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The Orthopedic Clinics of North America Jan 2015The authors' preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion... (Review)
Review
The authors' preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. For unstable yet salvageable OCD lesions, the senior author's preferred treatment is fixation with bone grafting. For unstable and unsalvageable OCD lesions, the senior author's preferred treatment is autologous chondrocyte implantation with bone grafting.
Topics: Algorithms; Athletic Injuries; Humans; Knee Joint; Osteochondritis Dissecans; Patient Selection
PubMed: 25435043
DOI: 10.1016/j.ocl.2014.09.010 -
The American Journal of Sports Medicine Sep 2014Osteochondritis dissecans (OCD) of the ankle is a disorder of the talar or distal tibial subchondral bone and articular cartilage whose incidence in children is not...
BACKGROUND
Osteochondritis dissecans (OCD) of the ankle is a disorder of the talar or distal tibial subchondral bone and articular cartilage whose incidence in children is not clearly known.
PURPOSE
To assess the demographics and epidemiology of OCD of the ankle in children.
STUDY DESIGN
Descriptive epidemiologic study.
METHODS
A retrospective chart review of an integrated health system was conducted on patients with ankle OCD aged 2 to 19 years from 2007 to 2011, with >1 million patients in this cohort. Lesion location, laterality, and all patient demographics were recorded. Ankle OCD incidence was determined for the group as a whole and by both sex and age group (divided into age groups of 2-5, 6-11, and 12-19 years). The risk for ankle OCD for age group, sex, and ethnicity was assessed using multivariate logistic regression models.
RESULTS
A total of 85 patients fit the inclusion criteria, and 71.8% of lesions found were in the medial talus, 56.5% of lesions were right sided, and none were bilateral. No ankle OCD lesions were found in 2- to 5-year-olds. The incidence of ankle OCD in patients aged 6 to 19 years was 4.6 per 100,000 overall and 3.2 and 6.0 per 100,000 for male and female patients, respectively. Patients aged 12 to 19 years represented the vast majority of those with OCD, with an incidence of 6.8 per 100,000 compared with 1.1 per 100,000 in those 6 to 11 years of age. In those aged 6 to 11 and 12 to 19 years, female patients had a respective incidence of 1.5 and 8.9 per 100,000, whereas male patients had a respective incidence of 0.7 and 4.8 per 100,000. The overall female/male ratio of ankle OCD was 1.6:1. Multivariate logistic regression analysis revealed a 6.9 times increased risk for ankle OCD in patients aged 12 to 19 years compared with those aged 6 to 11 years (95% CI, 3.8-12.5; P < .0001), and female patients had a 1.5 times greater risk for ankle OCD than male patients (95% CI, 1.0-2.3; P = .06). On the basis of race and ethnicity, non-Hispanic whites had the highest relative risk for disease and African Americans the lowest risk.
CONCLUSION
In this population-based cohort study of pediatric ankle OCD, female patients had a greater incidence of OCD and a 1.5 times greater risk for ankle OCD compared with male patients. Teenagers had nearly 7 times the risk for ankle OCD compared with children 6 to 11 years of age.
Topics: Adolescent; Ankle Joint; California; Cartilage, Articular; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Incidence; Infant; Male; Osteochondritis Dissecans; Retrospective Studies; Risk Factors; Sex Factors; Talus; Tibia; Young Adult
PubMed: 24989493
DOI: 10.1177/0363546514538406 -
Journal of Equine Veterinary Science Oct 2022Osteochondrosis (osteochondritis dissecans), OC(D), is an important joint disorder that has been studied through the years in different breeds but, to our knowledge,...
Osteochondrosis (osteochondritis dissecans), OC(D), is an important joint disorder that has been studied through the years in different breeds but, to our knowledge, there are no reports of its prevalence in Lusitano horses. The aim of this study was to assess the prevalence of OC(D) in Lusitanos, define the characteristics of the disorder in this breed and compare with Spanish Purebred horses. This is a retrospective study that analysed the radiographs from the metacarpometatarsophalangeal, tarsocrural and femoropatellar joints that were taken in 302 Lusitano horses (1-12 years; obtained from 2007 until 2019). The classification of the radiographs for OC(D) was performed using a 0-4 scale and scored by three veterinarians. Radiographical evidence of OC(D) was diagnosed in 53.3% of the horses examined. Most of the findings were lesions of score 1 or 2 corresponding to flattening, (36.8%). The distal intermediate ridge of the tibia in the tarsocrural joint was the most affected predilection site (31.0%, n=187/604 joints assessed). Overall, the tarsocrural joints were more likely to be affected, followed by metatarso-metacarpophalangeal joints and finally the femoropatellar joints. The prevalence of horses with scores 3 or 4 (fragments) in any of the joints was 16.6%. A positive correlation was found between the scores of contralateral joints. We can conclude that the prevalence of OC(D) in Lusitano horses is similar to the prevalence in Spanish Purebred, but there is a lower percentage of fragmentation. The present phenotypic description can provide valuable information for further quantitative and molecular genetic studies.
