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The Journal of Bone and Joint Surgery.... Jun 2021Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to... (Review)
Review
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Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis.
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While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition.
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Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging.
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Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions.
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Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.
Topics: Arthroscopy; Humans; Osteochondritis Dissecans; Radiography
PubMed: 34109940
DOI: 10.2106/JBJS.20.01399 -
Orthopaedics & Traumatology, Surgery &... Feb 2018Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and... (Review)
Review
Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The diagnosis is usually made during adolescence. Mechanical factors play a major role in the pathophysiology of OCD. When the radiographic diagnosis is made early in a patient with open physes, healing can often be obtained simply by restricting sports activities. The degree of lesion instability can be assessed by magnetic resonance imaging. When the lesion remains unstable and the pain persists despite a period of rest, surgery is indicated. Arthroscopic exploration is always the first step. Drilling of the lesion produces excellent outcomes if the lesion is stable. Unstable lesions require fixation and, in some cases, bone grafting. Defects must be filled, depending on their surface area. Although many surgical techniques are available, the therapeutic indications are now standardized.
Topics: Arthralgia; Arthroscopy; Humans; Knee Joint; Magnetic Resonance Imaging; Osteoarthritis, Knee; Osteochondritis Dissecans; Radiography
PubMed: 29197636
DOI: 10.1016/j.otsr.2017.02.016 -
Cartilage Dec 2021This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause... (Review)
Review
This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.
Topics: Adolescent; Adult; Ankle Joint; Arthroscopy; Child; Humans; Intra-Articular Fractures; Magnetic Resonance Imaging; Osteochondritis Dissecans; Osteonecrosis; Talus; Tomography, X-Ray Computed
PubMed: 33423507
DOI: 10.1177/1947603520985182 -
British Journal of Hospital Medicine... Apr 2023Osteochondritis dissecans is a condition characterised by acquired pathological subchondral bone lesions and its incidence is unknown. It has a multifactorial aetiology,...
Osteochondritis dissecans is a condition characterised by acquired pathological subchondral bone lesions and its incidence is unknown. It has a multifactorial aetiology, with a combination of genetic and acquired risk factors. It commonly presents in adolescents and young adults. Patients have variable presentations, including trauma, insidious onset and pain exacerbated by exercise. The joints primarily affected are the knee, ankle and elbow joint. Early identification is key to treatment and to prevent future osteoarthritis of the joint. This article gives an overview of the presentation, assessment and management of the juvenile form of osteochondritis dissecans.
Topics: Adolescent; Young Adult; Humans; Osteochondritis Dissecans; Knee Joint
PubMed: 37127418
DOI: 10.12968/hmed.2023.0044 -
Radiographics : a Review Publication of... 2018Several pathologic conditions may manifest as an osteochondral lesion of the knee that consists of a localized abnormality involving subchondral marrow, subchondral... (Review)
Review
Several pathologic conditions may manifest as an osteochondral lesion of the knee that consists of a localized abnormality involving subchondral marrow, subchondral bone, and articular cartilage. Although understanding of these conditions has evolved substantially with the use of high-spatial-resolution MRI and histologic correlation, it is impeded by inconsistent terminology and ambiguous abbreviations. Common entities include acute traumatic osteochondral injuries, subchondral insufficiency fracture, so-called spontaneous osteonecrosis of the knee, avascular necrosis, osteochondritis dissecans, and localized osteochondral abnormalities in osteoarthritis. Patient demographics, the clinical presentation, and the role of trauma are critical for differential diagnosis. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. MRI features that aid in diagnosis include the location and extent of bone marrow edema, the presence of a fracture line, a hypointense area immediately subjacent to the subchondral bone plate, and deformity of the subchondral bone plate. These findings are essential in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee. If the lesion consists of a subchondral region demarcated from the surrounding bone, the demarcation should be examined for completeness and the presence of a "double-line sign" that is seen in avascular necrosis or findings of instability, which are important for proper evaluation of osteochondritis dissecans. Subchondral bone plate collapse, demonstrated by the presence of a depression or a fluid-filled cleft, can be seen in advanced stages of both avascular necrosis and subchondral insufficiency fracture, indicating irreversibility. Once the diagnosis is established, it is important to report pertinent MRI findings that may guide treatment of each condition. RSNA, 2018 An earlier incorrect version of this article appeared online. This article was corrected on August 23, 2018.
