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Archives of Orthopaedic and Trauma... Sep 2012Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. Various... (Review)
Review
PURPOSE
Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. Various treatment strategies including non-surgical and surgical approaches have been described. An evidence-based treatment algorithm is still lacking. The present systematic review focuses on surgical treatment options and their stage-dependent outcome described for treatment of osteochondritis dissecans of the talus with special regard to the best available evidence.
METHODS
For this purpose, an OVID-based systematic literature search was performed including the following databases; MEDLINE, MEDLINE preprints, EMBASE, CINAHL, Life Science Citations, British National Library of Health and Cochrane Central Register of Controlled trials (CENTRAL). Literature search period was from January 1967 up to December 2009. After applying study specific inclusion criteria (minimum follow-up 12 months, patient evaluation by standardized scoring systems, etc.), a total of 54 studies with clinical follow-up of 1,105 patients was included. Methodology of these studies was systematically analyzed by the means of the Coleman Methodology Score. Outcome and success rate was evaluated in dependence of surgical treatment applied and in dependence of the stage of disease.
RESULTS
All 54 studies included were classified as evidence level IV representing case series. The average Coleman Methodology Score was 63 (SD ± 17) points. The average follow-up of the 1,105 patients was 47 months (SD ± 17) with a mean age of 29 (SD ± 5.6) years. The proportion of excellent and good treatment results was stage-independent in total 75 %. According to the criteria of the score applied for patient's evaluation in the individual study, the overall percentage of "good" and "excellent" clinical outcome in 869 patients was 79 %, and according the classification of Berndt and Harty, 82 % in stage I, 86 % in stage II, 83 % in stage III and 76 % in stage IV.
CONCLUSIONS
Although OCD of the talus represents a frequently observed orthopedic pathology, evidence concerning operative treatment of osteochondrosis dissecans of the talus is still elusive. With over 1,100 included patients in the present study, no strong recommendations based upon scientific evidence can be given.
Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Osteochondritis Dissecans; Talus; Young Adult
PubMed: 22622794
DOI: 10.1007/s00402-012-1544-1 -
Shoulder & Elbow Aug 2022Elbow trochlea osteochondritis dissecans (OCD) is rare with limited information on it. The aim of this systematic review is to assess the published evidence on trochlea... (Review)
Review
BACKGROUND
Elbow trochlea osteochondritis dissecans (OCD) is rare with limited information on it. The aim of this systematic review is to assess the published evidence on trochlea OCD in terms of presenting symptoms, location of OCD and outcome of management in adolescent patients.
PATIENT & METHODS
A review of the online databases MEDLINE and Embase was conducted according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting on any aspect of trochlea OCD management were eligible for inclusion and appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool.
RESULTS
16 studies were eligible for inclusion with a total of 75 elbow. Mean age was 14 years (8-19) of which 46 were males. The main presenting symptoms were pain (95%). Non-operative care was reported in 86% of elbows with resolution of symptoms in 76%. Surgical management was described in 14%. There were equal number of arthroscopic and open procedures. 94% had successfully resolution of symptoms post-operatively.
CONCLUSION
Elbow trochlea OCD is a rare pathology and one that can be managed non-operatively in the majority of cases with good resolution of symptoms. However, if this fails, operative options are available with excellent results reported.
LEVEL OF EVIDENCE
Level IV, Systematic review.
PubMed: 35846402
DOI: 10.1177/17585732221079585 -
Orthopaedics & Traumatology, Surgery &... Feb 2024Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others... (Review)
Review
BACKGROUND
Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes debridement and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage. The goal of this systematic review is to summarize the clinical outcomes of retroarticular drilling as a standalone procedure for stable talar OCD with intact cartilage.
PATIENTS AND METHODS
A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS).
RESULTS
Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9.
DISCUSSION
Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment.
LEVEL OF EVIDENCE
IV.
PubMed: 38340961
DOI: 10.1016/j.otsr.2024.103834 -
AJR. American Journal of Roentgenology Jul 2019The purpose of this study is to perform a systematic review and meta-analysis to estimate the clinical value of MRI in assessing the stability of osteochondritis...
