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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 -
The American Journal of Sports Medicine Dec 2021The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject.
BACKGROUND
The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject.
PURPOSE
To better understand the efficacy of different surgical modalities and nonoperative treatment of OCD as assessed by radiological and clinical outcomes and return to sports.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review of all treatment studies published between January 1975 and June 2020 was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 76 clinical studies, including 1463 patients, were suitable for inclusion. Aggregate analysis and subgroup analysis of individual patient data were performed to compare the functional and radiographic outcomes between the various nonoperative and surgical treatment options for capitellar OCD. A unified grading system (UGS; grades 1-4) was developed from existing validated classification systems to allow a comparison of patients with similar-grade OCD lesions in different studies according to their treatment. Patient-level data were available for 352 patients. The primary outcome measures of interest were patient-reported functional outcome, range of motion (ROM), and return to sports after treatment. The influences of the capitellar physeal status, location of the lesion, and type of sports participation were also assessed. Each outcome measure was evaluated according to the grade of OCD and treatment method (debridement/microfracture, fragment fixation, osteochondral autograft transplantation [OATS], or nonoperative treatment).
RESULTS
No studies reported elbow scores or ROM for nonoperatively treated patients. All surgical modalities resulted in significantly increased postoperative ROM and elbow scores for stable (UGS grades 1 and 2) and unstable lesions (UGS grades 3 and 4). There was no significant difference in the magnitude of improvement or overall scores according to the type of surgery for stable or unstable lesions. Return to sports was superior with nonoperative treatment for stable lesions, whereas surgical treatment was superior for unstable lesions. Patients with an open capitellar physis had superior ROM for stable and unstable lesions, but there was no correlation with lesion location and the outcomes of OATS versus fragment fixation for high-grade lesions.
CONCLUSION
Nonoperative treatment was similar in outcomes to surgical treatment for low-grade lesions, whereas surgical treatment was superior for higher grade lesions. There is currently insufficient evidence to support complex reconstructive techniques for high-grade lesions compared with microfracture/debridement alone.
Topics: Bone Transplantation; Elbow Joint; Humans; Osteochondritis Dissecans; Range of Motion, Articular; Transplantation, Autologous; Treatment Outcome
PubMed: 33886390
DOI: 10.1177/03635465211000763 -
The Physician and Sportsmedicine Dec 2023Osteochondritis dissecans can result in significant limitations in activity, pain, and early osteoarthritis. There are various treatment modalities to address these... (Review)
Review
OBJECTIVES
Osteochondritis dissecans can result in significant limitations in activity, pain, and early osteoarthritis. There are various treatment modalities to address these defects. The purpose of this study was to provide a qualitative summary of the various treatment options for unstable osteochondritis dissecans in the knee.
METHODS
A literature search was performed on osteochondritis dissecans in the knee using PubMed (MEDLINE), Embase, and Cochrane electronic databases. The search was completed using a combination of the following terms: 'osteochondritis dissecans,' 'OCD,' 'osteochondral,' 'articular cartilage,' 'repair,' 'surgery,' 'treatment,' 'osteochondral allograft,' 'autologous chondrocyte implantation,' 'unstable,' 'knee,' 'clinical studies.'
RESULTS
A total of 682 studies were found, of which 24 were included in the qualitative analysis. The quality score ranged from 46 to 80, and the mean follow-up ranged from 2 to 17 years. The most common surgical procedures were internal fixation (n = 7 studies), ACI (n = 6), fragment excision (n = 3), MACI (n = 2), bone graft + ACI (n = 2), OCA (n = 2), mosaicplasty/OAT (n = 2), and scaffold (n = 2). Overall, the reported outcome measures were heterogeneous in nature. Post-operative International Knee Documentations Committee (IKDC) scores ranged from 75 to 85 and Lysholm scores ranged from 70 to 93.5. Tegner scores ranged from 4 to 5. Rates of failure, complication, and revision were highly variable across studies and surgical techniques.
