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Radiographic evaluation of osteochondritis dissecans of the humeral capitellum: A systematic review.Journal of Orthopaedics 2021The purpose of this study was to evaluate radiographic-based classification systems for osteochondritis dissecans (OCD) of the capitellum and determine their agreement...
BACKGROUND
The purpose of this study was to evaluate radiographic-based classification systems for osteochondritis dissecans (OCD) of the capitellum and determine their agreement with intraoperative findings.
METHODS
Using PRISMA guidelines, we analyzed 44 studies utilizing a total of 19 classification systems.
RESULTS
Magnetic resonance imaging (MRI)-based systems showed better predictive value of intraoperative staging, and the Itsubo and Kohyama classifications showed best predictive value for lesion stability.
CONCLUSIONS
No classification system effectively correlated with intraoperative findings. A combination of radiograph, MRI, and computed tomography will most accurately determine OCD lesion stability.
LEVEL OF EVIDENCE
IV, Systematic Review.
PubMed: 34594097
DOI: 10.1016/j.jor.2021.09.005 -
Arthroscopy Techniques Aug 2020Osteochondritis dissecans (OCD) is a subchondral bone abnormality, in which subchondral bone and the overlying articular cartilage detach from the bony bed. Multiple...
Osteochondritis dissecans (OCD) is a subchondral bone abnormality, in which subchondral bone and the overlying articular cartilage detach from the bony bed. Multiple techniques for OCD fixation have been described, including metallic, bioabsorbable implants and biological fixation. We describe a surgical technique for OCD lesions including bony bed preparation with curettage and microfracture, anatomic reduction, and fixation using a suture anchor to provide stability and healing of the lesion.
PubMed: 32874902
DOI: 10.1016/j.eats.2020.04.021 -
Orthopaedic Journal of Sports Medicine Sep 2023Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results.
Characteristics and Clinical Outcomes After Osteochondral Allograft Transplantation for Treating Articular Cartilage Defects: Systematic Review and Single-Arm Meta-analysis of Studies From 2001 to 2020.
BACKGROUND
Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results.
PURPOSE
To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis.
RESULTS
In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m. The mean lesion area was 5.05 cm, the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm, and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty.
CONCLUSION
The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.
PubMed: 37745815
DOI: 10.1177/23259671231199418 -
The Iowa Orthopaedic Journal 2020To determine if children with Osteochondritis Dessicans (OCD) lesions of the distal femur are more likely to have a co-morbid diagnosis of Attention Deficit/...
BACKGROUND
To determine if children with Osteochondritis Dessicans (OCD) lesions of the distal femur are more likely to have a co-morbid diagnosis of Attention Deficit/ Hyperactivity Disorder (ADHD) than age matched controls and to assess the impact of ADHD on OCD outcomes.
METHODS
A retrospective chart review of patients treated at a single tertiary care hospital between 2000-2012 was performed. Charts were reviewed for a diagnosis of OCD of the distal femur in all skeletally immature patients (males < 16 years and females < 14 years). These were then screened for a comorbid diagnosis of ADHD. Age-matched controls with anterior knee pain without OCD were then reviewed to determine if ADHD was more common in the OCD population. Treatment and outcomes of the OCD lesions were then compared in children with and without ADHD.
RESULTS
The prevalence of ADHD was 23% in patients with OCD lesions and was significantly greater than the 11% found in the anterior knee pain age-matched controls (p<0.05). The average grade of lesions at presentation was similar in both groups (2.2 ADHD vs 2.1 no ADHD) however, at final follow-up, the average OCD grade was significantly worse for children with ADHD (1.4 vs 0.7, p<0.004).
CONCLUSION
There is a significantly higher prevalence of ADHD in children with OCD lesions compared with age-matched controls. This study suggests children that with osteochondritis dessicans and ADHD may not have as favorable treatment course as children without the hyperactivity disorder..
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Child; Female; Femur; Humans; Knee Joint; Male; Osteochondritis Dissecans; Prevalence; Retrospective Studies; Tertiary Care Centers
PubMed: 32742216
DOI: No ID Found -
BMJ Case Reports Apr 2022We present a case report of a man in his 20s with osteochondritis dissecans of the talus, treated with autologous transplantation of a vascularised osteochondral flap....
We present a case report of a man in his 20s with osteochondritis dissecans of the talus, treated with autologous transplantation of a vascularised osteochondral flap. The patient with high level of activity presented to our orthopaedic outpatient department for progressive limping and pain, mainly related to sports. An osteochondritis dissecans grade IV of the medial talus was identified by MRI. A microvascular transfer of osteochondral tissue was performed successfully. At follow-up 1 year after surgery, the MRI examination revealed vital cartilage; the patient was free of pain and had returned to his previous level of activity.