The purpose of this study is to perform a systematic review and meta-analysis to estimate the clinical value of MRI in assessing the stability of osteochondritis dissecans (OCD) lesions. A systematic review of the literature published from January 1995 to July 2018 was performed by two independent reviewers using predefined search terms. The reference standard was established as arthroscopy or open surgery. True- and false-positive results as well as true- and false-negative results were counted. The quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooling of diagnostic accuracy, subgroup analysis, and identification of publication bias were included. Sixteen studies were included in the general data pooling. The pooled sensitivity and specificity were 0.92 (95% CI, 0.87-0.95; = 0.55) and 0.85 (95% CI, 0.64-0.95; = 0.88), respectively. The pooled sensitivity and specificity for juvenile OCD lesions were 0.93 (95% CI, 0.82-0.97) and 0.68 (95% CI, 0.41-0.86), respectively. Subgroup analysis showed that the staging system of Dipaola and colleagues and the criteria of De Smet and colleagues had a significant independent association with sensitivity. There was no evidence of publication bias ( = 0.57). The current meta-analysis suggested that MRI has a high diagnostic value for assessing the stability of OCD lesions. However, the MRI criteria applied for adult OCD lesions do not perform well in predicting stability of juvenile OCD lesions. Although some new juvenile OCD-specific MRI criteria yielding a satisfactory outcome have been proposed, further investigations are warranted.
PubMed: 30995094
DOI: 10.2214/AJR.18.20710 -
International Orthopaedics Mar 2018We present a systematic review of the recent literatures regarding the arthroscopic and open technique in fragment fixation for osteochondritis dissecans (OCD) of the... (Meta-Analysis)
Meta-Analysis
PURPOSE
We present a systematic review of the recent literatures regarding the arthroscopic and open technique in fragment fixation for osteochondritis dissecans (OCD) of the humeral capitellum and an analysis of the subjective and objective outcomes between these two procedures.
METHODS
PubMed and EMBASE were reviewed for suitable articles relating to fragment fixation for OCD, both open and arthroscopic. We included all studies reporting on the clinical outcomes of these two procedures that were published in the English language. Data extracted from each study included level of evidence, number of patients, surgical techniques, length of follow-up, clinical outcome measures including outcome scores, range of motion (ROM), return to sports, osseous union and complications. We analyzed each study to determine the primary outcome measurement.
RESULTS
A total of ten studies met our inclusion criteria. Among all studies, 35 arthroscopic procedures and 107 open procedures were performed. After the procedure, 70 patients (86.4%) in the open group returned to their sports, and 32 patients (91.4%) in the arthroscopic group returned to their sports. In the arthroscopic group, patients gained 14.1 degrees of flexion and 9.5 degrees of extension after surgery. In the open group, patients gained 8 degrees of flexion and 5.7 degrees of extension. Five patients (4.7%) had complications in the open group. No complication was found in the arthroscopic group.
CONCLUSIONS
Both open and arthroscopic lesion debridement with fragment fixation are successful in treating unstable OCD. The arthroscopic technique may be a better choice than the open procedure, but we need high-level evidence to determine the superiority of the open or arthroscopic techniques in treating elbow OCD.
LEVEL OF EVIDENCE
Level III.
Topics: Adolescent; Arthroscopy; Debridement; Elbow Joint; Female; Fracture Fixation, Internal; Humans; Humerus; Male; Osteochondritis Dissecans; Postoperative Complications; Range of Motion, Articular; Return to Sport; Treatment Outcome
PubMed: 29349503
DOI: 10.1007/s00264-018-3768-3 -
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 -
Knee Surgery, Sports Traumatology,... Apr 2024Osteochondritis dissecans (OCD) is a common cause of knee pain. Management for adult-onset OCD (AOCD) usually involves surgery. Surgical treatments include palliative,... (Review)
Review
PURPOSE
Osteochondritis dissecans (OCD) is a common cause of knee pain. Management for adult-onset OCD (AOCD) usually involves surgery. Surgical treatments include palliative, reparative and reconstructive techniques. The aim of this systematic review and meta-analysis is to evaluate the efficacy of reconstructive techniques for the treatment of OCD in skeletally mature knees.
METHODS
A systematic search was carried out on four databases up to November 2023 (Medline, Embase, Cochrane Library, Web of Science). The study was registered on international prospective register of systematic reviews and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Clinical studies on skeletally mature patients were included, which utilised reconstructive techniques such as autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation, osteochondral allograft transplantation surgery or bone marrow-derived cellular transplantation. Demographical data, patient-reported outcome measures and postoperative complications were recorded. Quantitative outcome measures that were comparable across studies were pooled for meta-analysis. A random effects model was used. Heterogeneity was assessed using the I statistic and Cochran's Q test. Statistical significance was set at p < 0.05. Risk of bias was assessed using the risk of bias in non-randomised studies - of interventions tool for nonrandomised studies.