Topics: Bone Marrow Diseases; Cartilage Diseases; Diagnosis, Differential; Femoral Fractures; Humans; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Osteoarthritis, Knee; Osteochondritis Dissecans; Osteonecrosis
PubMed: 30118392
DOI: 10.1148/rg.2018180044 -
The Veterinary Clinics of North... Aug 2017This article reviews current knowledge of osteochondritis dissecans (OCD) development in horses, including normal cartilage development, early osteochondrosis... (Review)
Review
This article reviews current knowledge of osteochondritis dissecans (OCD) development in horses, including normal cartilage development, early osteochondrosis pathogenesis, and factors that result in healing or advancement to OCD fragments. Discussion includes current theories, detection, and therapeutic options.
Topics: Animals; Biomarkers; Cartilage, Articular; Horse Diseases; Horses; Osteochondritis Dissecans; Osteogenesis; Physical Conditioning, Animal; Synovial Fluid
PubMed: 28551287
DOI: 10.1016/j.cveq.2017.03.009 -
Clinics in Podiatric Medicine and... Jan 2022OCDs of the ankle are the third most common lesion in the body and a physician should include this in the differential while evaluating the pediatric population with the... (Review)
Review
OCDs of the ankle are the third most common lesion in the body and a physician should include this in the differential while evaluating the pediatric population with the history of injury and/or pain in the ankle. Pain, stiffness, and swelling are the most common presenting complaints about the pediatric and adolescent patients with an OCD. Conservative treatment options should be attempted before attempting surgical intervention. Multiple surgical procedures exist to manage the lesion based on location, size, and other factors.
Topics: Adolescent; Ankle Joint; Child; Humans; Osteochondritis; Osteochondritis Dissecans; Talus
PubMed: 34809789
DOI: 10.1016/j.cpm.2021.09.005 -
Current Reviews in Musculoskeletal... Jun 2016Capitellar osteochondritis dissecans (OCD) can be a significant problem in adolescent overhead athletes. The cause is likely multifactorial secondary to repetitive... (Review)
Review
Capitellar osteochondritis dissecans (OCD) can be a significant problem in adolescent overhead athletes. The cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch, and a tenuous vascular supply of the capitellum. Recent literature reveals that the prevalence is likely higher than previously thought. This, in conjunction with increased levels of athletic competition in children at younger ages, has fed the recent interest in this topic. The literature continues to show that non-operative treatment is still successful for stable lesions. Unstable lesions, therefore, have been the focus of the new literature regarding operative management and outcomes. The aim of this paper is to provide a summary of current literature and an up-to-date approach to the diagnosis, evaluation, and treatment of osteochondritis dissecans of the capitellum.
PubMed: 27125506
DOI: 10.1007/s12178-016-9342-y -
Ugeskrift For Laeger Nov 2017Osteochondritis dissecans (OCD) has been known for more than 100 years. Several reasons have been suggested as the major cause for developing OCD: trauma/microtrauma,... (Review)
Review
Osteochondritis dissecans (OCD) has been known for more than 100 years. Several reasons have been suggested as the major cause for developing OCD: trauma/microtrauma, ischaemic or genetic reasons. OCD is primarily located in the knee. In adolescent patients with knee symptoms, X-ray of the affected knee and often a subsequent MRI scan is indicated. Depending on the findings, an arthroscopy can be performed. Conservative treatment can be quiet regime or bracing. Operative treatment can be transchondral/retrograde drilling for the in situ lesion or fixation of the unstable lesion.
Topics: Adolescent; Adult; Child; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Osteochondritis Dissecans; Young Adult
PubMed: 29208201
DOI: No ID Found -
The Orthopedic Clinics of North America Jan 2020Osteochondritis dissecans (OCD) of the capitellum is a relatively rare condition, with a higher incidence in adolescents who participate in repetitive overhead sports.... (Review)
Review
Osteochondritis dissecans (OCD) of the capitellum is a relatively rare condition, with a higher incidence in adolescents who participate in repetitive overhead sports. The surgical treatment approach for this uncommon problem has varied from microfracture, loose body removal, abrasion chrondroplasty, lesion fixation, osteochondral allograft transplantation surgery, and osteochondral autologous transplantation surgery. The purpose of this study is to present the authors' preferred surgical technique for the treatment of unstable OCD lesions of the capitellum with osteochondral autologous transplantation surgery using autograft from the ipsilateral knee.
Topics: Adolescent; Cartilage, Articular; Child; Elbow Joint; Female; Fractures, Stress; Humans; Humerus; Incidence; Knee Joint; Magnetic Resonance Imaging; Male; Osteochondritis Dissecans; Radiography; Plastic Surgery Procedures; Sports; Transplantation, Autologous; Treatment Outcome
PubMed: 31739884
DOI: 10.1016/j.ocl.2019.08.004