CONCLUSION
There are a variety of surgical options for the treatment of unstable osteochondritis dissecans. In skeletally immature patients, internal fixation demonstrated acceptable rates of radiographic union and patient reported outcome measures. In skeletally mature patients with large lesions, MACI and OCA transplantation provided similar patient reported outcomes.
Topics: Humans; Osteochondritis Dissecans; Knee Joint; Bone Transplantation; Cartilage, Articular; Fracture Fixation, Internal; Transplantation, Autologous; Follow-Up Studies; Treatment Outcome
PubMed: 35611658
DOI: 10.1080/00913847.2022.2082262 -
Cartilage 2022Aim of this systematic review was to describe all classification systems for knee osteochondritis dissecans (OCD) lesions, evaluating their accuracy and reliability, as...
OBJECTIVE
Aim of this systematic review was to describe all classification systems for knee osteochondritis dissecans (OCD) lesions, evaluating their accuracy and reliability, as well as their use in the literature on knee OCD.
DESIGN
A systematic review of the literature was performed in July 2021 on PubMed, WebOfScience, and Cochrane Collaboration (library) to describe all published classification systems for knee OCD lesions and quantify the use of these classifications in the literature.
RESULTS
Out of 1,664 records, 30 studies on 33 OCD classifications systems were identified, describing 11 radiographic, 13 MRI, and 9 arthroscopic classifications. The search included 193 clinical studies applying at least one OCD classification, for a total of 7,299 knee OCD cases. Radiographic classifications were applied to 35.8%, MRI to 35.2%, and arthroscopic classifications to 64.2% of the included studies. Among these, in the last two decades, the International Cartilage Repair Society's (ICRS) arthroscopic classification was the most described approach in studies on knee OCD. Overall, there is a lack of data on accuracy and reliability of the available systems.
CONCLUSIONS
Several classifications are available, with ICRS being the most used system over the time period studied. Arthroscopy allows to confirm lesion stability, but noninvasive imaging approaches are the first line to guide patient management. Among these, radiographic classifications are still widely used, despite being partially superseded by MRI, because of its capability to detect the earliest disease stages and to distinguish stable from unstable lesions, and thus to define the most suitable conservative or surgical approach to manage patients affected by knee OCD.
LEVEL OF EVIDENCE
Systematic review, level IV.
Topics: Arthroscopy; Humans; Knee Joint; Magnetic Resonance Imaging; Osteochondritis Dissecans; Reproducibility of Results
PubMed: 36117427
DOI: 10.1177/19476035221121789 -
Arthroscopy, Sports Medicine, and... Apr 2021To analyze the available literature pertaining to the indications, outcomes, and complications of both microfracture (MFX) and simple debridement for capitellar... (Review)
Review
PURPOSE
To analyze the available literature pertaining to the indications, outcomes, and complications of both microfracture (MFX) and simple debridement for capitellar osteochondritis dissecans (OCD).
METHODS
A comprehensive literature review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Studies were included if they evaluated OCD of the capitellum that underwent either arthroscopic debridement (AD) or MFX. The risk of bias was assessed using the Methodological Index for Non-randomized Studies (MINORS) scale. Patient demographic characteristics, imaging findings, return-to-sport rates, patient-reported outcomes, range of motion (ROM), complications, failures, and reoperations were recorded.
RESULTS
Eleven studies with 327 patients (332 elbows) met the inclusion criteria. Methodological Index for Non-randomized Studies (MINORS) scores ranged from 63% to 75% and showed considerable heterogeneity. Both AD and MFX showed improvement in patient outcome scores, ROM, and return to play, although the data precluded relative conclusions. Improvement in motion after MFX ranged from 4.9° to 5° of flexion, 5° to 22.6° of extension, 1° to 2° of pronation, and 0.5° to 2° of supination, whereas after AD, it ranged from -4° to 6° of flexion and -0.4° to 14° of extension, with prono-supination noted in only 1 study. The rate of return to play at a similar level of preinjury athletic competition ranged from 55% to 75% after MFX and from 40% to 100% after AD. Lesion location was discussed in only 1 study. Postoperative imaging trended toward early degenerative changes, most commonly of the radial head. Complications were only reported in 1 MFX study; in all cases, the complication was transient ulnar nerve neurapraxia. Reoperation rates ranged from 0% to 10%, and reoperation was most commonly performed to address radial head enlargement. Five studies reported no reoperations.
