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Instructional Course Lectures 2021Osteochondritis dissecans is a condition of the subchondral bone, with secondary effects on the articular cartilage. It most commonly affects the knee, elbow, and ankle...
Osteochondritis dissecans is a condition of the subchondral bone, with secondary effects on the articular cartilage. It most commonly affects the knee, elbow, and ankle and is typically seen in young, active populations. Many osteochondritis dissecans lesions are asymptomatic, but more advanced lesions can cause pain, swelling, and mechanical symptoms. Multiple treatment options have been proposed, including nonsurgical and surgical approaches. It is important to be aware of the epidemiology, presenting symptoms, and indications for nonsurgical and surgical treatment options for osteochondritis dissecans of the knee, elbow, and ankle.
Topics: Ankle; Elbow; Elbow Joint; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 33438926
DOI: No ID Found -
Knee Surgery, Sports Traumatology,... Jul 2016Osteoarthritis is the most common joint disease and a major cause of disability. Distinct biological processes are considered crucial for the development of... (Review)
Review
Osteoarthritis is the most common joint disease and a major cause of disability. Distinct biological processes are considered crucial for the development of osteoarthritis and are assumed to act in concert with additional risk factors to induce expression of the disease. In the classical weightbearing joints, one such risk factor is an unfavourable biomechanical environment about the joint. While the elbow has long been considered a non-weightbearing joint, it is now assumed that the tissues of the upper extremity may be stressed to similar levels as those of the lower limb, and that forces across the elbow are in fact very high when the joint is extended from a flexed position. This review examined the available basic science, preclinical and clinical evidence regarding the role of several unfavourable biomechanical conditions about the elbow on the development of osteoarthritis: post-traumatic changes, osteochondritis dissecans, instability or laxity and malalignment. Post-traumatic osteoarthritis following fractures is well recognized, however, the role of overload or repetitive microtrauma as risk factors for post-traumatic osteoarthritis is unclear. The natural course of untreated cartilage defects in general, and osteochondritis dissecans at the elbow in particular, remains incompletely understood to date. However, larger lesions and older age seem to be associated with more symptoms and radiographic changes in the long term. Instability seems to play a role, although the association between instability and osteoarthritis is not yet clearly defined. No data are available on the association of malalignment and osteoarthritis, but based on force estimations across the elbow joint, it seems reasonable to assume an association.
Topics: Biomechanical Phenomena; Bone Malalignment; Cartilage Diseases; Elbow; Fractures, Bone; Humans; Joint Instability; Osteoarthritis; Osteochondritis Dissecans; Range of Motion, Articular; Elbow Injuries
PubMed: 25677500
DOI: 10.1007/s00167-015-3518-7 -
Cartilage Jul 2020The purpose of this manuscript is to analyze the evidence regarding etiopathogenesis of knee osteochondritis dissecans (OCD) lesions through a systematic review, so to...
OBJECTIVE
The purpose of this manuscript is to analyze the evidence regarding etiopathogenesis of knee osteochondritis dissecans (OCD) lesions through a systematic review, so to summate the current understanding of the origin and progression of this pathologic articular processes.
DESIGN
A systematic review of the literature was performed on the PubMed and Cochrane databases on October 2017 by 2 independent authors and included all levels of evidence. This included all English language literature, pertaining specifically to etiopathology of knee OCD with exclusions for review articles and expert opinion. Of 965 identified records, 154 full-text articles were assessed for eligibility and 86 studies met the inclusion criteria.
RESULTS
According to these studies, the etiology of OCD can be of a biological or mechanical origin: 40 articles proposed a biological hypothesis, including genetic causes (27), ossification center deficit (12), and endocrine disorders (9); conversely, 52 articles supported a mechanical hypothesis, including injury/overuse (18), tibial spine impingement (5), discoid meniscus (16), and biomechanical alterations (20) as the cause of the onset of OCD. The pathogenic processes were investigated by 36 of these articles, with a focus on subchondral bone fracture and ischemia as the ultimate events leading to OCD.
