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Arthroscopy : the Journal of... Apr 2024Osteochondritis dissecans (OCD) of the capitellum is a common cause of elbow pain in young throwers and gymnasts, symptoms of which can rob these young athletes of...
Osteochondritis dissecans (OCD) of the capitellum is a common cause of elbow pain in young throwers and gymnasts, symptoms of which can rob these young athletes of valuable time participating in sporting activities. The optimal treatment of adolescent capitellar OCD lesions is dependent on a variety of patient- and lesion-specific factors, including, but not limited to, lesion size, lesion location, physeal status, and lesion chronicity. Promisingly, marrow stimulation with or without debridement appears to confer high return-to-sport rates coupled with a low complication rate for young athletes suffering from this condition. Furthermore, these outcomes appear to remain consistent across the spectrum of OCD lesions typically encountered. There is concern, however, with the inconsistent reporting of patient- and lesion-specific factors across the literature, which greatly interferes with our ability to synthesize knowledge from multiple published studies and may lead surgeons astray when deciding on the optimal treatment for their patients. It is clear that no two OCD lesions are the same, and each patient requires a thorough history and physical exam, a complete radiographic workup, and a surgeon comfortable with a variety of surgical interventions if outcomes are to be maximized.
Topics: Humans; Adolescent; Osteochondritis Dissecans; Elbow; Bone Marrow; Sports; Elbow Joint; Athletes; Treatment Outcome
PubMed: 38219119
DOI: 10.1016/j.arthro.2023.10.036 -
Cartilage Dec 2023Loose bodies are free-floating tissues of cartilage and bone that can cause pain, swelling, the inability to straighten the knee, or intermittent locking of the knee....
OBJECTIVE
Loose bodies are free-floating tissues of cartilage and bone that can cause pain, swelling, the inability to straighten the knee, or intermittent locking of the knee. Loose bodies can arise from degenerative joint disease, flake fractures, osteochondritis dissecans, or chondromatosis. We hypothesized that loose bodies can be classified in stages with tissue characteristics similar to endochondral ossification.
DESIGN
Loose bodies were harvested from patients undergoing joint replacement. Samples were processed for histology, gene expression analysis, and micro-computed tomography (µCT). Cartilage- and bone-related genes and proteins were selected for immunofluorescence stainings (collagen type I, II, and X, SOX9 [SRY-box transcription factor 9], and MMP13 [matrix metalloproteinase 13]) and gene expression analysis ( [fibronectin], , and aggrecan []).
RESULTS
Loose bodies were grouped in 4 stages: fibrous, (mineralized) cartilaginous, cartilage and bone, and bone. Hyaline-like cartilage tissue with Benninghoff arcades was present in stages 2 and 3. A transition from cartilaginous to mineralized tissue and bone trabecula was defined by an increase in and (stage 3 vs. 4: = 0.047) positive area. Stage 4 showed typical trabecular bone tissue. The relative volume of calcified tissue (mineralized cartilage and bone tissue) decreased with stages (stages 1-2 vs. 3: = 0.002; stage 1-2 vs. 4: = 0.012). expression and stained area decreased from stages 1-2 to 4 ( = 0.010 and = 0.004). expression decreased from stage 1-2 to stage 3 ( = 0.049) and stage 4 ( = 0.002).
CONCLUSION
Loose bodies show tissue characteristics similar to endochondral ossification. They are probably a relevant substrate for regenerative therapeutic interventions in joint disease.
PubMed: 38041252
DOI: 10.1177/19476035231212608 -
The Orthopedic Clinics of North America Jul 2024Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with... (Review)
Review
Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with calcium (1 g/day) to promote bone healing. Although orthopedic F&A surgeons are frequently the first provider to detect the harbingers of osteoporosis by the occurrence of fragility fractures, this should trigger referral to the appropriate specialist for assessment and treatment. There is circumstantial evidence suggesting a role of hypovitaminosis D in bone marrow edema syndrome and possibly osteochondritis dissecans. There should be a low threshold for assessing vitamin D levels in such patients.
Topics: Humans; Vitamin D; Vitamin D Deficiency; Dietary Supplements; Orthopedic Procedures; Foot; Ankle
PubMed: 38782509
DOI: 10.1016/j.ocl.2024.01.002 -
Knee Surgery, Sports Traumatology,... Feb 2024To summarize management strategies and associated clinical outcomes in patients with osteochondritis dissecans (OCD) of the femoral trochlea. (Review)
Review
PURPOSE
To summarize management strategies and associated clinical outcomes in patients with osteochondritis dissecans (OCD) of the femoral trochlea.
METHODS
Three databases were searched from inception to 2 October 2023, for studies describing outcomes posttreatment for femoral trochlear OCD. The authors adhered to the preferred reporting items for systematic reviews and meta-analyses and revised assessment of multiple systematic reviews guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, injury characteristics, and operative details were extracted. Outcomes included patient reported outcome measures (PROMs), complications, and revision and return to sport (RTS) rates.
