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Journal of Medical Case Reports Jan 2016The optimal treatment option for osteochondritis dissecans of the knee is still controversial. We report the case of a boy who developed osteochondritis dissecans in the...
BACKGROUND
The optimal treatment option for osteochondritis dissecans of the knee is still controversial. We report the case of a boy who developed osteochondritis dissecans in the lateral femoral condyles of his bilateral knees requiring repeat surgical procedures. There has been no literature reporting juvenile osteochondritis dissecans of bilateral knees requiring repeat surgical procedures.
CASE PRESENTATION
A 6-year-old Japanese boy presented with pain in his bilateral knees. Although conservative treatment with prohibition of sports activities was continued for 6 months, healing could not be attained. Conservative treatment consisting of prohibition of sports activities that included running and jumping and use of a brace with a locking mechanism at full extension was applied. He was instructed to walk with the brace. Since his lateral femoral osteochondritis dissecans lesion was located at the contact area during flexion, weight bearing with the use of the brace could effectively unload the lesion. Surgery was subsequently conducted on his left knee which had a more advanced stage lesion. Transchondral drilling was performed because the articular surface maintained its smooth continuity. At 9 months after the surgery, no appreciable healing was observed in the follow-up radiographs. Moreover, during the postoperative time course, lesions suggestive of osteochondritis dissecans in his contralateral right knee had become more evident. Based on the diagnosis of delayed union of bilateral osteochondritis dissecans lesions, a second surgery was attempted. The preceding arthroscopic observation of his left knee showed preserved surface continuity with softening and suspected partial detachment. Considering the delayed healing process observed in this patient, autogenous cylindrical osteochondral graft transplantation (8 mm in diameter) was performed as a revision procedure, while transchondral drilling was performed for the stable osteochondritis dissecans lesion in his right knee. Postoperatively, healing was achieved at 6 months.
CONCLUSIONS
Following failed conservative treatment, he underwent arthroscopic drilling; however, the osteochondritis dissecans lesion did not heal requiring revision surgery using a cylindrical autogenous osteochondral graft. Finally, clinical and radiological healing was attained 6 months after the second surgery. Initial presentation at a young age with bilateral lesions may be clinical factors related to poor healing response and susceptibility to stress-related subchondral lesions.
Topics: Autografts; Braces; Child; Femur; Humans; Knee Joint; Male; Osteochondritis Dissecans; Radiography; Reoperation; Return to Sport; Transplantation, Autologous; Treatment Outcome; Weight-Bearing; Wound Healing
PubMed: 26768479
DOI: 10.1186/s13256-015-0795-1 -
Clinical Calcium Jun 2010Osteochondral lesions in children mainly occur in the physeal and epiphyseal cartilage. Osteochondritis dissecans and osteochondrosis (apophysitis) are common and... (Review)
Review
Osteochondral lesions in children mainly occur in the physeal and epiphyseal cartilage. Osteochondritis dissecans and osteochondrosis (apophysitis) are common and clinically important chronic disorders. These etiology and pathogenesis have also been well investigated in the Veterinary medicine in recent years. One of the most likely causes is proposed as a failure of blood supply to growth cartilage and following focal disturbance of endochondral ossification. Mechanical stress, trauma, rapid growth, anatomic conformation, and dietary imbalances would modify this initial step and break down the normal structure. In human, above-mentioned pathological changes can be detected using recent MRI technology, which contribute quite much in the early diagnosis of lesions in clinic. Another problem in children is acute traumatic growth plate injury, which increases the risk of the early closure of growth plate and following deformity of bone and joint. Early diagnosis and precise treatment are extremely important for children to prevent residual deformity and pain and growth disturbance. In future, less-invasive as well as effective treatments for the focally disturbed or accelerated ossification should be developed.
Topics: Cartilage; Child; Growth Plate; Humans; Magnetic Resonance Imaging; Ossification, Heterotopic; Osteochondritis Dissecans; Osteochondrosis; Salter-Harris Fractures
PubMed: 20513942
DOI: No ID Found -
Clinics in Podiatric Medicine and... Jul 2020Osteochondral lesion of the talar dome (OCLT) can be a devastating injury that affects mobility. Etiology of these lesions is debated but trauma seems the most supported... (Review)
Review
Osteochondral lesion of the talar dome (OCLT) can be a devastating injury that affects mobility. Etiology of these lesions is debated but trauma seems the most supported etiology. Diagnosis of lesions is based on imaging. Conservative management, including weight-bearing restrictions, physical therapy, and supportive measures, often is first-line treatment. Nonsurgical modalities have mixed results and surgical measures often are necessitated for symptom relief. Surgical treatments vary in invasiveness and often are dictated by OCLT size. Studies show patient satisfaction increases substantially after having these procedures performed after failing nonsurgical measures. Results are encouraging, although thorough work-up and discussion should be undertaken.
