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Zhongguo Gu Shang = China Journal of... Sep 2014Along with the popularity of youth movement, the incidence of osteochondritis dissecans (OCD) showed a trend of increase, but its pathogenesis is not yet clear. Previous... (Review)
Review
Along with the popularity of youth movement, the incidence of osteochondritis dissecans (OCD) showed a trend of increase, but its pathogenesis is not yet clear. Previous studies suggested that trauma is the main potential cause, but with the emergence of vast family cases, hereditary factor is also gradually taken seriously. Arthroscopy is the "gold standard" for diagnosing OCD, but for the patient with early incomplete joint surface lesions, the diagnositic value of MRI is better than the arthroscopy. For the patients with stable form OCD, nonoperative management should be used such as adjusting activity, fixator and drugs; for the patient with unstable form OCD or failing after conservative treatment, surgery should be generally used such as joint clearing, drilling, microfracture method, fixation and transplantation. With the progress of research, stem cell technology and platelet-rich plasma gradually applied in cartilage repair, which will improve the curative effect of OCD, but still further clinical and experimental research, and also a long-term effective follow-up are needed.
Topics: Humans; Osteochondritis Dissecans
PubMed: 25571667
DOI: No ID Found -
The Orthopedic Clinics of North America Jan 2015
Topics: Athletic Injuries; Humans; Joint Instability; Orthopedic Procedures; Osteochondritis Dissecans; Sports Medicine
PubMed: 25435052
DOI: 10.1016/j.ocl.2014.09.022 -
Clinics in Sports Medicine Apr 2018The treatment of sports injuries in the skeletally immature has a unique set of complications. Growth deformity may occur after anterior cruciate ligament... (Review)
Review
The treatment of sports injuries in the skeletally immature has a unique set of complications. Growth deformity may occur after anterior cruciate ligament reconstruction; therefore, skeletal age is used to help guide the choice between physeal sparing and transphyseal techniques. Arthrofibrosis after tibial spine fracture fixation can be reduced by initiating immediate range of motion, and should be treated early and cautiously to avoid iatrogenic fracture. Nonunions of medial epicondyle elbow fractures are more common with nonoperative treatment, but seldom lead to clinical problems outside of certain athletes. Risks of OCD fixation are specific to the material of screw used.
Topics: Anterior Cruciate Ligament Reconstruction; Athletic Injuries; Bone Screws; Child; Elbow; Fibrosis; Fracture Fixation, Internal; Fractures, Ununited; Humans; Open Fracture Reduction; Osteochondritis Dissecans; Postoperative Complications; Tibial Fractures; Youth Sports; Elbow Injuries
PubMed: 29525032
DOI: 10.1016/j.csm.2017.12.012 -
BioMed Research International 2018The healing potential of knee osteochondritis dissecans (OCD) focal lesions is not well defined. We performed a cross-sectional study correlating local and systemic...
The healing potential of knee osteochondritis dissecans (OCD) focal lesions is not well defined. We performed a cross-sectional study correlating local and systemic biological characteristics with the patients' characteristics. We evaluated both local tissue markers (CD34, CD146, CD166, and tartrate-resistant acid phosphatase (TRAP)) and systemic serum biomarkers (fragments or propeptide of type II collagen: C2C, CTX-II, CPII, and TRAP5b) on histologically scored osteochondral fragments or serum from OCD patients. These biological features were associated with the patients' characteristics (IKDC subjective score, age, and body mass index (BMI)). Histological cartilage tissue score correlated with patients' IKDC and C2C and CPII biomarkers. CPII correlated also with histological bone tissue score. The percentage of CD146 positive cells in cartilage and CD34 positive cells in bone highly correlated with the patient's age and BMI, respectively. The percentage of TRAP in bone was directly correlated with both IKDC and age. Multivariate statistical analysis evidenced that only four parameters significantly predicted IKDC. In conclusion, a complete picture of OCD knee characteristics, defined by local and systemic markers of cartilage and bone remodeling, together with the patients' characteristics, might help to better understand the healing potential of each patient and to target and improve current OCD treatments.
Topics: Adolescent; Biomarkers; Cartilage; Cartilage, Articular; Collagen Type II; Cross-Sectional Studies; Female; Humans; Knee Joint; Male; Osteochondritis Dissecans; Young Adult
PubMed: 29998134
DOI: 10.1155/2018/5458704 -
Knee Surgery, Sports Traumatology,... Jun 2019Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint... (Review)
Review
Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies-The advantages of allografts to address an osteochondral challenge.
Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint surfaces and accelerating wear and the cascade of joint degeneration. Accordingly, the restoration of articular surface integrity is of major importance, especially in young adults where, in lesions left untreated or following simple fragment excision, early osteoarthritis can be anticipated. Therefore, the treatment algorithm in unstable knee OCD of the young adult foresees surgical options to restore the articular surface. Several procedures have been proposed, including refixation of the detached fragment bone marrow stimulation, osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques. The aim of this review was to summarize the evidence for these surgical strategies, reporting their results and limitations. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, thus indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. The fixation of a good quality fragment should be pursued as a first option, while unfixable small lesions may benefit from autografts. For large lesions, available cell-based or cell-free osteochondral scaffold are a feasible solution but with limitation in terms of regenerated tissue quality. In this light, fresh allografts may offer articular surface restoration with viable physiologic osteochondral tissue providing a predictably successful outcome, and therefore they may currently represent the most suitable option to treat unstable irreparable OCD lesion in young adults. LEVEL OF EVIDENCE: V.
Topics: Allografts; Arthroplasty, Subchondral; Bone Marrow; Bone Transplantation; Cartilage; Chondrocytes; Humans; Joint Instability; Knee Joint; Orthopedic Fixation Devices; Osteochondritis Dissecans; Regeneration; Tissue Scaffolds; Young Adult
PubMed: 30523367
DOI: 10.1007/s00167-018-5316-5 -
Knee Surgery, Sports Traumatology,... Jul 2017To determine the rate of donor-site morbidity after osteochondral autologous transplantation (OATS) for capitellar osteochondritis dissecans. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine the rate of donor-site morbidity after osteochondral autologous transplantation (OATS) for capitellar osteochondritis dissecans.
METHODS
A literature search was performed in PubMed/MEDLINE, Embase, and Cochrane Library to identify studies up to November 6, 2016. Criteria for inclusion were OATS for capitellar osteochondritis dissecans, reported outcomes related to donor sites, ≥10 patients, ≥1 year follow-up, and written in English. Donor-site morbidity was defined as persistent symptoms (≥1 year) or cases that required subsequent intervention. Patient and harvest characteristics were described, as well as the rate of donor-site morbidity. A random effects model was used to calculate and compare weighted group proportions.
RESULTS
Eleven studies including 190 patients were included. In eight studies, grafts were harvested from the femoral condyle, in three studies, from either the 5th or 6th costal-osteochondral junction. The average number of grafts was 2 (1-5); graft diameter ranged from 2.6 to 11 mm. In the knee-to-elbow group, donor-site morbidity was reported in 10 of 128 patients (7.8%), knee pain during activity (7.0%) and locking sensations (0.8%). In the rib-to-elbow group, one of 62 cases (1.6%) was complicated, a pneumothorax. The proportion in the knee-to-elbow group was 0.04 (95% CI 0.0-0.15), and the proportion in the rib-to-elbow group was 0.01 (95% CI 0.00-0.06). There were no significant differences between both harvest techniques (n.s.).
CONCLUSIONS
Donor-site morbidity after OATS for capitellar osteochondritis dissecans was reported in a considerable group of patients.
LEVEL OF EVIDENCE
Level IV, systematic review of level IV studies.
Topics: Arthralgia; Bone Transplantation; Elbow Joint; Femur; Humans; Knee Joint; Osteochondritis Dissecans; Postoperative Complications; Ribs; Transplant Donor Site; Transplantation, Autologous
PubMed: 28391550
DOI: 10.1007/s00167-017-4516-8 -
Oral and Maxillofacial Surgery Mar 2024To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ). (Review)
Review
PURPOSE
To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ).
METHODS
An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'Temporomandibular Joint Disorders', 'Osteochondritis Dissecans', 'Joint Loose Bodies' and 'Temporomandibular Joint'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria.
RESULTS
Ten articles were included in the analysis - six case reports, one case series, one retrospective study, one comparative study and one correlational study - with a total of 39 patients. The most frequently reported clinical presentation involved TMJ pain, locked jaw and articular noises (clicking and crepitus). The imaging methods used to identify OCD were radiographs, tomography, arthrography and magnetic resonance imaging. The reported imaging findings varied widely, but the most frequent were (single or multiple) calcified intra-articular loose bodies, signs of degenerative osseous changes, disc displacements, widening of the joint space and alterations in condylar morphology. Seven articles reported treatments (surgical or conservative), but the treatment outcome was not reported in all of the articles, which makes it difficult to make comparisons.
CONCLUSION
OCD of the TMJ may present various non-specific clinical characteristics, and given the heterogeneous imaging findings, multiplanar images are required for an accurate diagnosis. Finally, the results do not allow recommending a standard treatment for OCD of the TMJ.
Topics: Humans; Osteochondritis Dissecans; Retrospective Studies; Temporomandibular Joint; Temporomandibular Joint Disorders; Radiography; Magnetic Resonance Imaging; Joint Loose Bodies
PubMed: 36631710
DOI: 10.1007/s10006-022-01134-2 -
Arthroscopy Techniques Mar 2022Osteochondritis dissecans of the humeral trochlea is a rare cause of elbow pain adolescents. Despite being a juvenile form of osteochondritis dissecans, spontaneous...