RESULTS
Sixteen studies were included with 458 OCD lesions in 432 patients. The average age was 24.9, and 62.6% were male. The mean follow-up time was 61.5 months. At 36 months follow-up, International Knee Documentation Committee (IKDC) subjective, Tegner and EuroQol-visual analogue scale (EQ-VAS) scores improved from 42.4 to 78.6 (standard mean difference [SMD]: 2.47; p < 0.001), 2.27-4.99 (SMD: 2.363; p = 0.002) and 30.4-57.5 (SMD: 2.390; p < 0.001), respectively. Overall complication rate was 8.9%. Smaller OCD lesion sizes resulted in a greater improvement in IKDC subjective (SMD: 2.64 vs. 2.01; p = 0.038), EQ-VAS (SMD: 3.16 vs. 0.95; p = 0.046) and Tegner scores (SMD: 3.13 vs. 1.05; p = 0.007) and had a lower complication rate (p = 0.008). Males showed a larger improvement in IKDC subjective scores than females (SMD: 2.56 vs. 1.56; p = 0.029), while younger patients had a larger improvement in IKDC subjective scores (SMD: 2.71 vs. 2.12; p = 0.045) and fewer complications than older patients (p = 0.003). There were no significant differences between cohorts treated with ACI and those treated with non-ACI reconstructive techniques. Publication bias was not detected (n.s.).
CONCLUSION
Reconstructive techniques used to treat OCD in the skeletally mature knee resulted in significant improvements in clinical and functional outcomes, with a low overall complication rate. Since a younger age leads to a greater improvement in IKDC subjective score and a lower complication rate, surgical intervention should not be delayed, especially in AOCD lesions which are more likely to follow a progressive and unremitting clinical course.
LEVEL OF EVIDENCE
Level III.
PubMed: 38686565
DOI: 10.1002/ksa.12214 -
Arthroscopy : the Journal of... Apr 2024To assess return to sport (RTS) in the high-risk young athlete population with capitellar osteochondritis dissecans (OCD) undergoing arthroscopic microfracture (MFX)...
PURPOSE
To assess return to sport (RTS) in the high-risk young athlete population with capitellar osteochondritis dissecans (OCD) undergoing arthroscopic microfracture (MFX) with or without debridement as well as associated indications, clinical outcomes, radiographic outcomes, and complications.
METHODS
A literature search of all published literature in the English language from PubMed, EMBASE, Scopus, and Cochrane from database inception to April 4, 2022, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies presented demographics and outcomes for adolescent (<21 years old) patients diagnosed with capitellar OCD who underwent arthroscopic MFX (or drilling/subchondral drilling) or MFX (or drilling/subchondral drilling) with debridement (or loose body removal/chondroplasty). Studies containing multiple surgical techniques that did not distinguish characteristics and outcomes of individual patients by surgical technique were excluded. Additionally, if there was overlap in patient populations between 2 studies, the study with less outcome data was excluded. Extracted data included study properties, patient demographics, lesion characteristics, surgery details, and patient outcomes, including range of motion, outcome scores, and RTS rates. Bias was assessed via the Methodological Index for Non-Randomized Studies (MINORS).
RESULTS
Nine studies of 136 patients and 138 elbows met criteria. Included articles were published between 2005 and 2020 with MINORS scores of 8 to 14 (50% to 88%). The age ranged from 12.7 to 15.7 years with most patients being involved in baseball or gymnastics and a rate of dominant elbow involvement of 55% to 100%. Patient follow-up ranged from 16 to 138 months. All 9 studies reported RTS, ranging from 65% to 100%. Six of these studies categorized the level to which the patient returned, with patients RTS at the same level of competition ranging from 60% to 100%. Six studies reported complications, with a range rate of 0% to 43%; there were a total of 10 complications, 7 of which required reoperations.
