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Foot & Ankle Specialist Dec 2015Avascular necrosis of the second metatarsal head was first described by Freiberg in 1913. Conservative treatment includes nonsteroidal anti-inflammatory medication,... (Review)
Review
UNLABELLED
Avascular necrosis of the second metatarsal head was first described by Freiberg in 1913. Conservative treatment includes nonsteroidal anti-inflammatory medication, reduced activity, padding, orthotics, and immobilization. Should conservative treatment fail, a wide variety of surgical procedures exist; however, the optimal procedure is unknown. This systematic review was undertaken to determine which surgical procedure allows for the best resolution of symptoms and return to activity. Included studies were restricted to articles published in English language peer-reviewed journals that consecutively enrolled patients of all ages, with Freiberg's infraction of any stage, who underwent operative treatment, and had a mean follow-up of greater than or equal to 12 months duration. Eighty-five publications were identified, of which 38 (44.7%) met all the inclusion criteria. Surgical techniques and outcomes were grouped into joint sparing and joint destructive procedures. A total of 70 joint destructive procedures were performed with a combined mean follow-up time of 15.0 months. A greater than 70% resolution of pain and full return to activity was reported. A total of 257 joint sparing procedures were performed with a combined mean follow-up of 30.4 months. A greater than 90% resolution of pain and full return to activity was reported. Results of this systematic review reveal that the results of joint sparing procedures are reported more often and appear to have a better prognosis for symptom resolution and return to activity. Smillie stage was not consistently reported, making it difficult to determine its effect on procedure selection.
LEVEL OF EVIDENCE
Therapeutic, Level IV: Systematic review of Level IV studies.
Topics: Diagnostic Imaging; Humans; Metatarsus; Orthopedic Procedures; Osteochondritis; Physical Examination; Recovery of Function
PubMed: 25990579
DOI: 10.1177/1938640015585966 -
Arthroscopy : the Journal of... Mar 2020The management of osteochondritis dissecans (OCD) continues to baffle even the savviest of surgeons, with unclear etiology, unknown relationship of presentation to...
The management of osteochondritis dissecans (OCD) continues to baffle even the savviest of surgeons, with unclear etiology, unknown relationship of presentation to outcome, bewildering response to various treatments, and frustratingly difficult-to-predict prognosis. Whether skeletal immaturity may be indicative of surgical success, at least when it comes to lesions requiring screw fixation, remains debatable. Treatment may include activity modification, drilling, fixation, or osteochondral replacement of OCD lesions in the knee. Regardless, each OCD lesion must be followed until osseous integration is confirmed by imaging -otherwise, progression of disease to osteoarthritis is likely.
Topics: Bone Screws; Growth Plate; Humans; Knee Joint; Osteochondritis Dissecans; Reoperation
PubMed: 32139056
DOI: 10.1016/j.arthro.2019.10.041 -
Foot and Ankle Clinics Mar 2015The clinical application of small joint arthroscopies (metatarsophalangeal joint, Lisfranc joint, Chopart joint, and interphlangeal joint) in the foot has seen... (Review)
Review
The clinical application of small joint arthroscopies (metatarsophalangeal joint, Lisfranc joint, Chopart joint, and interphlangeal joint) in the foot has seen significant advancements in the past decades. This article reviews the clinical indications, technical details, outcomes, and potential complications of small joint arthroscopies of the foot.
Topics: Ankle Joint; Arthroscopy; Foot Joints; Ganglion Cysts; Hallux; Humans; Joint Capsule; Joint Instability; Metatarsophalangeal Joint; Metatarsus; Osteochondritis
PubMed: 25726488
DOI: 10.1016/j.fcl.2014.10.007 -
Sports Medicine and Arthroscopy Review Dec 2014Osteochondritis dissecans (OCD) represents an important clinical entity in orthopedic sports medicine. Once surgical intervention is required, retrograde drilling for... (Review)
Review
Osteochondritis dissecans (OCD) represents an important clinical entity in orthopedic sports medicine. Once surgical intervention is required, retrograde drilling for OCD lesions remains technically challenging. A novel electromagnetic navigation system was developed to be a radiation-free navigation tool providing spatiotemporal real-time information to the surgeon without the need for a stationary patient tracker and without relevant setup and calibration times. The novel system was tested for arthroscopically assisted retrograde drilling of cadaveric OCD lesions of the knee and talus and compared with the gold standard fluoroscopy-guided retrograde drilling procedure in a controlled laboratory study setup. The novel method considerably improves on the standard operating procedure in terms of safety, operation time, and radiation exposure and will be available for further surgical indications.