Topics: Cartilage; Humans; Intra-Articular Fractures; Male; Osteochondritis; Osteochondritis Dissecans; Pain; Talus; Transplantation, Autologous
PubMed: 35393276
DOI: 10.1136/bcr-2021-248150 -
Strategies in Trauma and Limb... 2019Our goal was to assess the prevalence of ipsilateral distal femoral osteochondritis dissecans (OCD)-like lesions in children with Blount disease, including factors...
PURPOSE
Our goal was to assess the prevalence of ipsilateral distal femoral osteochondritis dissecans (OCD)-like lesions in children with Blount disease, including factors associated with this finding.
MATERIALS AND METHODS
Characteristics of patients with an OCD-like lesion on an imaging study [(X-ray and/or magnetic resonance imaging (MRI)] were compared with those without such a finding.
RESULTS
Over a 12-year period, 6/63 (10%) skeletally immature patients (9/87 limbs) with Blount disease had an OCD-like lesion visible on plain radiographs. Based on available MRI, 7/37 (19%) patients or 10/53 (19%) limbs had an OCD-like distal femoral lesion. All lesions were noted in the posterior third of the weight-bearing portion of the medial femoral condyle with intact overlying articular cartilage. All patients with OCD-like lesions were followed for an average of 1.9 years (range: 1-2.6 years), and complete radiographic resolution of lesion was noted in 7/9 limbs (78%). There was no association of the presence of OCD-like lesion with early- vs late-onset disease, gender, age at imaging, laterality, magnitude of deformity [mean mechanical axis deviation (MAD) 63.3 vs 71.9 mm], mean mechanical lateral distal femoral angle (mLDFA; 91.3 vs 89.7°), and mean medial proximal tibial angle (MPTA; 71.7 vs 71.8°). Children with an OCD-like lesion tended to have a lower mean body mass index (BMI; 21 vs 36, = 0.003).
CONCLUSION
The overall prevalence of OCD-like lesions in the medial femoral condyle in children with Blount disease lesions is 10% using plain radiographs and at least 19% on MRI. Based on the numbers available, we were unable to demonstrate any associations between the presence of such lesions and the patient's age, gender, or magnitude of varus deformity. Further research is needed to fully ascertain the aetiology and natural history of these benign appearing osteochondral imaging findings in children with Blount disease. Our current data support that these lesions do resolve with time and that no surgical intervention targeted at the femoral OCD-like lesion is warranted.
LEVEL OF EVIDENCE
Diagnostic study Level III.
HOW TO CITE THIS ARTICLE
Edobor-Osula F, Wenokor C, Bloom T, Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings. Strategies Trauma Limb Reconstr 2019;14(3):121-125.
PubMed: 32742426
DOI: 10.5005/jp-journals-10080-1438 -
Acta Orthopaedica Et Traumatologica... Jan 2020The aim of this study was compare the clinical success of treatments for avascular necrosis and osteochondritis dissecans in cases who underwent matrix autologous... (Comparative Study)
Comparative Study
Matrix induced autologous chondrocyte implantation in the knee: Comparison between osteochondritis dissecans and osteonecrosis and effect of chondrocyte thickness on prognosis.
OBJECTIVE
The aim of this study was compare the clinical success of treatments for avascular necrosis and osteochondritis dissecans in cases who underwent matrix autologous chondrocyte implantations, and evaluate cartilage thickness on the clinical outcomes after implantation.
METHODS
A total of 37 patients (29 men, and 8 women; mean age: 23.8 years (16-38)) were treated prospectively with a two-stage matrix autologous chondrocyte implantation (avascular necrosis, n=21; osteochondritis dissecans, n=18). Clinical improvements and follows-up were assessed based on the patients' International Cartilage Repair Society (ICRS) scores with simultaneous cartilage thickness measurement using short-TI inversion recovery magnetic resonance imaging. The patients were divided into four subgroups based on their clinical scores, as group D <65 points, Group C 65-83 points, Group B 84-90 and Group A ≥90.
RESULTS
The mean ICRS score was 28.33±7.14 in the preoperative period in the avascular necrosis group, which increased to 70.88±12.61 at 60 months; while the mean ICRS score increased from 29.75±7.15 preoperatively to 87.58±12.83 at 60 months in the osteochondritis dissecans group. A statistically significant difference in the ICRS scores was noted between the two groups, and also between the ICRS scores and cartilage thicknesses of the subgroups (p<0.05).
CONCLUSION
Our study results revealed that greater clinical improvement was achieved in patients with osteochondritis dissecans undergoing matrix autologous chondrocyte implantation than in those with avascular necrosis. In addition, cartilage thickness greater than 3.7 mm following an autologous chondrocyte transplantation showed excellent clinical improvement.
LEVEL OF EVIDENCE
Level III, Therapeutic Study.
