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Cartilage Dec 2021This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause... (Review)
Review
This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.
Topics: Adolescent; Adult; Ankle Joint; Arthroscopy; Child; Humans; Intra-Articular Fractures; Magnetic Resonance Imaging; Osteochondritis Dissecans; Osteonecrosis; Talus; Tomography, X-Ray Computed
PubMed: 33423507
DOI: 10.1177/1947603520985182 -
Clinics in Podiatric Medicine and... Jan 2022OCDs of the ankle are the third most common lesion in the body and a physician should include this in the differential while evaluating the pediatric population with the... (Review)
Review
OCDs of the ankle are the third most common lesion in the body and a physician should include this in the differential while evaluating the pediatric population with the history of injury and/or pain in the ankle. Pain, stiffness, and swelling are the most common presenting complaints about the pediatric and adolescent patients with an OCD. Conservative treatment options should be attempted before attempting surgical intervention. Multiple surgical procedures exist to manage the lesion based on location, size, and other factors.
Topics: Adolescent; Ankle Joint; Child; Humans; Osteochondritis; Osteochondritis Dissecans; Talus
PubMed: 34809789
DOI: 10.1016/j.cpm.2021.09.005 -
The Journal of Medical Investigation :... 2020Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association... (Review)
Review
Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association of player position with capitellar OCD. Elbow pain and a longer playing history might be related to progression of capitellar OCD but do not in themselves increase the risk of development of the condition. The cause of capitellar OCD is likely to include a combination of repetitive microtrauma and internal factors, such as ischemia and genetic predisposition. A combination of radiography, computed tomography, magnetic resonance imaging, and ultrasonography have aided our understanding of the pathology of capitellar OCD. Screening using ultrasonography enables early detection and provides an opportunity for successful conservative treatment. Treatment has conventionally included both operative and nonoperative measures based on the stage and size of the lesion, skeletal maturity, subjective symptoms, and structural integrity of the cartilage. Early-stage lesions respond better to nonoperative treatment than those in more advanced stages. Operative indications include persistent symptoms despite nonoperative treatment, symptomatic loose bodies, and displacement or detachment of fragments. J. Med. Invest. 67 : 217-221, August, 2020.
Topics: Humans; Osteochondritis Dissecans
PubMed: 33148891
DOI: 10.2152/jmi.67.217 -
Clinics in Sports Medicine Jul 1991Osteochondritis dissecans is a rare orthopaedic disorder of unknown etiology. Advances in CT and MRI scanning have increased our knowledge of the disorder, but... (Review)
Review
Osteochondritis dissecans is a rare orthopaedic disorder of unknown etiology. Advances in CT and MRI scanning have increased our knowledge of the disorder, but arthroscopy remains the principle means of monitoring its progress. Arthroscopic surgery has displaced traditional arthrotomy in many instances and is useful in retrieval of loose bodies, drilling of osteochondral fragments, retrograde bone grafting, and abrasion arthroplasty. Arthrotomy continues to be the best method of pinning and bone grafting of detached lesions. Advances in transplant surgery now permit large craters to be patched with osteochondral allografts.
Topics: Arthroscopy; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 1868560
DOI: No ID Found -
Bulletin of the Hospital For Joint... Mar 2016Osteochondritis dissecans (OCD) of the capitellum is an articular cartilage lesion commonly affecting young adolescents. The exact mechanism for the development of these... (Review)
Review
Osteochondritis dissecans (OCD) of the capitellum is an articular cartilage lesion commonly affecting young adolescents. The exact mechanism for the development of these lesions is still uncertain; however, both traumatic and vascular etiologies have been described. Careful physical examination in conjunction with appropriate diagnostic studies helps the surgeon to classify these lesions as stable or unstable and leads to proper management. There is a diverse array of treatments available for OCD lesions of the capitellum, including fragment excision or fixation, bone marrow stimulation, and osteochondral autograft transplantation. This review helps the orthopaedic surgeon understand the diagnosis and management options available for OCD lesions of the capitellum.
Topics: Athletic Injuries; Cumulative Trauma Disorders; Diagnostic Imaging; Elbow Joint; Humans; Osteochondritis Dissecans; Risk Factors
PubMed: 26977547
DOI: No ID Found -
Clinics in Sports Medicine Apr 2014Osteochondritis dissecans of the talus is a subset of osteochondral lesions of the talus that also includes osteochondral fractures, avascular necrosis, and degenerative... (Review)
Review
Osteochondritis dissecans of the talus is a subset of osteochondral lesions of the talus that also includes osteochondral fractures, avascular necrosis, and degenerative arthritis. Osteochondral lesions of the talus can be associated with injury to the ankle. This article discusses the anatomy, pathoanatomy, history, physical examination, imaging, management algorithm, and outcomes of surgical treatment of osteochondral lesions in these patients. This article also presents the authors' recommended surgical technique.