Topics: Animals; Horse Diseases; Horses; Osteochondritis Dissecans; Osteochondrosis; Prevalence; Retrospective Studies
PubMed: 35787450
DOI: 10.1016/j.jevs.2022.104063 -
The American Journal of Sports Medicine Sep 2023Preservation of articular cartilage in the setting of acute or chronic injury in the adolescent and young adult knee is paramount for long-term joint health. Achieving...
BACKGROUND
Preservation of articular cartilage in the setting of acute or chronic injury in the adolescent and young adult knee is paramount for long-term joint health. Achieving osseous union, minimizing implant-related injury, and eliminating the need for reoperation for traumatic chondral and osteochondral lesions (OCLs) and osteochondritis dissecans (OCD) remain a challenge for the orthopaedic surgeon.
PURPOSE
To evaluate radiographic healing, patient-reported outcomes, and short-term complications after suture-bridge fixation of chondral fragments, osteochondral fractures, and OCD lesions in the knee.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
The study included consecutive patients (38 patients, 40 knees) treated within a single academic sports medicine institution who underwent suture-bridge fixation of an OCL or an OCD lesion of the knee from initiation of the technique in October 2019 through March 2021. The suture-bridge technique entailed bioabsorbable knotless anchors placed on the outside margins of the lesion with multiple strands of hand-tensioned absorbable (No. 0 or No. 1 Vicryl) or nonabsorbable (1.3-mm braided polyester tape) bridging suture. Healing was assessed by radiography and magnetic resonance imaging (MRI), with MRI scans obtained on all OCD lesions and any chondral-only lesions. MRI scans were available for 33 of 40 (82.5%) knees within 1 year of surgery and were evaluated for lesion healing. Complications and rates and timing of return to sport were evaluated. Patient-reported outcomes in the OCD cohort were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) to determine early pain and functional improvement.
RESULTS
In total, 33 (82.5%) lesions demonstrated full union, and no lesions failed treatment. MRI assessment of healing (mean, 5.8 months; range, 3-12 months) demonstrated 9 (64.3%) OCD lesions with full union, 5 (35.7%) OCD lesions with stable union, and no OCD lesions with nonunion. Of the OCLs, 17 (89.5%) had full union, 2 (10.5%) had stable union, and none had nonunion. The 7 bony OCLs without an MRI scan demonstrated complete radiographic union. In 30 (75.0%) lesions, patients returned to sports at a mean of 6.5 months (range, 3.8-10.2 months). KOOS Activities of Daily Living, Pain, Quality of Life, and Symptoms scores demonstrated significant improvement from baseline at 6 months and at 1 year. There were 2 (5%) complications, consisting of reoperation for marginal chondroplasty on an otherwise stable lesion, and re-operation for intial un-treated patellar instability, with no reoperations for failure or revision of the suture-bridge construct.
CONCLUSION
In this series of OCLs and OCD lesions of the knee, suture-bridge fixation demonstrated excellent rates of MRI and radiographic union and good early outcomes with minimal short-term complications. This technique may be used for lesion salvage as an alternative to metallic and nonmetallic screw/tack constructs in the treatment of these challenging lesions. Longer term follow-up and investigation are warranted.
Topics: Adolescent; Young Adult; Humans; Osteochondritis Dissecans; Joint Instability; Activities of Daily Living; Quality of Life; Patellofemoral Joint; Knee Joint; Sutures; Pain; Treatment Outcome; Follow-Up Studies
PubMed: 37565525
DOI: 10.1177/03635465231189244 -
The American Journal of Sports Medicine Jun 2018Osteochondritis dissecans (OCD) has frequently been described in children and adolescents, but cases of OCD in adults are certainly encountered. Little has been...
BACKGROUND
Osteochondritis dissecans (OCD) has frequently been described in children and adolescents, but cases of OCD in adults are certainly encountered. Little has been published on the epidemiology of OCD in adult patients.
PURPOSE
To assess the frequency of OCD lesions in adults and assess the risk by age, sex, and ethnicity.
STUDY DESIGN
Descriptive epidemiology study.
METHODS
The authors assessed all patients aged 20 to 45 years from the entire database of patients enrolled as members of Kaiser Permanente Southern California from January 2011 until December 2013. Kaiser Southern California is an integrated health care system serving a racially, ethnically, and socioeconomically diverse population of >3.5 million patients. A retrospective chart review was done on OCD during this period. Inclusion criteria included OCD of any joint. Exclusion criteria included traumatic osteochondral fractures and coexistence of intra-articular lesions other than OCD. Joint involvement/location, laterality, and all patient demographics were recorded.
