-
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 -
EFORT Open Reviews May 2019Juvenile osteochondritis dissecans (JOCD) is a joint disorder of the subchondral bone and articular cartilage that affects skeletally immature patients.The aetiology of... (Review)
Review
Juvenile osteochondritis dissecans (JOCD) is a joint disorder of the subchondral bone and articular cartilage that affects skeletally immature patients.The aetiology of JOCD is unknown and the natural history is poorly characterized in part due to inconsistent and largely retrospective literature.Most OCD in children and adolescents presents as a stable lesion amenable to non-operative treatment or minimally invasive drilling. However, unstable forms can require a more aggressive approach.This article reviews the most recent literature available and focuses on the pathophysiology, diagnosis and treatment of JOCD of the knee. Cite this article: 2019;4:201-212. DOI: 10.1302/2058-5241.4.180079.
PubMed: 31191988
DOI: 10.1302/2058-5241.4.180079 -
Indian Journal of Orthopaedics 2018Osteochondritis dissecans (OCD) is a disorder primarily affecting subchondral bone, with secondary effects on the overlying articular cartilage. Knee joint (75%) and... (Review)
Review
BACKGROUND
Osteochondritis dissecans (OCD) is a disorder primarily affecting subchondral bone, with secondary effects on the overlying articular cartilage. Knee joint (75%) and radiocapitellar joint (6%) are the most common sites for OCD lesions. The presence of an open growth plate differentiates juvenile osteochondritis dissecans from adult form of osteochondritis. Early diagnosis and treatment produce best long term results. The objective of this study is to determine the best mode of management of a Grade I osteochondritis lesion in a young athlete.
MATERIALS AND METHODS
A PubMed search was made using the keywords "OCD" and "athlete". Articles that were based on participants between the ages of 6-24 years (children, adolescent and young adult) and early stages of OCD were included in this study. A total of 25 articles were thus included for the review.
RESULTS
The healing potential is based on the age of the patient, status of physis, and stage of the lesion. Most authors have observed good to excellent results of drilling of early OCD in skeletally mature patients. Similarly, most authors also reported equally successful outcomes of nonoperative treatment for early OCD in skeletally immature patients.
CONCLUSIONS
We recommend initial nonoperative line of management in patients with open physis. In case of progression of the lesion or failure of conservative treatment a reparative, restorative or palliative surgical intervention can be done. For Stage I OCD lesions in patients with closed physis, we advocate reparative surgery either by means of retro- or trans-articular drilling.
PubMed: 30078890
DOI: 10.4103/ortho.IJOrtho_322_17 -
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 -
Healthcare (Basel, Switzerland) Jun 2022Osteochondral lesions (OCLs) that are frequently encountered in skeletally immature and adult patients are more common than once thought, and their incidence rate is...
Osteochondral lesions (OCLs) that are frequently encountered in skeletally immature and adult patients are more common than once thought, and their incidence rate is rising. These lesions can appear in many synovial joints of the body, such as the shoulder, elbow, hip, and ankle, occurring most often in the knee. The term osteochondral lesion includes a vast spectrum of pathologies such as osteochondritis dissecans, osteochondral defects, osteochondral fractures, and osteonecrosis of the subchondral bone. When considering this, the term osteochondral fracture is preserved only for an osteochondral defect that combines disruption of the articular cartilage and subchondral bone. These fractures commonly occur after sports practice and are associated with acute lateral patellar dislocations. Many of these lesions are initially diagnosed by plain radiographs; however, a computed tomography (CT) scan or magnetic resonance imaging (MRI) can add significant value to the diagnosis and treatment. Treatment methods may vary depending on the location and size of the fracture, fragment instability, and skeletal maturity. The paper reports a 14-year-old boy case with an osteochondral fracture due to sports trauma. The medical approach involved an arthrotomy of the knee, drainage of the hematoma, two Kirschner wires (K-wires) for temporary fixation to restructure anatomic alignment, and a titanium Herbert screw fixing the fracture permanently. The patient had a favorable postoperative outcome with no residual pain, adequate knee stability, and a normal range of motion. The mobility of the knee was fully recovered.
PubMed: 35742112
DOI: 10.3390/healthcare10061061 -
Capitellar osteochondritis dissecans in an elite pre-adolescent gymnast: a case report and overview.The Journal of the Canadian... Dec 2022Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in...
OBJECTIVE
Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in pediatric athletic trauma, particularly during the pre-puberty through adolescent years of rapid skeletal growth. This paper presents the diagnosis and management of osteochondritis dissecans in its third most common location, the elbow, a presentation of which chiropractors should be aware, including the importance of timely diagnosis and appropriate treatment.