CONCLUSIONS
Arthroscopic MFX with or without arthroscopic debridement is a safe and effective treatment for OCD lesions of the capitellum in young, athletic patients. Included studies reported improved clinical, radiographic, and patient-reported outcomes. Aside from 1 study reporting an RTS of 65%, the rate of RTS ranged from 86% to 100%. The percentage of patients returning to sport at the same level of competition ranged from 60% to 100% with a time to RTS ranging from 4.1 to 5 months. A single study reported a complication rate of 43%, while remaining studies reported complication rates between 0% and 19%, with loose bodies being the most common complication requiring reoperation. Follow-up ranged from 16 to 138 months.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
Topics: Adolescent; Child; Humans; Young Adult; Arthroscopy; Athletes; Elbow Joint; Fractures, Stress; Joint Loose Bodies; Osteochondritis Dissecans; Return to Sport; Sports; Treatment Outcome
PubMed: 37714441
DOI: 10.1016/j.arthro.2023.08.075 -
Orthopaedic Journal of Sports Medicine Jun 2016Capitellar osteochondritis dissecans (OCD) is commonly managed surgically in symptomatic adolesent throwers and gymnasts. Little is known about the impact that surgical...
BACKGROUND
Capitellar osteochondritis dissecans (OCD) is commonly managed surgically in symptomatic adolesent throwers and gymnasts. Little is known about the impact that surgical technique has on return to sport.
PURPOSE
To evaluate the clinical outcomes and return-to-sport rates after operative management of OCD lesions in adolescent athletes.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
The PubMed, CINAHL, EMBASE, SPORTDiscus (EBSCO), and Cochrane Central Register of Controlled Trials databases were queried for studies evaluating outcomes and return to sport after surgical management of OCD of the capitellum. Two independent reviewers conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting patient outcomes with return-to-sport data and minimum 6-month follow-up were included in the review.
RESULTS
After review, 24 studies reporting outcomes in 492 patients (mean age ± SD, 14.3 ± 0.9 years) were analyzed. The overall return-to-sport rate was 86% at a mean 5.6 months. Return to the highest preoperative level of sport was most common after osteochondral autograft procedures (94%) compared with debridement and marrow stimulation procedures (71%) or OCD fixation surgery (64%). Elbow range of motion improved by 15.9° after surgery. The Timmerman-Andrews subjective and objective scores significantly improved after surgery. Complications were low (<5%), with 2 cases of donor site morbidity after osteoarticular autograft transfer (OAT) autograft harvest. The most common indications for reoperation were repeat debridement/loose body removal.
CONCLUSION
A high rate of return to sport was observed after operative management of capitellar OCD. Patients were more likely to return to their highest level of preoperative sport after OAT autograft compared with debridement or fixation. Significant improvements in elbow range of motion and patient outcomes are seen with low complication rates after OCD surgery.
PubMed: 27482526
DOI: 10.1177/2325967116654651 -
Cartilage Jul 2019Osteochondritis dissecans (OCD) lesions are a relevant problem that affects the long-term prognosis of young patients. The purpose of this study was to analyze the...
OBJECTIVE
Osteochondritis dissecans (OCD) lesions are a relevant problem that affects the long-term prognosis of young patients. The purpose of this study was to analyze the evidence on potential and indications of nonsurgical treatment strategies for knee OCD.
DESIGN
The search was conducted on 3 medical electronic databases according to PRISMA guidelines, including reports of any level of evidence dealing with the conservative management of knee OCD. Of 1688 identified records, 55 full-text articles were screened: 27 studies met the inclusion criteria, for a total of 908 knees, and were used for the analysis.
RESULTS
No high-level studies were found: 24 articles were case series and 3 case reports, reporting on different treatments summarized in (1) restriction of physical activity, (2) physiokinesitherapy and muscle-strengthening exercises, (3) physical instrumental therapies, (4) limitation of weightbearing, and (5) immobilization. The analysis showed an overall healing rate of 61.4%, with large variability (10.4%-95.8%). A conservative treatment based on restriction of sport and strenuous activities seems a favorable approach, possibly combined with physiokinesitherapy. Negative prognostic factors were also identified: larger lesion size, more severe lesion stages, older age and skeletal maturity, discoid meniscus, and clinical presentation with swelling or locking.
CONCLUSIONS
The literature on conservative treatments for knee OCD is scarce. Among different non-surgical treatment options, strenuous activity restriction seems a favorable approach, whereas there is no evidence that physical instrumental therapy, immobilization, or weightbearing limitation could be beneficial. However, further studies are needed to improve treatment potential and indications for the conservative management of knee OCD.
Topics: Adolescent; Cartilage; Child; Child, Preschool; Conservative Treatment; Exercise; Female; Humans; Knee Joint; Male; Osteochondritis Dissecans; Outcome Assessment, Health Care; Physical Therapy Modalities; Prevalence; Prognosis; Resistance Training; Young Adult
PubMed: 29468901
DOI: 10.1177/1947603518758435