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The Journal of Knee Surgery May 2018Osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. Lateral patella... (Review)
Review
Osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. Lateral patella dislocation is a common traumatic cause of osteochondral injury that typically occurs at the medial facet of the patella or at the lateral aspect of the distal femur. Multiple theories have been proposed for the cause of an OCD lesion in the knee, including trauma or repetitive microtrauma, local vascular insufficiency, and family history. The most "classic" location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. Multiple treatment options are available for both traumatic osteochondral injuries and OCD lesions, with important determining factors of treatment being skeletal maturity of the patient, instability of the fragment, lesion location, and size of the lesion. Nonsurgical management is appropriate in some situations. Surgical options range from simple fragment excision to internal fixation of the fracture fragment to more complex cartilage restoration or replacement procedures. This special focus section will discuss the diagnosis and treatment options for traumatic osteochondral knee injuries, including the subset secondary to juvenile OCD lesions.
Topics: Age Factors; Arthroscopy; Cartilage, Articular; Child; Fracture Fixation; Humans; Intra-Articular Fractures; Knee Injuries; Osteochondritis Dissecans; Patellar Dislocation
PubMed: 29381884
DOI: 10.1055/s-0038-1625956 -
Acta Orthopaedica Aug 2018Background and purpose - The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well...
Background and purpose - The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Patients and methods - This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3-10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results - No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle-hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Interpretation - Nonoperative treatment can be considered a good option for patients with OCL.
Topics: Adult; Disease Progression; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Osteoarthritis; Osteochondritis; Radiography; Retrospective Studies; Talus; Treatment Outcome; Weight-Bearing
PubMed: 29635971
DOI: 10.1080/17453674.2018.1460777 -
The Physician and Sportsmedicine Dec 2023Osteochondritis dissecans can result in significant limitations in activity, pain, and early osteoarthritis. There are various treatment modalities to address these... (Review)
Review
OBJECTIVES
Osteochondritis dissecans can result in significant limitations in activity, pain, and early osteoarthritis. There are various treatment modalities to address these defects. The purpose of this study was to provide a qualitative summary of the various treatment options for unstable osteochondritis dissecans in the knee.
METHODS
A literature search was performed on osteochondritis dissecans in the knee using PubMed (MEDLINE), Embase, and Cochrane electronic databases. The search was completed using a combination of the following terms: 'osteochondritis dissecans,' 'OCD,' 'osteochondral,' 'articular cartilage,' 'repair,' 'surgery,' 'treatment,' 'osteochondral allograft,' 'autologous chondrocyte implantation,' 'unstable,' 'knee,' 'clinical studies.'
RESULTS
A total of 682 studies were found, of which 24 were included in the qualitative analysis. The quality score ranged from 46 to 80, and the mean follow-up ranged from 2 to 17 years. The most common surgical procedures were internal fixation (n = 7 studies), ACI (n = 6), fragment excision (n = 3), MACI (n = 2), bone graft + ACI (n = 2), OCA (n = 2), mosaicplasty/OAT (n = 2), and scaffold (n = 2). Overall, the reported outcome measures were heterogeneous in nature. Post-operative International Knee Documentations Committee (IKDC) scores ranged from 75 to 85 and Lysholm scores ranged from 70 to 93.5. Tegner scores ranged from 4 to 5. Rates of failure, complication, and revision were highly variable across studies and surgical techniques.
CONCLUSION
There are a variety of surgical options for the treatment of unstable osteochondritis dissecans. In skeletally immature patients, internal fixation demonstrated acceptable rates of radiographic union and patient reported outcome measures. In skeletally mature patients with large lesions, MACI and OCA transplantation provided similar patient reported outcomes.
Topics: Humans; Osteochondritis Dissecans; Knee Joint; Bone Transplantation; Cartilage, Articular; Fracture Fixation, Internal; Transplantation, Autologous; Follow-Up Studies; Treatment Outcome
PubMed: 35611658
DOI: 10.1080/00913847.2022.2082262 -
Osteoarthritis and Cartilage Dec 2018
Topics: Cartilage, Articular; Humans; Knee Joint; Obsessive-Compulsive Disorder; Osteochondritis Dissecans; Osteochondrosis
PubMed: 30248502
DOI: 10.1016/j.joca.2018.09.008 -
Ultrasound in Medicine & Biology Sep 2023Osteochondritis dissecans (OCD) of the capitellum is a joint defect that is common among adolescent athletes. It is important to diagnose OCD as early as possible,...
OBJECTIVE
Osteochondritis dissecans (OCD) of the capitellum is a joint defect that is common among adolescent athletes. It is important to diagnose OCD as early as possible, because early-stage OCD lesions have a high rate of spontaneous healing with rest. Medical ultrasound could potentially be used as a screening tool for OCD but is limited by the use of delay-and-sum (DAS) reconstruction. In this study, we tested conventional delay-multiply-and-sum (DMAS) and novel low-pass DMAS reconstruction algorithms for better visualization of OCD lesions.
METHODS
We created phantom and cadaveric OCD models that simulated a range of OCD lesion severities and stabilities. We also imaged an in vivo case of OCD in a patient study. In the reconstructed images, several profiles were taken to measure OCD lesion contrast, cartilage contrast, crack thickness error and bone interface clarity.
RESULTS
In the phantom and cadaveric OCD models, we found that histogram-matched conventional DMAS reconstruction improved lesion contrast by up to 16%, cartilage contrast by 26% and bone interface clarity by 15% on average compared with DAS reconstruction. Histogram-matched low-pass DMAS reconstruction improved lesion contrast by up to 22%, cartilage contrast by 45%, and bone interface clarity by 29% on average compared with DAS reconstruction. In the in vivo case of OCD, we found that histogram-matched conventional and low-pass DMAS reconstruction improved lesion contrast by 22% and 26%, respectively.