CLINICAL FEATURES
A 9-year-old elite gymnast presented at a chiropractic clinic with elbow pain and restricted range of motion after a fall during training. Following multidisciplinary involvement, the diagnosis was eventually made as osteochondritis dissecans.
INTERVENTION AND OUTCOMES
The patient underwent successful arthroscopic surgery in order to remove the osteochondral fragment, followed by a specific regimen of rehabilitation exercises, which helped to enhance and accelerate optimal healing for her return to athletic activity.
SUMMARY
This case reminds the practicing chiropractor of the valuable role he/she can play in a multidisciplinary management of pediatric sports trauma, particularly in diagnosis and post-surgical care. A literature review presents a synopsis of the reported clinical presentations, diagnostic assessment and therapeutic options for capitellar osteochondritis dissecans.
PubMed: 36818357
DOI: No ID Found -
Cartilage Jan 2017The incidence of osteochondral lesions, as well as osteoarthritis of the ankle joint following osteochondritis dissecans and trauma, has been reappraised in recent... (Review)
Review
The incidence of osteochondral lesions, as well as osteoarthritis of the ankle joint following osteochondritis dissecans and trauma, has been reappraised in recent years. Consequently, an increasing number of surgical interventions using different cartilage repair techniques is performed in the ankle joint, which has resulted in a growing demand for repetitive and objective assessment of cartilage tissue and its repair. While morphological imaging does enable monitoring of macroscopic changes with increasing precision, it fails to provide information about the ultrastructural composition of cartilage. The significance of molecular changes in cartilage matrix composition, however, is increasingly recognized, as it is assumed that macroscopic cartilage degeneration is preceded by a loss in glycosaminoglycans and a disorganization of the collagen network. Recent advances in biochemical magnetic resonance imaging (MRI) have yielded sequences sensitive to these changes, thus providing invaluable insight into both early cartilage degeneration and maturation of repair tissue, on a molecular level. The aim of this review was to provide a comprehensive overview of these techniques, including water and collagen-sensitive T2/T2* mapping, as well as glycosaminoglycan-sensitive sequences such as delayed gadolinium-enhanced MRI of cartilage dGEMRIC, and sodium imaging, and describe their applications for the ankle joint.
PubMed: 27994718
DOI: 10.1177/1947603516632848 -
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 -
Orthopaedic Journal of Sports Medicine Dec 2018Osteochondritis dissecans (OCD) of the elbow is a disorder of subchondral bone and articular cartilage, of which the incidence among children is not clearly known.
BACKGROUND
Osteochondritis dissecans (OCD) of the elbow is a disorder of subchondral bone and articular cartilage, of which the incidence among children is not clearly known.
PURPOSE
To assess the demographics and epidemiology of OCD of the elbow among children.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
A retrospective chart review of an integrated health system for the years 2007 through 2011 was performed for patients with elbow OCD aged 2 to 19 years. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole as well as by sex and age group (2-5, 6-11, 12-19 years). Patient differences based on age, sex, and ethnicity were analyzed, and multivariable logistic regression models were used to assess the risk of elbow OCD by group.
RESULTS
A total of 37 patients with 40 OCD lesions fit the inclusion criteria. No lesion was found among 2- to 5-year-olds. A majority of lesions (n = 39, 97.5%) were in the capitellum, and 1 (2.5%) was in the trochlea. Twenty-five patients (67.6%) had right-sided lesions; 9 (24.3%), left-sided; and 3 (8.1%), bilateral. The incidence of elbow OCD for patients aged 6 to 19 years was 2.2 per 100,000 overall and 3.8 and 0.6 per 100,000 for males and females, respectively. The majority of OCD cases were seen in those aged 12 to 19 years, with an incidence of 3.4 per 100,000 versus 0.38 among 6- to 11-year-olds. Multivariable logistic regression analysis revealed a 21.7-times increased odds ratio of elbow OCD among patients aged 12 to 19 years versus 6 to 11 years, and males had a 6.8-times greater odds ratio of elbow OCD than females ( < .0001 for both). Based on race and ethnicity, non-Hispanic whites had the highest incidence of elbow OCD as compared with all other ethnic groups.
CONCLUSION
In this population-based cohort study of pediatric elbow OCD, males had almost 7 times the risk of elbow OCD as compared with females, and 12- to 19-year-olds had nearly 22 times the risk of elbow OCD versus 6- to 11-year-olds. In keeping with many prior studies, the majority of patients had right-sided lesions.
PubMed: 30622996
DOI: 10.1177/2325967118815846