CONCLUSIONS
Biological and mechanical factors are found to result in subchondral bone remodeling alterations, acting independently or more likely synergically in the progression of knee OCD. The former includes genetic causes, deficit of ossification centers and endocrine disorders; the latter, tibial spine impingement, discoid meniscus, and biomechanical alterations, together with injuries and overuse. The resultant subchondral bone ischemia and/or fracturing appears to determine the onset and progression of OCD.
LEVEL OF EVIDENCE
Systematic review of level II-IV studies, level IV.
Topics: Adolescent; Biomechanical Phenomena; Bone Remodeling; Cartilage, Articular; Causality; Child; Cumulative Trauma Disorders; Female; Humans; Knee; Knee Injuries; Knee Joint; Male; Menisci, Tibial; Osteochondritis Dissecans; Tibia; Young Adult
PubMed: 29998741
DOI: 10.1177/1947603518786557 -
Praxis Jan 2017
Review
Topics: Arthralgia; Arthroscopy; Cervical Vertebrae; Diagnosis, Differential; Elbow Joint; Fractures, Bone; Humans; Joint Instability; Magnetic Resonance Imaging; Nerve Compression Syndromes; Osteochondritis Dissecans; Radial Neuropathy; Radiculopathy; Tennis Elbow; Elbow Injuries
PubMed: 28055316
DOI: 10.1024/1661-8157/a002572 -
The Journal of Knee Surgery Oct 2016Osteochondritis dissecans (OCD) of the knee remains a relatively common and poorly understood pediatric and adolescent knee condition. Both conservative and surgical... (Review)
Review
Osteochondritis dissecans (OCD) of the knee remains a relatively common and poorly understood pediatric and adolescent knee condition. Both conservative and surgical treatments have major impact on the lives of young active, athletic patients with knee OCD. OCD has been recently redefined as a "focal, idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis." The 2011 American Academy of Orthopedic Surgeons Clinical Practice Guidelines found limited evidence for all aspects of the treatment of knee OCD. The multicenter study group Research in Osteochondritis dissecans of the Knee (ROCK) was formed to advance the understanding and treatment of this condition. This article will review our current understanding of the pathophysiology, treatment options, and outcomes of OCD of the knee, with a focus on the past, present, and future research including the work of the ROCK study group.
Topics: Cohort Studies; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 27532280
DOI: 10.1055/s-0036-1586723 -
Journal of Pediatric Orthopedics Feb 2024Previous research on patellar and trochlear groove osteochondritis dissecans (OCD) is limited by small sample sizes. This study aims to describe the presentation of...
OBJECTIVE
Previous research on patellar and trochlear groove osteochondritis dissecans (OCD) is limited by small sample sizes. This study aims to describe the presentation of patients with OCD lesions of the patella and trochlea and characterize the outcomes of operative and nonoperative treatments.
METHODS
This retrospective cohort study identified all patients from a single institution from 2008 to 2021 with patellar and/or trochlear OCD lesions. Patients were excluded from the study if surgical records were unavailable or if the patient had knee surgery for a different injury at index surgery or in the 12 months postoperative. Minimum follow-up was 12 months. Outcomes included a return to sports (RTS), pain resolution, radiographic healing, and treatment "success" (defined as full RTS, complete pain resolution, and full healing on imaging).
RESULTS
A total of 68 patients (75 knees) were included-45 (60%) with patellar OCD and 30 (40%) with trochlear. Of the patients, 69% were males. The median age at knee OCD diagnosis was 14 years. At the final follow-up, 62% of knees (n = 44) recovered sufficiently to allow a full RTS and 54% of knees (n = 39) had full pain resolution. Of the 46 knees with radiographic imaging at least 1 year apart, 63% had full healing of the lesion. There was no significant difference in RTS, pain resolution, radiographic healing, or overall success when comparing treatments.
CONCLUSIONS
This study provides valuable epidemiologic demographic and outcome data regarding the scarcely reported patellar and trochlear OCD. While over half of patients fully returned to sports and reported full pain resolution, a large proportion continued to experience symptoms over a year after presentation. Future research should aim to better define the treatment algorithms for these OCD subtypes.
LEVEL OF EVIDENCE
Level III.