Osteochondritis dissecans of the humeral trochlea is a rare cause of elbow pain adolescents. Despite being a juvenile form of osteochondritis dissecans, spontaneous resolution is not uniform, and more than one-half of patients experience ongoing pain, crepitus and loss of motion. Traditionally, nonsurgical management has been favoured as distal trochlea articular lesions were only accessible via olecranon osteotomy. Consequently, the threshold for intervention is high as the recovery prolonged. We present our technique of accessing the trochlear osteochondritis dissecans via ulnohumeral joint arthroscopy with transolecranon microfracture, which enables these lesions to be managed with reduced morbidity.
PubMed: 35256965
DOI: 10.1016/j.eats.2021.10.021 -
Journal of Paediatrics and Child Health Nov 2017Growing children are susceptible to a number of disorders to their lower extremities of varying degrees of severity. The diagnosis and management of these conditions can... (Review)
Review
Growing children are susceptible to a number of disorders to their lower extremities of varying degrees of severity. The diagnosis and management of these conditions can be challenging. With musculoskeletal symptoms being one of the leading reasons for visits to general practitioners, a working knowledge of the basics of these disorders can help in the appropriate diagnosis, treatment, counselling, and specialist referral. This review covers common disorders affecting the hip, the knee and the foot. The aim is to assist general practitioners in recognising developmental norms and differentiating physiological from pathological conditions and to identify when a specialist referral is necessary.
Topics: Child; Foot Deformities, Congenital; Genu Valgum; Genu Varum; Hip Dislocation, Congenital; Humans; Legg-Calve-Perthes Disease; Lower Extremity Deformities, Congenital; Osteochondritis Dissecans; Osteochondrosis; Slipped Capital Femoral Epiphyses
PubMed: 29148202
DOI: 10.1111/jpc.13756 -
Skeletal Radiology Jan 2022Tarsal coalition is known to cause abnormal talocrural stress, hindfoot malalignment, and ankle sprains. These can all be associated with osteochondritis dissecans (OCD)...
OBJECTIVE
Tarsal coalition is known to cause abnormal talocrural stress, hindfoot malalignment, and ankle sprains. These can all be associated with osteochondritis dissecans (OCD) of the talar dome. We present the first detailed description of a series of talar OCDs occurring in patients with tarsal coalition, with the goal of determining whether there is an increased prevalence of OCDs among patients with tarsal coalition.
MATERIALS AND METHODS
We studied ankle MRIs in 57 patients with tarsal coalitions, excluding those with a reported inciting traumatic event. The MRIs were performed on magnetic field strengths ranging from 0.3 to 1.5 T and included axial, coronal, and sagittal T1 and T2 or PD fat-suppressed sequences. We evaluated the morphology and location of classically described OCDs in these patients, type and location of concomitant tarsal coalition, and, when available, the presence of pes planus and hindfoot valgus on weight-bearing radiographs. Chi-squared analysis was used to compare categorical variables and a Student's t test was used for parametric continuous variables. Additionally, logistic regression was used to compute the odds ratio of talar OCD associated with patient age, gender, laterality, pes planus status, hindfoot valgus status, and coalition type.
RESULTS
Eighty-nine percent of tarsal coalitions were non-osseous coalitions and the calcaneonavicular space was the most common site of abnormal tarsal connection (54.4%). In the 29 patients with tarsal coalitions and talar OCDs, OCDs commonly occurred medially (75.9%). In the sagittal plane, talar OCDs occurred centrally, with only one case sparing the central talar dome. The mean surface area of the 29 OCDs was 89.7 mm. Both osseous coalition and hindfoot valgus were associated with smaller talar OCD mean surface area (p = 0.015 and p = 0.0001, respectively). There was no association between depth and surface area of talar OCD with either coalition location or presence of pes planus (coalition location: p = 0.455 for depth and p = 0.295 for surface area; presence of pes planus: p = 0.593 for depth and p = 0.367 for surface area).
CONCLUSION
Talar OCD prevalence is higher in patients with tarsal coalition than that reported for the general population. This occurrence may relate to altered biomechanics and repetitive talocrural stress owing to altered subtalar motion, particularly given the findings of increased odds of talar OCD in older patients, as well as weak associations between OCD surface area and both non-osseous coalition and hindfoot alignment. However, we did not find any specific OCD morphologic features attributable to the precise location of the tarsal coalition.
Topics: Aged; Flatfoot; Humans; Magnetic Resonance Imaging; Osteochondritis Dissecans; Radiography; Tarsal Bones; Tarsal Coalition
PubMed: 34160680
DOI: 10.1007/s00256-021-03800-0