RESULTS
Among 122 patients, a total of 124 OCD lesions were found. The majority of lesions were in the ankle (n = 76) and knee (n = 43), with 3 foot lesions and 2 elbow lesions identified. OCD lesions were identified in 75 men (62%) and 47 women (38%). Overall incidence rates per 100,000 person-years were 3.42 for all OCD, 2.08 for ankle OCD, and 1.21 for knee OCD. The relative risk of adult OCD for men was twice that of women. The relative risk of adult OCD for white patients was 2.3 that of Asians and 1.7 that of Hispanics. Risk of knee OCD was 3.6 times higher for men than women. As compared with women, men had a higher risk for lateral femoral condyle OCD lesions versus the medial femoral condyle ( P = .05; odds ratio [OR], 5.19).
CONCLUSION
This large cohort study of Southern California adults with OCD demonstrated an increased OR for men (vs women) of OCD in all joints. The majority of symptomatic lesions were present in the ankle rather than the knee, as previously found in children. White and black patients had the highest OR of OCD; men had a significantly greater OR of lateral femoral condyle knee lesions as compared with women.
Topics: Adult; Age Distribution; Ankle Joint; California; Elbow Joint; Epiphyses; Female; Femur; Humans; Incidence; Knee Joint; Male; Middle Aged; Odds Ratio; Osteochondritis Dissecans; Retrospective Studies; Sex Distribution; Young Adult
PubMed: 29613834
DOI: 10.1177/0363546518764676 -
The Veterinary Clinics of North... Mar 2021Elbow dysplasia is a major cause of front limb lameness in medium to large dog breeds. Underlying causes include ununited anconeal process, medial coronoid process... (Review)
Review
Elbow dysplasia is a major cause of front limb lameness in medium to large dog breeds. Underlying causes include ununited anconeal process, medial coronoid process disease, and osteochondritis dissecans. When a definitive diagnosis of elbow dysplasia is made, the surgeon can improve elbow function but cannot entirely prevent progression of osteoarthrosis. Conventional surgical treatment with joint debridement and removal of loose osteocartilaginous bodies is not rewarding if joint incongruity persists; the result is overloading and subchondral bone exposure with erosion of the cartilage of the medial humeral condyle and medial coronoid area of the ulna leading to medial compartment disease.
Topics: Animals; Dog Diseases; Dogs; Elbow Joint; Fractures, Ununited; Joint Diseases; Osteochondritis Dissecans; Ulna
PubMed: 33558015
DOI: 10.1016/j.cvsm.2020.12.007 -
Acta Orthopaedica Belgica Sep 2022Osteochondritis dissecans as a pathology is pre-dominantly described in the knee, elbow and ankle. Osteochondritis dissecans of the humeral head is a more uncommon...
Osteochondritis dissecans as a pathology is pre-dominantly described in the knee, elbow and ankle. Osteochondritis dissecans of the humeral head is a more uncommon reported injury. We present a case of a bilateral osteochondritis dissecans of the humeral head in a 16-year-old soccer player and an algorithm for treatment of OCD of the humeral head. To our knowledge this has never been described so specifically in literature before.
Topics: Humans; Adolescent; Shoulder; Osteochondritis Dissecans; Humeral Head; Knee Joint; Elbow Joint
PubMed: 36791713
DOI: 10.52628/88.3.9419 -
AJR. American Journal of Roentgenology Jul 2015The objective of our study was to correlate specimens of juvenile osteochondritis dissecans (OCD) lesions of the knee to MRI examinations to elucidate the...
OBJECTIVE
The objective of our study was to correlate specimens of juvenile osteochondritis dissecans (OCD) lesions of the knee to MRI examinations to elucidate the histopathologic basis of characteristic imaging features.
MATERIALS AND METHODS
Five children (three boys and two girls; age range, 12-13 years old) who underwent transarticular biopsy of juvenile OCD lesions of the knee were retrospectively included in this study. Two radiologists reviewed the MRI examinations and a pathologist reviewed the histopathologic specimens and recorded characteristic features. Digital specimen photographs were calibrated to the size of the respective MR image with the use of a reference scale. Photographs were rendered semitransparent and over-laid onto the MR image with the location chosen on the basis of the site of the prior biopsy.
RESULTS
A total of seven biopsy specimens were included. On MRI, all lesions showed cystlike foci in the subchondral bone, bone marrow edema pattern on proton density-or T2-weighted images, and relatively thick unossified epiphyseal cartilage. In four patients, a laminar signal intensity pattern was seen, and two patients had multiple breaks in the subchondral bone plate. Fibrovascular tissue was found at histopathology in all patients. Cleft spaces near the cartilage-bone interface and were seen in all patients while chondrocyte cloning was present in most cases. Focal bone necrosis and inflammation were infrequent MRI findings. Precise correlation of the MRI appearance to the histopathologic overlays consistently was found.