CONCLUSIONS
Both AD and MFX for capitellar OCD appear to yield excellent improvements in pain, ROM, patient outcome scores, and return to sport. Given that comparable mid-term outcomes can be achieved with debridement alone, without the use of MFX, similarly to recent prospective studies in the knee, AD alone may be a reasonable approach to relatively small OCD defects.
LEVEL OF EVIDENCE
Level IV, systematic review of studies, all Level IV evidence.
PubMed: 34027472
DOI: 10.1016/j.asmr.2020.10.002 -
Knee Surgery, Sports Traumatology,... Sep 2021The current systematic review and meta-analysis aim to pool together the incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knee. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The current systematic review and meta-analysis aim to pool together the incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knee.
METHODS
The systematic review was conducted according to PRISMA guidelines. A search was conducted using PubMed and Cochrane Library with the keywords being "knee" and "osteochondritis dissecans" or "osteochondral lesion". All original human studies that reported the incidence or risk factors of osteoarthritis following osteochondritis dissecans of the knee were included.
RESULTS
Nine studies with 496 patients were included. The incidence of osteoarthritis following osteochondritis dissecans is 0.39 (95% CI 0.19-0.59). Patients with a body mass index greater than 25 kg/m had a significantly increased risk of osteoarthritis. Fragment excision had an increased relative risk of 1.89 (95% CI 1.19-3.01) of osteoarthritis as compared to fragment preservation. Significant heterogeneity was identified when comparing between juvenile and adult osteochondritis dissecans. The size of the lesions moderated the between-study heterogeneity with regards to the incidence of osteoarthritis, with the relative risk of osteoarthritis in lesions bigger than 4 cm being 2.29 (95% CI 1.24-4.23). No other risk factors, including gender of the patient, location of osteochondritis dissecans, stability of osteochondritis dissecans, and surgical versus non-surgical management were significant risk factors.
CONCLUSION
Significant risk factors for osteoarthritis were increased body mass index and fragment excision. Probable but inconclusive risk factors were the age of the patients and the size of the osteochondritis dissecans. The gender of the patient, location of osteochondritis dissecans, the stability of osteochondritis dissecans, and surgical versus non-surgical management of osteochondritis dissecans when appropriate were not significant risk factors.
Topics: Adult; Humans; Incidence; Knee Joint; Osteoarthritis, Knee; Osteochondritis Dissecans; Risk Factors
PubMed: 33211214
DOI: 10.1007/s00167-020-06365-y -
Arthroscopy : the Journal of... Oct 2022The purpose of this study was to evaluate the impact of patient sex on outcomes after treatment of osteochondritis dissecans (OCD) lesions of the knee through a... (Review)
Review
PURPOSE
The purpose of this study was to evaluate the impact of patient sex on outcomes after treatment of osteochondritis dissecans (OCD) lesions of the knee through a systematic review of current evidence.
METHODS
This review was conducted according to the PRISMA guidelines using the PubMed, PubMed Central, Embase, Ovid Medline, Cochrane Libraries, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Relevant outcomes included functional (e.g., International Knee Documentation Committee and Subjective Knee Evaluation, Lysholm Knee Score) and clinical outcomes (e.g., symptom/pain resolution, reoperation rates) for males and females after operative or nonoperative treatment of knee OCD lesions.
RESULTS
Ten articles with a total of 691 (73%) males and 260 (27%) females were included. Mean age ranged from 11.3 ± 2.1 years to 34.5 ± 10.3 years, and follow-up ranged from 6 months to 16.3 years. In four studies reporting functional outcomes, no significant differences were found between males and females in any metric assessed (all P > .05). Seven studies reported clinical outcomes after treatment of knee OCD lesions. One study determined males were more likely to have a successful nonoperative outcome than females (OR: 1.85, 95% CI: 1.00-3.40). Another study found males had a lower risk of developing symptomatic knee pain following operative or nonoperative treatment at a mean 14-year follow-up (HR: 0.24; 95% CI: 0.07-0.81). The remaining 5 studies reported statistically comparable clinical outcomes between males and females (all P > .05).