Topics: Adult; Cartilage, Articular; Chondrocytes; Female; Follow-Up Studies; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Orthopedic Procedures; Osteochondritis Dissecans; Osteonecrosis; Outcome Assessment, Health Care; Transplantation, Autologous
PubMed: 32175899
DOI: 10.5152/j.aott.2020.01.347 -
Orthopaedics & Traumatology, Surgery &... May 2023Treatment options for patients with Preiser's disease are challenging and varied. This article thus provides a systematic review of existing studies on the outcomes of... (Review)
Review
BACKGROUND
Treatment options for patients with Preiser's disease are challenging and varied. This article thus provides a systematic review of existing studies on the outcomes of the treatments for patients suffering from Preiser's disease in order to investigate the most appropriate management of Preiser's in each stage of the disease.
METHODS
We followed PRISMA guidelines while performing the study, and reviewed 107 papers in all languages from 1981 till November 2020 and included 42 studies that met the eligibility criterion. Studies investigating the outcome of one or more treatment options for Preiser's disease were eligible. Besides, quantitative analysis on 130 individuals (135 wrists) of the included studies was performed.
RESULTS
The results show that in stages II and III, pain score reduces more in surgical approach than in conservative treatment. In stage II of the Preiser's, Vascularized Bone Grafting (VBG) was more effective in pain alleviation and improvement in wrist range of motion (ROM) and Mayo Modified Wrist Score (MMWS) than immobilization. Proximal Row Carpectomy (PRC) in stage III causes more pain relief and ROM improvement than VBG and conservative treatments like prescribing NSAIDs. Inconsistent evidence was found in case studies of stage IV; however, they generally favour PRC and SILASTIC implants. Surgical studies of stage I are not yet enough for making a conclusive assessment.
CONCLUSION
Surgical treatment outcomes seem more satisfactory in all Preiser's disease stages. Specifically, VBG for patients of stage II provided they have no scaphoid degenerative changes, and PRC seems more satisfactory for stage III.
LEVEL OF EVIDENCE
IV; systematic review of case reports and case series on Preiser's disease.
Topics: Humans; Scaphoid Bone; Upper Extremity; Wrist Joint; Osteonecrosis; Pain; Osteochondritis Dissecans
PubMed: 36410658
DOI: 10.1016/j.otsr.2022.103480 -
Journal of Clinical Medicine Jun 2023Research on the long-term outcomes following surgical therapy for osteochondritis dissecans (OCD) of the knee is scarce. A single-center retrospective cohort study was...
Research on the long-term outcomes following surgical therapy for osteochondritis dissecans (OCD) of the knee is scarce. A single-center retrospective cohort study was conducted to investigate surgically treated patients for knee OCD between 1993 and 2007. A total of 37 patients with an average follow-up duration of 14 years (range 8-18) were in the final cohort. IKDC and Lysholm scores were assessed. The duration and types of sport activity were reported. Long-term results were compared with existing midterm data. Knee scores showed a very good outcome with a mean of 91.3 in the IKDC score and 91.7 in the Lysholm score. Compared to midterm outcomes, both IKDC ( = 0.028) and Lysholm scores ( = 0.01) improved on final follow-up. Patients with open physes showed a significantly better Lysholm score compared to patients with closed physes ( = 0.034). Defect localization and size did not influence the outcome, but a defect depth of <0.8 cm achieved significantly better scores than ≥0.8 cm. Of all surgical interventions, refixation achieved the best outcome. Long-term results significantly improved compared to midterm results with a follow-up of 40 months ( = 0.01). Thirty-six out of 37 patients were physically active, with 56% of sports being knee-straining activities. Long-term results following surgically treated OCD fragments show excellent function and a good athletic level. Patients with open physes potentially have better knee outcomes. Midterm results are sustainable and could improve further in the long term.
PubMed: 37373833
DOI: 10.3390/jcm12124140 -
JBJS Essential Surgical Techniques 2019Osteochondritis dissecans (OCD) of the femoral condyle is an idiopathic focal bone abnormality affecting the subchondral bone and can result in unstable osteochondral...
Osteochondritis dissecans (OCD) of the femoral condyle is an idiopathic focal bone abnormality affecting the subchondral bone and can result in unstable osteochondral lesions. The treatment of unstable OCD lesions with open reduction and internal fixation with metallic compression screws is well documented in the literature. Fixation is performed to prevent dislodgement of unstable OCD lesions or fix displaced fragments that have been surgically reduced. The procedure is performed by approaching the knee through a midline incision and medial parapatellar arthrotomy. The lesion is identified, and a scalpel is used to incise the cartilage circumferentially, leaving 1 side intact, to create a "trap door" flap. The OCD fragment is lifted from the bed, and the bed is prepared by debriding the fibrocartilage scar and bone-grafting the bed. The osteochondral fragment is reduced back to the bed, and guidewires are placed to secure the reduction and plan screw trajectories. Guide pins are overdrilled and Herbert compression screws are placed to secure the OCD fragment. The wound is irrigated and closed. Complications are rare, but later screw removal is typically recommended. Reported outcomes are satisfactory, with an 80% rate of radiographic healing and good-to-excellent patient-reported outcomes.
PubMed: 32021717
DOI: 10.2106/JBJS.ST.18.00035