CONCLUSION
A direct correlation exists between the histopathologic findings and the MRI features in patients with juvenile OCD. Additional studies are needed to correlate these MRI features with juvenile OCD healing success rates.
Topics: Arthroscopy; Biopsy; Child; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Osteochondritis Dissecans; Retrospective Studies
PubMed: 26102409
DOI: 10.2214/AJR.14.13579 -
Journal of Pediatric Orthopedics Feb 2018Sports injuries are common in pediatric and adolescent patients and the evaluation and treatment of these injuries continues to evolve. The purpose of this review is to... (Review)
Review
BACKGROUND
Sports injuries are common in pediatric and adolescent patients and the evaluation and treatment of these injuries continues to evolve. The purpose of this review is to provide a comprehensive appraisal of the literature, highlighting recent updates on sports-related knee injuries in the pediatric athlete. We specifically examined literature on tibial spine fractures, osteochondritis dissecans (OCD) of the knee, and patellar instability. Because of the volume of literature on the subject, pediatric, and adolescent anterior cruciate ligament injuries were not included in this review.
METHODS
An electronic search of the PubMed, EMBASE, and Google Scholar databases was performed for keywords related to pediatric: tibial spine fractures, patellar instability, and osteochondritis dissecans (OCD). Search results were filtered by publication date to yield articles published electronically or in print on or after January 1, 2013. Papers were selected based on expert opinion and consensus by the authors and included if deemed to have contributed important findings to the above topics.
RESULTS
A total of 31 articles were deemed to have contributed significant findings to the literature: 5 tibial spine, 17 patellar instability, and 9 OCD. The level of evidence for most studies was either level III or IV.
CONCLUSIONS
The optimal treatment for tibial spine fractures remains controversial. The evaluation of risk factors for recurrent patellar instability is important in determining the optimal treatment strategy following first-time patellar dislocation. Future multicenter studies on pediatric OCD have the potential to further understanding of this difficult problem. High-level, comparative outcomes research on a variety of pediatric sports related injuries is lacking and this review may help inform topics for future study.
LEVEL OF EVIDENCE
Level IV-literature review.
Topics: Adolescent; Age Factors; Athletic Injuries; Child; Female; Humans; Joint Instability; Knee Injuries; Male; Osteochondritis Dissecans; Risk Factors; Tibial Fractures
PubMed: 29189538
DOI: 10.1097/BPO.0000000000001107 -
Cartilage Dec 2021Fixation of unstable osteochondritis dissecans (OCD) lesions and displaced osteochondral fragments are frequently performed procedures in pediatric orthopedic surgery....
OBJECTIVE
Fixation of unstable osteochondritis dissecans (OCD) lesions and displaced osteochondral fragments are frequently performed procedures in pediatric orthopedic surgery. Since 2018, CE-certified MAGNEZIX pins are used in our institution in these cases. The aim of this study was (1) to analyze safety, efficiency, and limitations of magnesium-pin-based fixation of unstable OCD lesions and displaced osteochondral fragments and (2) to report clinical and radiological outcomes at short-term follow-up (FU).
DESIGN
In this prospective cohort study, 19 patients (10 girls and 9 boys) were included. Inclusion criteria were (1) magnetic resonance imaging-confirmed unstable OCD lesion or displaced osteochondral fragment, (2) fixation with magnesium-based pins, and (3) minimum FU of 6 months. X-rays were taken 6 weeks and 6 months after operation and magnetic resonance imaging scans every 4 to 6 months to assess the healing progress.
RESULTS
In total 67 pins were used, with a mean of 3.6 ± 1.4 per patient. Average age at surgery was 13.7 years (11-17 years). Mean time of operation was 56 ± 31 minutes, including arthroscopy, fixation, and patellar realignment ( = 6). No intraoperative complications occurred. Average FU was 11.3 ± 4.2 months (6-20 months). No redislocation or new dislocation occurred. Until now a complete radiographic healing occurred in 12 cases. Due to an implant failure in one case 11 weeks after the index surgery a revision became necessary.
CONCLUSIONS
In short-term FU of 11 ± 4 months MAGNEZIX pins provide high stability after fixation of unstable OCDs and displaced osteochondral fragments leading to uncomplicated and timely healing.
Topics: Absorbable Implants; Adolescent; Arthroscopy; Child; Female; Fracture Fixation, Internal; Humans; Intra-Articular Fractures; Joint Instability; Knee Joint; Magnesium; Magnetic Resonance Imaging; Male; Osteochondritis Dissecans; Prospective Studies; Young Adult
PubMed: 32693621
DOI: 10.1177/1947603520942943