CONCLUSION
The present systematic review found mostly comparable clinical and functional outcomes between males and females following treatment of knee OCD lesions. Despite sex-related differences in the prevalence of these lesions and limited evidence of differences in clinical outcomes, these data suggest that sex does not independently predict outcomes after treatment.
LEVEL OF EVIDENCE
III, systematic review of Level II and III studies.
Topics: Female; Humans; Infant; Knee; Knee Joint; Male; Osteochondritis Dissecans; Pain; Second-Look Surgery
PubMed: 35337959
DOI: 10.1016/j.arthro.2022.03.015 -
Knee Surgery, Sports Traumatology,... Dec 2021The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow. (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow.
METHODS
The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score.
RESULTS
Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10-18.5) and a median follow-up of 39 months (range 5-156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic-assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8-99.5%, I = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70-87.1%, I = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3-94.5%, I = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5-95.1%, I = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3-99.6%, I = 1%) and for an open procedure was 97.8% (95% CI 93.7-99.9%, I = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients).
CONCLUSION
Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures.
LEVEL OF EVIDENCE
Level IV.
Topics: Adolescent; Arthroscopy; Child; Elbow; Humans; Infant; Joint Instability; Osteochondritis Dissecans; Return to Sport; Shoulder Joint
PubMed: 33620512
DOI: 10.1007/s00167-021-06489-9 -
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 -
Orthopaedic Journal of Sports Medicine Feb 2019Osteochondritis dissecans (OCD) of the capitellum is an increasingly recognized disease affecting young athletes. Because lesion progression is common, early... (Review)
Review
Predictive Role of Symptom Duration Before the Initial Clinical Presentation of Adolescents With Capitellar Osteochondritis Dissecans on Preoperative and Postoperative Measures: A Systematic Review.
BACKGROUND
Osteochondritis dissecans (OCD) of the capitellum is an increasingly recognized disease affecting young athletes. Because lesion progression is common, early identification is potentially beneficial for an athlete's treatment and recovery. However, there is currently no analysis available that evaluates the impact of symptom duration on preoperative and postoperative outcomes.
PURPOSE/HYPOTHESIS
The purpose of this study was to perform a systematic review of surgically treated OCD lesions to examine the effect of symptom duration before the initial presentation on preoperative and postoperative outcomes. We hypothesized that a longer symptom duration would correlate with more severe preoperative signs and symptoms and poorer postoperative outcomes.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Ovid MEDLINE, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects were queried for studies evaluating symptom duration before the clinical presentation of capitellar OCD and surgical outcomes. A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS
A total of 23 studies reporting outcomes in 258 patients (mean patient age, 14.4 ± 1.5 years) were analyzed. Locking as a chief complaint predominated in a greater proportion of patients who presented with a longer history of OCD symptoms ( = .007). A longer symptom duration also correlated with a longer time to return to sport ( = .008) and older age ( < .001). Range of motion limitations as both a chief complaint and a physical examination finding correlated with a longer symptom duration ( = .014 and .001, respectively). Symptom duration did not show a relationship with most postoperative outcomes, including the return-to-sport rate ( = .172), which ranged from 70.7% to 91.1% depending on the surgical procedure performed. No significant difference was observed between symptom duration and the surgical procedure performed ( = .376).
CONCLUSION
Advanced OCD lesions were observed in patients with a longer symptom duration. However, treatment specifics rather than symptom duration correlated best with return to sport for patients with advanced OCD lesions requiring surgery. The earlier detection of capitellar OCD may be valuable in reducing the severity of lesions, the time to return to sport, and potential need for surgery in young athletes.
PubMed: 30800689
DOI: 10.1177/2325967118825059