Topics: Male; Humans; Adolescent; Female; Osteochondritis Dissecans; Patella; Retrospective Studies; Pain; Knee Joint; Demography
PubMed: 38108383
DOI: 10.1097/BPO.0000000000002588 -
Current Opinion in Pediatrics Feb 2021The purpose of this review is to update the reader on the controversial subject of osteochondritis dissecans (OCD) with a focus on nonoperative treatment indications,... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to update the reader on the controversial subject of osteochondritis dissecans (OCD) with a focus on nonoperative treatment indications, methods, and success rate.
RECENT FINDINGS
Work by an international multicenter study group ROCK (Research in OsteoChondritis of the Knee) will be reviewed including new classifications systems of healing, arthroscopy, radiographs, and MRI, along with new evidence on off-loading bracing compared to restricted weight bearing.
SUMMARY
The paucity of evidence behind OCD treatment of the knee can lead to confusion for doctors, patients, and parents. The present review will bring more clarity to the subject.
Topics: Arthroscopy; Humans; Knee Joint; Magnetic Resonance Imaging; Multicenter Studies as Topic; Osteochondritis Dissecans; Radiography
PubMed: 33315689
DOI: 10.1097/MOP.0000000000000976 -
The Journal of Hand Surgery Nov 2023Reconstruction of unstable osteochondritis dissecans lesions of the capitellum using fresh osteochondral allograft transplantation from the capitellum has the advantages... (Review)
Review
Reconstruction of unstable osteochondritis dissecans lesions of the capitellum using fresh osteochondral allograft transplantation from the capitellum has the advantages of restoring hyaline cartilage, matching the native radius of curvature, and avoiding the donor-site morbidity encountered with osteochondral autograft transfer. This technical note describes the indications and contraindications, pertinent anatomy, and surgical technique of open osteochondral allograft transplantation using fresh distal humerus allograft for the treatment of unstable osteochondritis dissecans lesions of the capitellum.
Topics: Humans; Osteochondritis Dissecans; Elbow; Treatment Outcome; Elbow Joint; Transplantation, Autologous; Bone Transplantation; Allografts
PubMed: 36967310
DOI: 10.1016/j.jhsa.2023.01.020 -
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 -
Knee Surgery, Sports Traumatology,... Sep 2021The current systematic review and meta-analysis aim to pool together the incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knee. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The current systematic review and meta-analysis aim to pool together the incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knee.
METHODS
The systematic review was conducted according to PRISMA guidelines. A search was conducted using PubMed and Cochrane Library with the keywords being "knee" and "osteochondritis dissecans" or "osteochondral lesion". All original human studies that reported the incidence or risk factors of osteoarthritis following osteochondritis dissecans of the knee were included.
RESULTS
Nine studies with 496 patients were included. The incidence of osteoarthritis following osteochondritis dissecans is 0.39 (95% CI 0.19-0.59). Patients with a body mass index greater than 25 kg/m had a significantly increased risk of osteoarthritis. Fragment excision had an increased relative risk of 1.89 (95% CI 1.19-3.01) of osteoarthritis as compared to fragment preservation. Significant heterogeneity was identified when comparing between juvenile and adult osteochondritis dissecans. The size of the lesions moderated the between-study heterogeneity with regards to the incidence of osteoarthritis, with the relative risk of osteoarthritis in lesions bigger than 4 cm being 2.29 (95% CI 1.24-4.23). No other risk factors, including gender of the patient, location of osteochondritis dissecans, stability of osteochondritis dissecans, and surgical versus non-surgical management were significant risk factors.
CONCLUSION
Significant risk factors for osteoarthritis were increased body mass index and fragment excision. Probable but inconclusive risk factors were the age of the patients and the size of the osteochondritis dissecans. The gender of the patient, location of osteochondritis dissecans, the stability of osteochondritis dissecans, and surgical versus non-surgical management of osteochondritis dissecans when appropriate were not significant risk factors.
Topics: Adult; Humans; Incidence; Knee Joint; Osteoarthritis, Knee; Osteochondritis Dissecans; Risk Factors
PubMed: 33211214
DOI: 10.1007/s00167-020-06365-y