CONCLUSION
The application of DMAS reconstruction improved the ability of medical ultrasound to detect OCD lesions of the capitellum when compared with DAS reconstruction.
Topics: Adolescent; Humans; Osteochondritis Dissecans; Ultrasonography; Algorithms; Phantoms, Imaging; Cadaver; Elbow Joint
PubMed: 37357080
DOI: 10.1016/j.ultrasmedbio.2023.05.001 -
The Orthopedic Clinics of North America Jan 2015The authors' preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion... (Review)
Review
The authors' preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. For unstable yet salvageable OCD lesions, the senior author's preferred treatment is fixation with bone grafting. For unstable and unsalvageable OCD lesions, the senior author's preferred treatment is autologous chondrocyte implantation with bone grafting.
Topics: Algorithms; Athletic Injuries; Humans; Knee Joint; Osteochondritis Dissecans; Patient Selection
PubMed: 25435043
DOI: 10.1016/j.ocl.2014.09.010 -
The Journal of the American Academy of... Jul 2024Osteochondritis dissecans (OCD) of the knee is a potentially disabling condition in adolescent and young adults, which is likely multifactorial in origin. In recent... (Review)
Review
Osteochondritis dissecans (OCD) of the knee is a potentially disabling condition in adolescent and young adults, which is likely multifactorial in origin. In recent years, there have been notable improvements in identification and treatment. Clinical presentation varies based mostly on OCD lesion stability. Patients with stable lesions generally present with vague knee pain and altered gait while mechanical symptoms and effusion are more common with unstable lesions. Lesions most commonly occur on the lateral aspect of the medial femoral condyle in patients aged 10 to 20 years. Magnetic resonance imaging is vital to diagnose and predict clinical treatment, which is largely based on stability of the fragment. Conservative treatment of stable lesions in patients with open physis is recommended with protected weight-bearing and gradual progression of activities over the course of 3 to 6 months. Stable OCD lesions which failed a nonsurgical course can be treated with transarticular or retrograde drilling while unstable lesions usually require fixation, autologous chondrocyte implantation (ACI), osteochondral autograft transfer (OATS), or osteochondral allograft transplantation. This review highlights the most current understanding of knee OCD lesions and treatment options with the goal of optimizing outcomes in this difficult pathology.
Topics: Humans; Osteochondritis Dissecans; Knee Joint; Adolescent; Magnetic Resonance Imaging; Young Adult; Evidence-Based Medicine; Chondrocytes; Transplantation, Autologous; Child; Bone Transplantation
PubMed: 38295387
DOI: 10.5435/JAAOS-D-23-00494 -
Journal of Pediatric OrthopedicsWith the rise of social media, patients are using a variety of online resources to gather information about medical conditions and connect with others for support....
BACKGROUND
With the rise of social media, patients are using a variety of online resources to gather information about medical conditions and connect with others for support. Osteochondritis dissecans (OCD) occurs most commonly among children and adolescents, necessitating early diagnosis and management. The purpose of this study is to evaluate content on social media about OCD to quantify the reach of information shared and themes of discussion surrounding this condition.
METHODS
A search was performed across Facebook, Instagram, YouTube, and TikTok using the term "osteochondritis dissecans" to identify information shared related to this topic which was then analyzed based on engagement using number of followers, posts, and/or views.
RESULTS
Facebook groups provided a forum for online support and information sharing among patients with OCD and their families. The 4 identified groups had a cumulative following of over 4000 people with posts that shared personal recovery stories, solicited treatment advice, and provided updates on patient progress. Review of related Instagram hashtags revealed over 4500 posts, many of which shared personal accounts of living with OCD. The top 5 most viewed YouTube videos collectively had over 189,000 views and were focused on educational information about OCD, relevant surgical techniques, and pertinent anatomy. The top 3 OCD-related TikTok hashtags had over 4 million total views centered on factual knowledge and sharing changes before and after surgical treatment.
CONCLUSION
Patients with OCD and their families seek information about their condition and treatment on online sources including social media. Although social media provides a supportive community to share and receive advice, the quality of information shared in these groups is a subject for concern. Increasing physician involvement and awareness of the information shared across social media platforms may improve accuracy of information and content available to patients.
CLINICAL RELEVANCE
It is important for physicians treating patients with OCD to be aware of all sources of information and support, including content shared on social media as these platforms allow for the sharing of personal stories, recommendations for treatment, and educational content.
Topics: Adolescent; Child; Humans; Osteochondritis; Social Media
PubMed: 36037441
DOI: 10.1097/BPO.0000000000002244 -
Pediatric Clinics of North America Dec 2014There are multiple causes of pediatric foot and ankle pain. Although conservative measures are appropriate for initial management, patients with refractory pain should... (Review)
Review
There are multiple causes of pediatric foot and ankle pain. Although conservative measures are appropriate for initial management, patients with refractory pain should be given consideration for further intervention. This review highlights some of the most common causes of foot and ankle pain in the child, with specific attention to demographics, etiologies, diagnostic workup, and treatment options.
Topics: Adolescent; Ankle; Bone Diseases; Child; Diagnosis, Differential; Foot; Humans; Joint Diseases; Orthopedic Procedures; Osteochondritis; Osteonecrosis; Pain; Radiography
PubMed: 25439019
DOI: 10.1016/j.pcl.2014.08.005 -
MMW Fortschritte Der Medizin Mar 2015
Review
Topics: Arthralgia; Arthroscopy; Humans; Knee Joint; Magnetic Resonance Imaging; Osteochondritis Dissecans
PubMed: 25743985
DOI: 10.1007/s15006-015-2549-9