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Matrix Biology : Journal of the... Oct 2018Hyaline cartilages, fibrocartilages and elastic cartilages play multiple roles in the human body including bearing loads in articular joints and intervertebral discs,... (Review)
Review
Hyaline cartilages, fibrocartilages and elastic cartilages play multiple roles in the human body including bearing loads in articular joints and intervertebral discs, providing joint lubrication, forming the external ears and nose, supporting the trachea, and forming the long bones during development and growth. The structure and organization of cartilage's extracellular matrix (ECM) are the primary determinants of normal function. Most diseases involving cartilage lead to dramatic changes in the ECM which can govern disease progression (e.g., in osteoarthritis), cause the main symptoms of the disease (e.g., dwarfism caused by genetically inherited mutations) or occur as collateral damage in pathological processes occurring in other nearby tissues (e.g., osteochondritis dissecans and inflammatory arthropathies). Challenges associated with cartilage diseases include poor understanding of the etiology and pathogenesis, delayed diagnoses due to the aneural nature of the tissue and drug delivery challenges due to the avascular nature of adult cartilages. This narrative review provides an overview of the clinical and pathological features as well as current treatment options available for various cartilage diseases. Late breaking advances are also described in the quest for development and delivery of effective disease modifying drugs for cartilage diseases including osteoarthritis, the most common form of arthritis that affects hundreds of millions of people worldwide.
Topics: Cartilage Diseases; Cartilage, Articular; Disease Progression; Extracellular Matrix; Humans; Mutation
PubMed: 29803938
DOI: 10.1016/j.matbio.2018.05.005 -
Journal of Orthopaedic Surgery and... Dec 2018The absence of a single, identifiable traumatic cause has been traditionally used as a definition for a causative factor of overuse injury. Excessive loading,... (Review)
Review
BACKGROUND
The absence of a single, identifiable traumatic cause has been traditionally used as a definition for a causative factor of overuse injury. Excessive loading, insufficient recovery, and underpreparedness can increase injury risk by exposing athletes to relatively large changes in load. The musculoskeletal system, if subjected to excessive stress, can suffer from various types of overuse injuries which may affect the bone, muscles, tendons, and ligaments.
METHODS
We performed a search (up to March 2018) in the PubMed and Scopus electronic databases to identify the available scientific articles about the pathophysiology and the incidence of overuse sport injuries. For the purposes of our review, we used several combinations of the following keywords: overuse, injury, tendon, tendinopathy, stress fracture, stress reaction, and juvenile osteochondritis dissecans.
RESULTS
Overuse tendinopathy induces in the tendon pain and swelling with associated decreased tolerance to exercise and various types of tendon degeneration. Poor training technique and a variety of risk factors may predispose athletes to stress reactions that may be interpreted as possible precursors of stress fractures. A frequent cause of pain in adolescents is juvenile osteochondritis dissecans (JOCD), which is characterized by delamination and localized necrosis of the subchondral bone, with or without the involvement of articular cartilage. The purpose of this compressive review is to give an overview of overuse injuries in sport by describing the theoretical foundations of these conditions that may predispose to the development of tendinopathy, stress fractures, stress reactions, and juvenile osteochondritis dissecans and the implication that these pathologies may have in their management.
CONCLUSIONS
Further research is required to improve our knowledge on tendon and bone healing, enabling specific treatment strategies to be developed for the management of overuse injuries.
Topics: Athletic Injuries; Cumulative Trauma Disorders; Humans; Inflammation Mediators; Osteoarthritis; Sports; Tendinopathy
PubMed: 30518382
DOI: 10.1186/s13018-018-1017-5 -
The Journal of Bone and Joint Surgery.... Jun 2021Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to... (Review)
Review
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Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis.
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While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition.
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Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging.
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Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions.
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Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.
Topics: Arthroscopy; Humans; Osteochondritis Dissecans; Radiography
PubMed: 34109940
DOI: 10.2106/JBJS.20.01399 -
Orthopaedics & Traumatology, Surgery &... Feb 2018Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and... (Review)
Review
Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The diagnosis is usually made during adolescence. Mechanical factors play a major role in the pathophysiology of OCD. When the radiographic diagnosis is made early in a patient with open physes, healing can often be obtained simply by restricting sports activities. The degree of lesion instability can be assessed by magnetic resonance imaging. When the lesion remains unstable and the pain persists despite a period of rest, surgery is indicated. Arthroscopic exploration is always the first step. Drilling of the lesion produces excellent outcomes if the lesion is stable. Unstable lesions require fixation and, in some cases, bone grafting. Defects must be filled, depending on their surface area. Although many surgical techniques are available, the therapeutic indications are now standardized.
Topics: Arthralgia; Arthroscopy; Humans; Knee Joint; Magnetic Resonance Imaging; Osteoarthritis, Knee; Osteochondritis Dissecans; Radiography
PubMed: 29197636
DOI: 10.1016/j.otsr.2017.02.016 -
Cartilage Dec 2021This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause... (Review)
Review
This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.
Topics: Adolescent; Adult; Ankle Joint; Arthroscopy; Child; Humans; Intra-Articular Fractures; Magnetic Resonance Imaging; Osteochondritis Dissecans; Osteonecrosis; Talus; Tomography, X-Ray Computed
PubMed: 33423507
DOI: 10.1177/1947603520985182 -
British Journal of Hospital Medicine... Apr 2023Osteochondritis dissecans is a condition characterised by acquired pathological subchondral bone lesions and its incidence is unknown. It has a multifactorial aetiology,...
