts or cell-based procedures such as chondrocyte transplantation. There is a tendency toward better results when using procedures that reconstruct the bone and the cartilage and there is also a trend toward better long-term results when comorbidities are treated. Severe grades of osteoarthrosis are rare.
Topics: Adolescent; Adult; Arthroscopy; Cartilage, Articular; Child; Chondrocytes; Conservative Treatment; Female; Growth Plate; Humans; Knee Joint; Male; Osteochondritis Dissecans
PubMed: 28639852
DOI: 10.1177/1947603517715736 -
Sports Medicine and Arthroscopy Review Jun 2016The subchondral zone plays an important role in both the structural and biochemical maintenance of articular cartilage. Knowledge of the structure, function, and... (Review)
Review
The subchondral zone plays an important role in both the structural and biochemical maintenance of articular cartilage. Knowledge of the structure, function, and pathophysiology of the normal subchondral bone/articular surface interface is essential for an understanding of the pathogenesis of many of the disease entities that we will review in this chapter.
Topics: Bone and Bones; Contusions; Humans; Knee Joint; Magnetic Resonance Imaging; Osteochondritis Dissecans
PubMed: 27135285
DOI: 10.1097/JSA.0000000000000112 -
The American Journal of Sports Medicine Dec 2021The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject.
BACKGROUND
The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject.
PURPOSE
To better understand the efficacy of different surgical modalities and nonoperative treatment of OCD as assessed by radiological and clinical outcomes and return to sports.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review of all treatment studies published between January 1975 and June 2020 was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 76 clinical studies, including 1463 patients, were suitable for inclusion. Aggregate analysis and subgroup analysis of individual patient data were performed to compare the functional and radiographic outcomes between the various nonoperative and surgical treatment options for capitellar OCD. A unified grading system (UGS; grades 1-4) was developed from existing validated classification systems to allow a comparison of patients with similar-grade OCD lesions in different studies according to their treatment. Patient-level data were available for 352 patients. The primary outcome measures of interest were patient-reported functional outcome, range of motion (ROM), and return to sports after treatment. The influences of the capitellar physeal status, location of the lesion, and type of sports participation were also assessed. Each outcome measure was evaluated according to the grade of OCD and treatment method (debridement/microfracture, fragment fixation, osteochondral autograft transplantation [OATS], or nonoperative treatment).
RESULTS
No studies reported elbow scores or ROM for nonoperatively treated patients. All surgical modalities resulted in significantly increased postoperative ROM and elbow scores for stable (UGS grades 1 and 2) and unstable lesions (UGS grades 3 and 4). There was no significant difference in the magnitude of improvement or overall scores according to the type of surgery for stable or unstable lesions. Return to sports was superior with nonoperative treatment for stable lesions, whereas surgical treatment was superior for unstable lesions. Patients with an open capitellar physis had superior ROM for stable and unstable lesions, but there was no correlation with lesion location and the outcomes of OATS versus fragment fixation for high-grade lesions.
CONCLUSION
Nonoperative treatment was similar in outcomes to surgical treatment for low-grade lesions, whereas surgical treatment was superior for higher grade lesions. There is currently insufficient evidence to support complex reconstructive techniques for high-grade lesions compared with microfracture/debridement alone.
Topics: Bone Transplantation; Elbow Joint; Humans; Osteochondritis Dissecans; Range of Motion, Articular; Transplantation, Autologous; Treatment Outcome
PubMed: 33886390
DOI: 10.1177/03635465211000763 -
The Journal of Hand Surgery Nov 2023Reconstruction of unstable osteochondritis dissecans lesions of the capitellum using fresh osteochondral allograft transplantation from the capitellum has the advantages... (Review)
Review
Reconstruction of unstable osteochondritis dissecans lesions of the capitellum using fresh osteochondral allograft transplantation from the capitellum has the advantages of restoring hyaline cartilage, matching the native radius of curvature, and avoiding the donor-site morbidity encountered with osteochondral autograft transfer. This technical note describes the indications and contraindications, pertinent anatomy, and surgical technique of open osteochondral allograft transplantation using fresh distal humerus allograft for the treatment of unstable osteochondritis dissecans lesions of the capitellum.
Topics: Humans; Osteochondritis Dissecans; Elbow; Treatment Outcome; Elbow Joint; Transplantation, Autologous; Bone Transplantation; Allografts
PubMed: 36967310
DOI: 10.1016/j.jhsa.2023.01.020