RESULTS
Twenty studies comprising 105 patients (119 knees) were included. Females comprised 10.1% (range: 0%-100%) of patients and the mean age of patients was 14.5 (range: 11-28) years. A total of 89 (74.7%) of knees received operative management, with 28 of 34 (82.4%) known open procedures being open reduction internal fixation (ORIF), and nine of 29 (31%) known arthroscopic procedures receiving arthroscopic reduction internal fixation (ARIF) or drilling. Lysholm and International Knee Documentation Committee scores in 20 patients each ranged from 93.4 to 100 and 74.7 to 96.6, respectively. The revision rate for operative procedures was 9.0%, and the overall RTS rate was 93.3%.
CONCLUSION
There is very little high quality evidence investigating patients with femoral trochlear OCD lesions. Drilling, ARIF, and ORIF were the most common surgical options for this patient population. Patients treated with either nonoperative or operative management returned to sport at a high rate, and those requiring operative management had a low revision rate.
LEVEL OF EVIDENCE
Level V.
Topics: Female; Humans; Child; Adolescent; Young Adult; Adult; Male; Osteochondritis Dissecans; Return to Sport; Knee Joint; Femur; Sports; Treatment Outcome
PubMed: 38270223
DOI: 10.1002/ksa.12040 -
The Journal of Hand Surgery Feb 2024Osteochondritis dissecans (OCD) of the capitellum occurs relatively infrequently but can be found in young overhead-throwing athletes, most commonly in baseball players... (Review)
Review
Osteochondritis dissecans (OCD) of the capitellum occurs relatively infrequently but can be found in young overhead-throwing athletes, most commonly in baseball players and gymnasts. Although non-operative management can effectively treat stable lesions, unstable lesions can lead to debilitating symptoms of the elbow and diminished quality of life without surgical intervention. This article reviews methods of treating OCD of the capitellum categorized by stability, size, and patient characteristics, and seeks to familiarize the reader with the appropriate selection of osteochondral allograft versus autograft in treating large, unstable lesions. We complement this review with 3 case examples, each using either an osteochondral autograft or allograft, and discuss the decision-making methodology used in each case.
Topics: Humans; Osteochondritis Dissecans; Autografts; Quality of Life; Treatment Outcome; Elbow Joint; Allografts; Obsessive-Compulsive Disorder
PubMed: 37865912
DOI: 10.1016/j.jhsa.2023.08.012 -
Biomimetics (Basel, Switzerland) Apr 2024Osteochondritis dissecans (OCD) of the knee is an uncommon injury in young active patients. There is currently a lack of knowledge regarding clinical outcomes and...
Clinical Outcomes and Return-to-Sport Rates following Fragment Fixation Using Hydroxyapatite/Poly-L-Lactate Acid Threaded Pins for Knee Osteochondritis Dissecans: A Case Series.
Osteochondritis dissecans (OCD) of the knee is an uncommon injury in young active patients. There is currently a lack of knowledge regarding clinical outcomes and return-to-sport rates after fragment fixation surgery using hydroxy appetite poly-L-lactic acid (HA/PLLA) threaded pins for knee OCD among athletes. Our purpose was to investigate the clinical outcomes and return-to-sport rates following osteochondral fragment fixation using HA/PLLA pins for the treatment of knee OCD lesions among athletes. A total of 45 patients were retrospectively reviewed. In total, 31 patients were excluded, and 14 patients were included. Pre- and postoperative patient-reported outcome scores (PROSs), including the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcome Scale (KOOS), were compared. In addition, patients were categorized into four groups according to postoperative sports status: higher, same, lower than preinjury, or unable to return to sports. The mean age was 14.4 years (SD 1.67). All patients were male. All PROSs significantly improved at 6, 12, and 24 months postsurgery compared to presurgery. 50% of the patients returned to sports at the same or higher level after surgery. Fragment fixation using HA/PLLA pins leads to favorable clinical outcome scores and high return-to-sport rates in the treatment of athletes with knee OCD.
PubMed: 38667242
DOI: 10.3390/biomimetics9040232 -
European Journal of Orthopaedic Surgery... Feb 2024This study aims to examine whether Pridie drilling, a form of bone marrow stimulation, can expedite the healing process and enable a faster return to sports activity in...
PURPOSE
This study aims to examine whether Pridie drilling, a form of bone marrow stimulation, can expedite the healing process and enable a faster return to sports activity in patients with knee Osteochondritis dissecans (OCD). The primary objective is to assess the effectiveness of Pridie drilling in stable OCD lesions that do not respond to non-operative treatment, by evaluating the absence of painful symptoms 6 months after the procedure. Secondary objectives include evaluating radiographic reconstruction 6 months post-surgery and determining the time it takes to resume sports participation.
