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Clinics in Sports Medicine Jul 2017Although osteochondritis dissecans (OCD) has been a recognized condition for more than 100 years, our understanding of the etiology, natural history, and treatment... (Review)
Review
Although osteochondritis dissecans (OCD) has been a recognized condition for more than 100 years, our understanding of the etiology, natural history, and treatment remains poorly characterized. OCD most commonly affects the knee, followed by the elbow and ankle. Adolescents and young adults are most commonly affected. Patients present with vague, often intermittent symptoms and generally have no history of acute injury. Although diagnosis can be made with plain radiographs, treatment decisions are generally based on MRI. Skeletal maturity and stability of the OCD lesion determine treatment. Treatments range from immobilization and activity restriction to operative therapies. Clinical indications are discussed.
Topics: Ankle Joint; Arthroplasty; Elbow Joint; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 28577707
DOI: 10.1016/j.csm.2017.02.005 -
Current Opinion in Pediatrics Feb 2016Juvenile osteochondritis dissecans (JOCD) knee lesions are common abnormalities in adolescents and children, and have higher rates of spontaneous healing with... (Review)
Review
PURPOSE OF REVIEW
Juvenile osteochondritis dissecans (JOCD) knee lesions are common abnormalities in adolescents and children, and have higher rates of spontaneous healing with nonoperative management compared to adult osteochondritis dissecans (OCD) lesions. Multiple classification and assessment systems have been established in order to help clinicians determine which lesions are amenable to nonoperative management. However, these assessments often use adult OCD classification systems of lesion stability, which have poor reliability in JOCD lesions. The purpose of this review is to assess these various classification systems proposed for JOCD lesions.
RECENT FINDINGS
Although arthroscopy remains the gold standard for the definitive assessment of lesion stability, recent evidence suggests that MRI characteristics indicative of instability in adult OCD lesions are not applicable in determining JOCD lesion instability. In addition, the correlation between arthroscopic and MRI indications of instability is highly varied in these younger patients.
SUMMARY
In order for the pediatric orthopedic surgeon to more accurately predict treatment outcomes in patients with JOCD knee lesions, further investigation into the radiographic characteristics specific to JOCD lesion instability and healing is warranted.
Topics: Arthroscopy; Child; Humans; Knee Joint; Magnetic Resonance Imaging; Osteochondritis Dissecans; Radiography; Severity of Illness Index
PubMed: 26709687
DOI: 10.1097/MOP.0000000000000308 -
Instructional Course Lectures 2021Osteochondritis dissecans and cartilage injuries of the knee are among the most challenging clinical entities that pediatric sports medicine specialists encounter. As a...
Osteochondritis dissecans and cartilage injuries of the knee are among the most challenging clinical entities that pediatric sports medicine specialists encounter. As a weight-bearing joint with significant long-term implications on mobility and overall physical health, the knee also happens to be the most injured or adversely affected joint in preadolescent and adolescent athletes. However, cartilage injuries are unique among other musculoskeletal pathologies in children, in that the healing potential of articular cartilage tissue is limited, and minor injuries or small focal defects can have devastating implications on the lifelong health of the joint. Although the most common form of degenerative joint disease affecting the general population is, of course, osteoarthritis, other conditions such as osteochondritis dissecans or acute, traumatic osteochondral shear injuries can activate their own arthritic pathway, whereby focal injuries precipitate an eventual cascade of diffuse degeneration. Thus, it is important for sports medicine and pediatric orthopaedic specialists alike to understand, diagnose, and initiate early, evidence-based management for cartilage conditions of the knee in pediatric patients. This chapter reviews principles of diagnosis and management of both knee osteochondritis dissecans (a chronic condition of subchondral bone that often secondarily affects the articular cartilage) and acute traumatic cartilage shear injuries. Although the two entities are quite different from an etiologic standpoint, there is significant overlap in technical considerations and treatment principles between these two conditions.