Topics: Arthroscopy; Humans; Osteochondritis Dissecans; Surgery, Computer-Assisted
PubMed: 25370876
DOI: 10.1097/JSA.0000000000000036 -
Journal of Orthopaedic Research :... Jul 2023Current clinical MRI of patients with juvenile osteochondritis dissecans (JOCD) is limited by the low reproducibility of lesion instability evaluation and inability to...
Current clinical MRI of patients with juvenile osteochondritis dissecans (JOCD) is limited by the low reproducibility of lesion instability evaluation and inability to predict which lesions will heal after nonoperative treatment and which will later require surgery. The aim of this study is to verify the ability of apparent diffusion coefficient (ADC) to detect differences in lesion microstructure between different JOCD stages, treatment groups, and healthy, unaffected contralateral knees. Pediatric patients with JOCD received quantitative diffusion MRI between January 2016 and September 2020 in this prospective research study. A disease stage (I-IV) and stability of each JOCD lesion was evaluated. ADCs were calculated in progeny lesion, interface, parent bone, cartilage overlying lesion, control bone, and control cartilage regions. ADC differences were evaluated using linear mixed models with Bonferroni correction. Evaluated were 30 patients (mean age, 13 years; 21 males), with 40 JOCD-affected and 12 healthy knees. Nine patients received surgical treatment after MRI. Negative Spearman rank correlations were found between ADCs and JOCD stage in the progeny lesion (ρ = -0.572; p < 0.001), interface (ρ = -0.324; p = 0.041), and parent bone (ρ = -0.610; p < 0.001), demonstrating the sensitivity of ADC to microstructural differences in lesions at different JOCD stages. We observed a significant increase in the interface ADCs (p = 0.007) between operative (mean [95% CI] = 1.79 [1.56-2.01] × 10 mm /s) and nonoperative group (1.27 [0.98-1.57] × 10 mm /s). Quantitative diffusion MRI detects microstructural differences in lesions at different stages of JOCD progression towards healing and reveals differences between patients assigned for operative versus nonoperative treatment.
Topics: Male; Humans; Child; Adolescent; Osteochondritis Dissecans; Cartilage, Articular; Reproducibility of Results; Prospective Studies; Knee Joint; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging
PubMed: 36484124
DOI: 10.1002/jor.25505 -
Praxis Feb 2020Not a Chronic Tennis Elbow Lateral elbow pain is a highly unspecific finding and may be caused by one of several possible differential diagnoses. Unfortunately, it is...
Not a Chronic Tennis Elbow Lateral elbow pain is a highly unspecific finding and may be caused by one of several possible differential diagnoses. Unfortunately, it is often assumed to be epicondylitis, commonly referred to as tennis elbow, although instability is a frequent cause in chronic cases. In the presented case, it is the less frequent nerve compression of the radial nerve which must also be considered, together with plica syndrome, osteochondritis dissecans and arthrosis of the radiocapitellar joint, as a differential diagnosis of lateral elbow pain.
Topics: Arthralgia; Elbow Joint; Humans; Osteochondritis Dissecans; Tennis Elbow
PubMed: 32019453
DOI: 10.1024/1661-8157/a003357 -
Adolescent Medicine: State of the Art... Apr 2015
Review
Topics: Adolescent; Adolescent Medicine; Anterior Cruciate Ligament Injuries; Athletes; Athletic Injuries; Fractures, Bone; Hand Injuries; Humans; Joint Dislocations; Osteochondritis Dissecans; Peripheral Nerve Injuries; Spondylolysis; Sports; Sports Medicine
PubMed: 26514032
DOI: No ID Found -
Arthroscopy : the Journal of... Oct 2017To evaluate the surgical treatment of the discoid lateral meniscus (DLM) with long-term follow-up and to search which factors are related to good clinical or... (Review)
Review
PURPOSE
To evaluate the surgical treatment of the discoid lateral meniscus (DLM) with long-term follow-up and to search which factors are related to good clinical or radiological outcomes.
