-
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 -
The American Journal of Sports Medicine Feb 2022Gymnastics is a unique sport that places significant loads across the growing elbow, resulting in unique overuse injuries, some of which are poorly described in the... (Review)
Review
BACKGROUND
Gymnastics is a unique sport that places significant loads across the growing elbow, resulting in unique overuse injuries, some of which are poorly described in the current literature.
PURPOSE
To provide a comprehensive review of the unique overuse elbow injuries seen in youth gymnasts and to provide an up-to-date synthesis of the available literature and clinical expertise guiding treatment decisions in this population.
STUDY DESIGN
Narrative review.
METHODS
A review of the PubMed database was performed to include all studies describing elbow biomechanics during gymnastics, clinical entities of the elbow in gymnasts, and outcomes of operative and/or nonoperative treatment of elbow pathology in gymnasts.
RESULTS
Participation in gymnastics among youth athletes is high, being the sixth most common sport in children. Early specialization is the norm in this sport, and gymnastics also has the highest number of participation hours of all youth sports. As a result, unique overuse elbow injuries are common, primarily on the lateral side of the elbow. Beyond common diagnoses of radiocapitellar plica and osteochondritis dissecans of the capitellum, we describe a pathology unique to gymnasts involving stress fracture of the radial head. Additionally, we synthesized our clinical experience and expertise in gymnastics to provide a sport-specific rehabilitation program that can be used by providers treating surgical and nonsurgical conditions of the elbow and wishing to provide detailed activity instructions to their athletes.
CONCLUSION
Overuse injuries of the elbow are common in gymnastics and include osteochondritis dissecans of the capitellum, radiocapitellar plica syndrome, and newly described radial head stress fractures. A thorough understanding of the psychological, cultural, and biomechanical aspects of gymnastics are necessary to care for these athletes.
Topics: Adolescent; Athletic Injuries; Child; Cumulative Trauma Disorders; Elbow Joint; Gymnastics; Humans; Osteochondritis Dissecans; Elbow Injuries
PubMed: 33780632
DOI: 10.1177/03635465211000776 -
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 -
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 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 -
Orthopadie (Heidelberg, Germany) Oct 2022Juvenile osteonecrosis is an important topic in orthopedics. A wide variety of body regions of the growing patient are affected, predominantly during adolescence. All... (Review)
Review
BACKGROUND
Juvenile osteonecrosis is an important topic in orthopedics. A wide variety of body regions of the growing patient are affected, predominantly during adolescence. All are characterized by a usually unknown aetiology as well as a stadium-like course. The main problem is a local osseous circulatory disorder, which causes osteonecrosis.
RISK FACTORS
Mechanical overloading due to increased body weight, axial misalignment, and sports activity is discussed as a risk factor. Healing depends on the localization and extent of the osseous necrosis.
DIAGNOSTICS
Diagnostically, radiologic imaging is used, in which the typical bony remodeling can be followed.
THERAPY
The therapeutic procedure depends on the affected region but is usually accompanied by a reduction of mechanical loading. If the clinical and radiological findings worsen, surgical treatment must be considered. The recognition and treatment of juvenile osteonecrosis is important and significantly influences the further development of the patient.
Topics: Adolescent; Bone Remodeling; Humans; Necrosis; Osteochondritis Dissecans; Osteochondrosis; Osteonecrosis
PubMed: 36064862
DOI: 10.1007/s00132-022-04305-x -
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 -
International Journal of Surgery... Dec 2015Extracorporeal shockwave therapy (ESWT) has gained acceptance in the medical field and in the treatment of non-unions and delayed bone healing. ESWT has been used... (Review)
Review
Extracorporeal shockwave therapy (ESWT) has gained acceptance in the medical field and in the treatment of non-unions and delayed bone healing. ESWT has been used effectively for many years as a noninvasive surgical procedure. The idea of treating Osteochondritis dissecans of knee and talus arose in the middle of the 1990's. OCD is known as a pre-arthritic factor in the long-term and still there is no consistent treatment. In the literature there is still only a small number of publications but international societies for shockwave treatment are convinced that ESWT on OCD shows to be an effective and safe method in the treatment of OCD in the early stages. We want to summarize the actual data on the treatment of OCD by ESWT.
Topics: Adult; High-Energy Shock Waves; Humans; Magnetic Resonance Imaging; Osteochondritis Dissecans
PubMed: 26455533
DOI: 10.1016/j.ijsu.2015.09.035 -
Cartilage Oct 2021This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed... (Review)
Review
This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed by an analysis of particular characteristics and outcomes of the treatment. OCD is seen in patients with open growth plates (juvenile OCD [JOCD] and in adults [AOCD] with closed growth plates [adult OCD). The etiology at smaller joints remains as unclear as for the knee. Mechanical factors (throwing activities [capitulum] seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important for the diagnosis. In low-grade and stable lesions, treatment involves rest and different degrees of immobilization until healing. When surgery is necessary, the procedure depends on the OCD stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable while with damaged cartilage, several techniques are used. Techniques such as drilling and microfracturing produce a reparative cartilage while other techniques reconstruct the defect with osteochondral grafts or cell-based procedures such as chondrocyte implantation. There is a tendency toward better results when reconstructive procedures for both the bone and cartilage are used. In addition, comorbidities at the joint have to be treated. Severe grades of osteoarthritis are rare.
Topics: Chondrocytes; Elbow; Elbow Joint; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 31113206
DOI: 10.1177/1947603519847735 -
Journal of Children's Orthopaedics Feb 2023Osteochondritis dissecans is an acquired condition of the joint that affects the articular surface and the subchondral bone. The juvenile form of osteochondritis... (Review)
Review
BACKGROUND
Osteochondritis dissecans is an acquired condition of the joint that affects the articular surface and the subchondral bone. The juvenile form of osteochondritis dissecans presents in those aged 5-16 years with open growth plates. The causes of osteochondritis dissecans are unknown.
METHODS
The goals of treatment are to promote healing of the subchondral bone and prevent chondral collapse, subsequent fracture, osteochondral defect formation, and early joint degeneration. Treatment modality is influenced on clinical symptoms, skeletal maturity, as well as the size, stability, and location of the lesion. This article will review the treatment strategies of juvenile form of osteochondritis dissecans of medial femoral condyle and of atypical regions, such as lateral femoral condyle, patellofemoral joint, and tibial plateau.
LEVEL OF EVIDENCE
level III.
PubMed: 36755556
DOI: 10.1177/18632521231152269