Topics: Adult; Athletic Injuries; Autografts; Female; Fractures, Bone; Humans; Male; Osteochondritis Dissecans; Radiography; Talus
PubMed: 24698042
DOI: 10.1016/j.csm.2014.01.003 -
The Veterinary Clinics of North... Feb 1983
Review
Topics: Animal Nutritional Physiological Phenomena; Animals; Bone Diseases; Breeding; Diagnosis, Differential; Dog Diseases; Dogs; Female; Male; Osteochondritis; Prognosis
PubMed: 6346647
DOI: 10.1016/s0195-5616(83)50007-7 -
Clinics in Sports Medicine Jul 2017Although osteochondritis dissecans (OCD) has been a recognized condition for more than 100 years, our understanding of the etiology, natural history, and treatment... (Review)
Review
Although osteochondritis dissecans (OCD) has been a recognized condition for more than 100 years, our understanding of the etiology, natural history, and treatment remains poorly characterized. OCD most commonly affects the knee, followed by the elbow and ankle. Adolescents and young adults are most commonly affected. Patients present with vague, often intermittent symptoms and generally have no history of acute injury. Although diagnosis can be made with plain radiographs, treatment decisions are generally based on MRI. Skeletal maturity and stability of the OCD lesion determine treatment. Treatments range from immobilization and activity restriction to operative therapies. Clinical indications are discussed.
Topics: Ankle Joint; Arthroplasty; Elbow Joint; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 28577707
DOI: 10.1016/j.csm.2017.02.005 -
Instructional Course Lectures 1999Osteochondritis dissecans of the elbow remains one of the leading causes of permanent elbow disability in adolescents and young adults engaged in throwing sports or... (Review)
Review
Osteochondritis dissecans of the elbow remains one of the leading causes of permanent elbow disability in adolescents and young adults engaged in throwing sports or gymnastics. The insidious onset of lateral elbow pain and restriction of full extension should alert the physician and prompt further investigation. Early recognition and appropriate treatment may allow for the prevention of long-term sequelae. Conservative care following early detection provides the best opportunity for a complete recovery. Surgical management at this point consists primarily of excision or removal of the osteochondral fragment with drilling or burring of the base of the lesion. Prognosis is fair with approximately half of all patients experiencing chronic pain or limitation of motion in the elbow. Research efforts are currently focusing on the treatment of established articular surface defects. Newer procedures such as the transplantation of osteochondral, perichondral, and periosteal tissues, chondrocyte transplantation, and the biochemical manipulation of the chondrocyte environment may provide us with exciting new approaches to an old problem. Osteochondritis dissecans of the elbow continues to present a difficult challenge to the treating physician. The current literature provides very little guidance for the clinician but active and innovative investigations into the treatment of articular cartilage defects may soon provide the answers.
Topics: Adolescent; Adult; Arthroplasty; Athletic Injuries; Elbow Joint; Female; Humans; Male; Osteochondritis Dissecans; Treatment Outcome; Elbow Injuries
PubMed: 10098065
DOI: No ID Found -
Current Opinion in Pediatrics Feb 2013Osteochondritis dissecans (OCD) of the knee is a well-described condition that can cause significant morbidity in children and adolescents; timely diagnosis is key to... (Review)
Review
PURPOSE OF REVIEW
Osteochondritis dissecans (OCD) of the knee is a well-described condition that can cause significant morbidity in children and adolescents; timely diagnosis is key to preventing compromise to the articular cartilage and maximizing opportunity to perform a restorative procedure. Juvenile OCD has a better prognosis than does adult OCD, with higher rates of spontaneous healing with conservative treatment. Still, there are certain indications for surgical restoration procedures. Controversies arise over when to decide surgical procedure and what is the best surgical treatment option in this young population.
RECENT FINDINGS
Some authors believe nonoperative management should be the first-line treatment for stable OCD lesions in children. The only consensus in regard to this modality is that, if a patient is truly asymptomatic or experiencing low-level symptoms, then the duration of nonoperative treatment should be at least 3-6 months before opting for operative treatment. In the case of failed nonsurgical management or in the setting of an unstable fragment, surgical intervention should be implemented. Recent published data suggest no difference in clinical or radiographic outcome when comparing different surgical techniques.
SUMMARY
OCD of the knee requires a timely diagnosis to maximize opportunity to perform a reparative procedure. Indications for surgical treatment are based on lesion stability, skeletal maturity, and clinical symptoms. Reestablishing the joint surface, improving the blood supply of the fragment, rigid fixation, and early motion are primary goals for osteochondral fragment preservation. When the fragment is not suitable for preservation, careful consideration of defect location and the patient's clinical presentation will determine when cartilage restoration procedures should be utilized.
Topics: Adolescent; Child; Humans; Knee Joint; Osteochondritis Dissecans; Prognosis
PubMed: 23128839
DOI: 10.1097/MOP.0b013e32835adbf5