METHODS
Search was performed using a MEDLINE, EMBASE, and Cochrane database, and each of the selected studies was evaluated for methodological quality using a risk of bias (ROB) covering 7 criteria. Clinical and radiological outcomes with more than 5 years of follow-up were evaluated after surgical treatment of DLM. They were analyzed according to the age, follow-up period, kind of surgery, DLM type, and alignment.
RESULTS
Eleven articles (422 DLM cases) were included in the final analysis. Among 7 criteria, 3 criteria showed little ROB in all studies. However, 4 criteria showed some ROB ("Yes" in 63.6% to 81.8%). The minimal follow-up period was 5.5 years (weighted mean follow-up: 9.1 years). Surgical procedures were performed with open or arthroscopic partial central meniscectomy, subtotal meniscectomy, total meniscectomy, or partial meniscectomy with repair. The majority of the studies showed good clinical results. Mild joint space narrowing was reported in the lateral compartment, but none of the knees demonstrated moderate or advanced degenerative changes. Increased age at surgery, longer follow-up period, and subtotal or total meniscectomy could be related to degenerative change. The majority of the complications was osteochondritis dissecans at the lateral femoral condyle (13 cases) and reoperation was performed by osteochondritis dissecans (4 cases), recurrent swelling (2 cases), residual symptom (1 case), stiffness (1 case), and popliteal stenosis (1 case).
CONCLUSIONS
Good clinical results were obtained with surgical treatment of symptomatic DLM. The progression of degenerative change was minimal and none of the knees demonstrated moderate or advanced degenerative changes. Increased age at surgery, longer follow-up period, and subtotal or total meniscectomy were possible risk factors for degenerative changes.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
Topics: Age Factors; Humans; Knee Joint; Menisci, Tibial; Osteochondritis Dissecans; Postoperative Complications; Recurrence; Risk Factors
PubMed: 28655477
DOI: 10.1016/j.arthro.2017.04.006 -
The Orthopedic Clinics of North America Jan 2015Multiple systems for classifying osteochondritis dissecans (OCD) of the knee have been reported. These existing classification systems have some similar characteristics,... (Review)
Review
Multiple systems for classifying osteochondritis dissecans (OCD) of the knee have been reported. These existing classification systems have some similar characteristics, such as stable lesion/intact articular cartilage and presence of a loose body. However, variations are found in the number of stages and specific lesion characteristics assessed. Currently, no system has been universally accepted. A future classification system should be developed that reconciles the discrepancies among the current systems and provides a clear, consistent, and reliable method for classifying OCD lesions of the knee during arthroscopy.
Topics: Arthroscopy; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 25435042
DOI: 10.1016/j.ocl.2014.09.009 -
Arthroscopy : the Journal of... Feb 2021The ideal treatment of juvenile osteochondritis dissecans (OCD) varies according to the chronicity of symptoms and radiographic classification. Traditionally, "stable"...
The ideal treatment of juvenile osteochondritis dissecans (OCD) varies according to the chronicity of symptoms and radiographic classification. Traditionally, "stable" OCD lesions of the knee are managed conservatively with limited weight bearing and nonoperative care. However, this can require up to 6 to 12 months of observation, and success rates are estimated at only 59%. By contrast, recent data suggest that early subchondral drilling of OCD lesions may more consistently facilitate new vascular channels and remodeling of the compromised osteochondral unit. When considering overarching health care costs and probabilistic modeling, contemporary treatment paradigms may preferentially suggest early surgical treatment of OCD lesions for greater cost-effectiveness and an optimized timeline for a return to full activity. Additionally, surgery may be prioritized for larger lesions, atypical locations, closing physes, and/or the presence of mechanical symptoms.
Topics: Cost-Benefit Analysis; Humans; Knee; Knee Joint; Osteochondritis Dissecans; Weight-Bearing
PubMed: 33546800
DOI: 10.1016/j.arthro.2020.11.036