Topics: Adolescent; Bone and Bones; Cartilage Diseases; Cartilage, Articular; Child; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 33438925
DOI: No ID Found -
The Orthopedic Clinics of North America Oct 2016Osteochondritis dissecans (OCD) can cause knee pain and dysfunction in children. The etiology of OCD remains unclear; theories on causes include inflammation, ischemia,... (Review)
Review
Osteochondritis dissecans (OCD) can cause knee pain and dysfunction in children. The etiology of OCD remains unclear; theories on causes include inflammation, ischemia, ossification abnormalities, genetic factors, and repetitive microtrauma. Most OCD lesions in skeletally immature patients will heal with nonoperative treatment. The success of nonoperative treatment decreases once patients reach skeletal maturity. The goals of surgical treatment include maintenance of articular cartilage congruity, rigid fixation of unstable fragments, and repair of osteochondral defects with cells or tissues that can adequately replace lost or deficient cartilage. Unsalvageable OCD lesions can be treated with various surgical techniques.
Topics: Arthralgia; Child; Humans; Knee Joint; Orthopedic Procedures; Osteochondritis Dissecans
PubMed: 27637663
DOI: 10.1016/j.ocl.2016.05.001 -
Clinics in Sports Medicine Oct 2022Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. It may be caused by multiple factors,... (Review)
Review
Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. It may be caused by multiple factors, including repetitive stress, local ischemia, aberrant endochondral ossification of the subarticular physis, and hereditary disposition. Nonoperative treatment is typically attempted for patients with open physes, stable lesions, and minimal symptoms. Operative treatment is offered to patients with closed physes, unstable lesions, mechanical symptoms, and failure of nonoperative treatment. Customized rehabilitation and return to sport programs are important for successful outcomes regardless of treatment type.
Topics: Athletes; Growth Plate; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 36210160
DOI: 10.1016/j.csm.2022.06.001 -
Veterinary and Comparative Orthopaedics... Mar 2021
Topics: Animals; Dog Diseases; Dogs; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Orthopedics; Osteochondritis Dissecans; Shoulder
PubMed: 33725735
DOI: 10.1055/s-0041-1725062 -
Journal of Orthopaedic Science :... Mar 2018Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. However, its etiology remains unknown.... (Review)
Review
Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. However, its etiology remains unknown. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. A plain anteroposterior radiograph with the elbow in 45° of flexion is essential for the diagnosis of an OCD lesion. The stability of OCD lesions is evaluated on plain radiographs, computed tomography, and magnetic resonance imaging (MRI). Imaging features of the unstable lesions are an epiphyseal closure of the capitellum or a lateral epicondyle, a displaced fragment, or irregular contours of the articular surface and a high signal interface on T2-weighted MRI. A stable lesion has the potential to be healed with conservative treatment. By contrast, surgical treatment should be considered if there is no radiographic improvement within 3 months. In addition, surgery should be performed for the lesions that cause pain during daily activities, have a locking phenomenon, or which are assessed by imaging as obviously unstable. Arthroscopic debridement/loose body removal can be performed for small lesions (≤12 mm in diameter). For large lesions (>12 mm), preservation and/or reconstruction of the articular surface should be selected, such as bone-peg fixation of the lateral part of the fragment and osteochondral autograft transplantation (OAT) from the knee. In the future directions, there is no comparative study of OAT from the knee and rib. In addition, little is known about its long-term outcome, or resulting osteoarthritis. A recent meta-analysis showed that grafts harvested from the knee may lead to donor site morbidity (7.8%). Thus, a novel cartilage tissue engineering approach is anticipated.