MATERIALS AND METHODS
This single-center retrospective study included all cases of stable OCD in the knee that underwent anterograde chondral drilling between 2008 and 2020. Diagnosis of OCD was established using knee radiographs, and the surgical technique involved multiple multidirectional subchondral drilling. Treatment efficacy was defined by the absence of painful symptoms for 6 months postoperatively.
RESULTS
A total of 41 knees were included in the study, and no complications were observed before or after surgery. At 6 months postoperatively, 32 knees (78%) showed complete resolution of symptoms. Complete radiographic reconstruction was observed in 66% of cases. Asymptomatic patients at 6 months returned to sports activity of similar intensity to that practiced previously in an average time of 7.9 months; while, patients who were symptomatic at 6 months returned in an average time of 16.5 months.
CONCLUSION
This study provides evidence supporting the short-term efficacy of anterograde chondral drilling in stable lesion of OCD in children and adolescents after failed functional treatment.
LEVEL OF EVIDENCE
Level III (retrospective cohort study).
Topics: Child; Adolescent; Humans; Young Adult; Osteochondritis Dissecans; Retrospective Studies; Follow-Up Studies; Knee Joint; Knee; Treatment Outcome; Pain
PubMed: 37930425
DOI: 10.1007/s00590-023-03769-7 -
Hand Surgery & Rehabilitation Dec 2023We report the case of a 17-year-old climber presenting a rare case of osteochondritis dissecans of a proximal interphalangeal finger joint. A thorough bibliographic...
We report the case of a 17-year-old climber presenting a rare case of osteochondritis dissecans of a proximal interphalangeal finger joint. A thorough bibliographic search confirmed the rarity of this pathology. The diagnosis and treatment choice are discussed in view of the literature findings.
Topics: Humans; Adolescent; Osteochondritis Dissecans
PubMed: 37709256
DOI: 10.1016/j.hansur.2023.08.009 -
Foot and Ankle Clinics Jun 2024Osteochondral lesions of the talus (OLTs) are the lesions that affect the articular cartilage and the subchondral bone of the talus. Symptoms develop between 6 and... (Review)
Review
Osteochondral lesions of the talus (OLTs) are the lesions that affect the articular cartilage and the subchondral bone of the talus. Symptoms develop between 6 and 12 months after the index trauma and are associated with degradation of quality of life. Two-thirds of the lesions (73%) are located on the medial part of the talus, 28% of the lesions are posteromedial, and 31% of the lesions are centromedial. Currently, OLT of up to 100 mm can behave in a more indolent condition, and above that area, the defect tends to transmit more shearing forces to adjacent cartilage and is more symptomatic.
Topics: Humans; Talus; Quality of Life; Cartilage, Articular; Osteochondritis
PubMed: 38679434
DOI: 10.1016/j.fcl.2023.07.007 -
Journal of Shoulder and Elbow Surgery Apr 2024Osteochondritis dissecans (OCD) of the humeral capitellum is an important cause of elbow disability in young athletes. Large and unstable lesions sometimes require joint...
BACKGROUND
Osteochondritis dissecans (OCD) of the humeral capitellum is an important cause of elbow disability in young athletes. Large and unstable lesions sometimes require joint reconstruction with osteochondral autograft. Several approaches have been described to expose the capitellum for the purpose of treating OCD. The posterior anconeus-splitting approach and the lateral approach with or without release of the lateral ligamentous complex are the most frequently used for this indication. The surface accessible by these approaches has not been widely studied. This study compared the extent of the articular surface of the capitellum that could be exposed with the Kocher approach (without ligament release) vs. the posterior anconeus-splitting approach. A secondary outcome was the measurement of any additional area that could be reached with lateral ulnar collateral ligament release (Wrightington approach).
METHODS
The 3 approaches were performed on 8 adult cadaveric elbows: first, the Kocher approach; then, the anconeus-splitting approach; and finally, the Wrightington approach. The visible articular surface was marked out after completion of each approach.
RESULTS
The mean articular surface of the capitellum was 708 mm (range, 573-830 mm). The mean visible articular surface was 49% (range, 43%-60%) of the total surface with the Kocher approach, 74% (range, 61%-90%) with the posterior anconeus-splitting approach, and 93% (range, 91%-97%) with the Wrightington approach. Although the Kocher approach provided access to the anterior part of the capitellum, the anconeus-splitting approach showed adequate exposure to the posterior three-quarters of the articular surface and overlapped the most posterior part of the Kocher approach. A combination of the 2 lateral ulnar collateral ligament-preserving approaches allowed access to 100% of the joint surface.
CONCLUSION
Most OCD lesions are located in the posterior area of the capitellum and can therefore be reached with the anconeus-splitting approach. When OCD lesions are located anteriorly, the Kocher approach without ligament release is efficient. A combination of these 2 approaches enabled the entirety of the joint surface to be viewed.
Topics: Adult; Humans; Elbow; Elbow Joint; Humerus; Ulna; Elbow Injuries; Osteochondritis Dissecans
PubMed: 37890766
DOI: 10.1016/j.jse.2023.09.022