Osteochondritis dissecans is a condition characterised by acquired pathological subchondral bone lesions and its incidence is unknown. It has a multifactorial aetiology, with a combination of genetic and acquired risk factors. It commonly presents in adolescents and young adults. Patients have variable presentations, including trauma, insidious onset and pain exacerbated by exercise. The joints primarily affected are the knee, ankle and elbow joint. Early identification is key to treatment and to prevent future osteoarthritis of the joint. This article gives an overview of the presentation, assessment and management of the juvenile form of osteochondritis dissecans.
Topics: Adolescent; Young Adult; Humans; Osteochondritis Dissecans; Knee Joint
PubMed: 37127418
DOI: 10.12968/hmed.2023.0044 -
Orthopaedics & Traumatology, Surgery &... Feb 2015Increased intensity of sports activities combined with a decrease in daily physical activity is making overuse injuries in children more common. These injuries are... (Review)
Review
Increased intensity of sports activities combined with a decrease in daily physical activity is making overuse injuries in children more common. These injuries are located mainly in the epiphyseal cartilage. The broad term for these injuries is osteochondrosis, rather than osteochondritis, which more specifically refers to inflammatory conditions of bone and cartilage. The osteochondrosis may be epiphyseal, physeal, or apophyseal, depending on the affected site. The condition can either be in the primary deformans form or the dissecans form. While there is no consensus on the etiology of osteochondrosis, multiple factors seem to be involved: vascular, traumatic, or even microtraumatic factors. Most overuse injuries involve the lower limbs, especially the knees, ankle and feet. The most typical are Osgood-Schlatter disease and Sever's disease; in both conditions, the tendons remain relatively short during the pubescent grown spurt. The main treatment for these injuries is temporary suspension of athletic activities, combined with physical therapy in many cases. Surgery may be performed if conservative treatment fails. It is best, however, to try to prevent these injuries by analyzing and correcting problems with sports equipment, lifestyle habits, training intensity and the child's level of physical activity, and by avoiding premature specialization. Pain in children during sports should not be considered normal. It is a warning sign of overtraining, which may require the activity to be modified, reduced or even discontinued.
Topics: Adolescent; Athletic Injuries; Child; Child, Preschool; Cumulative Trauma Disorders; Growth Plate; Humans; Life Style; Lower Extremity; Orthopedic Procedures; Osteochondrosis; Physical Therapy Modalities; Prevalence; Radiography; Salter-Harris Fractures; Sports
PubMed: 25555804
DOI: 10.1016/j.otsr.2014.06.030 -
Sports Health 2016Isolated chondral and osteochondral defects of the knee are a difficult clinical challenge, particularly in younger patients for whom alternatives such as partial or... (Review)
Review
CONTEXT
Isolated chondral and osteochondral defects of the knee are a difficult clinical challenge, particularly in younger patients for whom alternatives such as partial or total knee arthroplasty are rarely advised. Numerous surgical techniques have been developed to address focal cartilage defects. Cartilage treatment strategies are characterized as palliation (eg, chondroplasty and debridement), repair (eg, drilling and microfracture [MF]), or restoration (eg, autologous chondrocyte implantation [ACI], osteochondral autograft [OAT], and osteochondral allograft [OCA]).
EVIDENCE ACQUISITION
PubMed was searched for treatment articles using the keywords knee, articular cartilage, and osteochondral defect, with a focus on articles published in the past 5 years.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
In general, smaller lesions (<2 cm(2)) are best treated with MF or OAT. Furthermore, OAT shows trends toward greater longevity and durability as well as improved outcomes in high-demand patients. Intermediate-size lesions (2-4 cm(2)) have shown fairly equivalent treatment results using either OAT or ACI options. For larger lesions (>4 cm(2)), ACI or OCA have shown the best results, with OCA being an option for large osteochondritis dissecans lesions and posttraumatic defects.
CONCLUSION
These techniques may improve patient outcomes, though no single technique can reproduce normal hyaline cartilage.
Topics: Arthroplasty; Cartilage; Cartilage, Articular; Chondrocytes; Debridement; Genetic Therapy; Guided Tissue Regeneration; Humans; Knee Injuries; Stem Cell Transplantation; Transplantation, Autologous; Transplantation, Homologous
PubMed: 26502188
DOI: 10.1177/1941738115611350 -
Current Reviews in Musculoskeletal... Apr 2020Osteochondritis dissecans (OCD) is a pathologic condition of subchondral bone most frequently occurring in the medial femoral condyle of the knee in children and... (Review)
Review
PURPOSE OF THE REVIEW
Osteochondritis dissecans (OCD) is a pathologic condition of subchondral bone most frequently occurring in the medial femoral condyle of the knee in children and adolescents. Salvage techniques are necessary when either nonoperative or typical operative treatments fail, or the OCD presents in an unsalvageable state. The purpose of this review is to describe the evaluation and management of failed OCDs.
RECENT FINDINGS
Thorough preoperative planning is essential to the treatment of failed OCDs. Radiographs and advanced imaging such as MRI and CT allow for a detailed assessment of subchondral bone and cartilage. Long-leg alignment radiographs are critical to assess for malalignment which may increase the contact forces on the affected condyle. Malalignment can be corrected with hemiepiphysiodesis or an osteotomy depending on the skeletal maturity of the patient. Osteochondral allografts and autologous chondrocyte implantation treat the defect in both bone and cartilage or solely cartilage and have good short to moderate term outcomes, particularly as compared to the inferior outcomes of microfracture of larger OCDs. Osteochondritis dissecans of the knee that fails to heal with initial operative measures can result in a large defect of bone and cartilage in the knee of adolescents. Treatment of the bone and cartilage defect can be accomplished with either osteochondral allograft transplantation or matrix-assisted autologous chondrocyte implantation can be performed with good outcomes. Assessment and correction of lower extremity malalignment is a critical component of treatment. Durable long-term solutions are necessary for the treatment of these difficult lesions.
PubMed: 32147780
DOI: 10.1007/s12178-020-09611-5