Topics: Adult; Arthralgia; Arthroscopy; Athletic Injuries; Conservative Treatment; Debridement; Elbow Joint; Female; Humans; Humeral Head; Magnetic Resonance Imaging; Male; Osteochondritis Dissecans; Prognosis; Recovery of Function; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 29276039
DOI: 10.1016/j.jos.2017.11.013 -
The Journal of Medical Investigation :... 2020Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association... (Review)
Review
Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association of player position with capitellar OCD. Elbow pain and a longer playing history might be related to progression of capitellar OCD but do not in themselves increase the risk of development of the condition. The cause of capitellar OCD is likely to include a combination of repetitive microtrauma and internal factors, such as ischemia and genetic predisposition. A combination of radiography, computed tomography, magnetic resonance imaging, and ultrasonography have aided our understanding of the pathology of capitellar OCD. Screening using ultrasonography enables early detection and provides an opportunity for successful conservative treatment. Treatment has conventionally included both operative and nonoperative measures based on the stage and size of the lesion, skeletal maturity, subjective symptoms, and structural integrity of the cartilage. Early-stage lesions respond better to nonoperative treatment than those in more advanced stages. Operative indications include persistent symptoms despite nonoperative treatment, symptomatic loose bodies, and displacement or detachment of fragments. J. Med. Invest. 67 : 217-221, August, 2020.
Topics: Humans; Osteochondritis Dissecans
PubMed: 33148891
DOI: 10.2152/jmi.67.217 -
Hand (New York, N.Y.) Dec 2016Osteochondritis dissecans (OCD) of the capitellum is a painful condition, which often affects young throwing athletes. Our current understanding regarding the etiology,... (Review)
Review
Osteochondritis dissecans (OCD) of the capitellum is a painful condition, which often affects young throwing athletes. Our current understanding regarding the etiology, risks factors, diagnosis, and efficacy of the available treatment options has expanded over recent years, however remains suboptimal. Recent data on patient-reported outcomes following osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the capitellum have been promising but limited. This review seeks to critically analyze and summarize the available literature on the etiology, diagnosis, and reported outcomes associated with OCD of the capitellum and the use of OAT for its treatment. A comprehensive literature search was conducted. Unique and customized search strategies were formulated in PubMed, Embase, Scopus, Web of Science, and CENTRAL. Combinations of keywords and controlled vocabulary terms were utilized in order to cast a broad net. Relevant clinical, biomechanical, anatomic and imaging studies were reviewed along with recent review articles, and case series. Forty-three articles from our initial literature search were found to be relevant for this review. The majority of these articles were either review articles, clinical studies, anatomic or imaging studies or biomechanical studies. Current evidence suggests that OAT may lead to better and more consistent outcomes than previously described methods for treating large OCD lesions of the capitellum.
Topics: Autografts; Cartilage; Elbow Joint; Humans; Humerus; Osteochondritis Dissecans; Transplantation, Autologous; Treatment Outcome
PubMed: 28149204
DOI: 10.1177/1558944716643293 -
Arthroscopy : the Journal of... May 2021Fresh osteochondral allograft transplantation has been my preferred procedure for chondral and osteochondral lesions for many decades. This is particularly true for...
Fresh osteochondral allograft transplantation has been my preferred procedure for chondral and osteochondral lesions for many decades. This is particularly true for patients younger than 18 years of age, where diagnoses such as osteochondritis dissecans, osteochondral fractures, and osteonecrosis predominate, rendering the situation as much a "bone problem" as a "cartilage problem." In the universe of cartilage-repair techniques, osteochondral allografts are particularly useful when bone defects must be managed. Furthermore, allografts have stood the test of time for safety, efficacy, and durability, even in a young, active population. For me, I don't think twice about using fresh allografts in young patients. I might even have to admit that an osteochondral allograft transplantation procedure for an osteochondritis dissecans lesion in a patient younger than 18 years old is my favorite surgery!
Topics: Adolescent; Allografts; Bone Transplantation; Cartilage; Humans; Knee Joint; Osteochondritis Dissecans; Transplantation, Homologous
PubMed: 33896511
DOI: 10.1016/j.arthro.2021.02.027