Topics: Adolescent; Adult; Cartilage, Articular; Female; Humans; Osteochondritis; Range of Motion, Articular; Talus
PubMed: 32471617
DOI: 10.1016/j.cpm.2020.02.002 -
Tidsskrift For Den Norske Laegeforening... Feb 1976
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Male; Osteochondritis; Radiography; Talus
PubMed: 1257971
DOI: No ID Found -
The Journal of Bone and Joint Surgery.... May 1989We reviewed lesions of the femoral condyles seen in 5,000 knee arthroscopies, recording the findings and the age and sex of the patients. We were able to distinguish the...
We reviewed lesions of the femoral condyles seen in 5,000 knee arthroscopies, recording the findings and the age and sex of the patients. We were able to distinguish the characteristics of developing and late osteochondritis dissecans, acute and old osteochondral fractures, chondral separations, chondral flaps and idiopathic osteonecrosis, and suggest that these are separate distinct conditions. Haemarthrosis was associated only with acute osteochondral fractures. The characteristic feature of osteochondritis dissecans was an expanding concentric lesion at the 'classical' site on the medial femoral condyle which appeared during the second decade of life and progressed to a concave steep-sided defect in the mature skeleton. Caffey's (1958) classification of epiphyseal dysplasias could not be applied to osteochondritis dissecans, which appeared to have a gradual onset without acute trauma. Much of the controversy about the cause of osteochondritis dissecans is the result of imprecise nomenclature.
Topics: Adolescent; Adult; Aged; Arthroscopy; Cartilage Diseases; Cartilage, Articular; Child; Female; Femur; Fractures, Bone; Fractures, Cartilage; Humans; Male; Middle Aged; Osteochondritis; Osteochondritis Dissecans
PubMed: 2722949
DOI: 10.1302/0301-620X.71B3.2722949 -
Clinical Orthopaedics and Related... 1968
Topics: Adolescent; Child; Female; Femur Head; Humans; Male; Osteochondritis; Prognosis; Radiography; Traction
PubMed: 5669858
DOI: No ID Found -
Knee Surgery, Sports Traumatology,... Feb 2013Osteochondritis dissecans (OCD) is thought to be an acquired osteochondral disorder, and its aetiology may be multifactorial. Trauma, both acute and repetitive events,...
Osteochondritis dissecans (OCD) is thought to be an acquired osteochondral disorder, and its aetiology may be multifactorial. Trauma, both acute and repetitive events, has previously been proposed as a potential cause for OCD development. We present two cases of skeletally immature boys who developed a symptomatic OCD lesion following a femoral condyle bone contusion. These cases suggest that an acute traumatic event may lead to the development of OCD of the knee.
Topics: Adolescent; Child; Contusions; Femur; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Osteochondritis Dissecans
PubMed: 22481267
DOI: 10.1007/s00167-012-1983-9 -
Current Opinion in Pediatrics Feb 2007Osgood Schlatter syndrome presents in growing children (boys, 12-15 years; girls, 8-12 years) with local pain, swelling and tenderness over the tibial tuberosity.... (Review)
Review
PURPOSE OF REVIEW
Osgood Schlatter syndrome presents in growing children (boys, 12-15 years; girls, 8-12 years) with local pain, swelling and tenderness over the tibial tuberosity. Symptoms are exacerbated with sporting activities that involve jumping (basketball, volleyball, running) and/or on direct contact (e.g. kneeling). With increased participation of adolescent children in sports, we critically looked at the current literature to provide the best diagnostic and treatment guidelines.
RECENT FINDINGS
Osgood Schlatter syndrome is a traction apophysitis of the tibial tubercle due to repetitive strain on the secondary ossification center of the tibial tuberosity. Radiographic changes include irregularity of apophysis with separation from the tibial tuberosity in early stages and fragmentation in the later stages. About 90% of patients respond well to nonoperative treatment that includes rest, icing, activity modification and rehabilitation exercises. In rare cases surgical excision of the ossicle and/or free cartilaginous material may give good results in skeletally mature patients, who remain symptomatic despite conservative measures.
SUMMARY
Osgood Schlatter syndrome runs a self-limiting course, and usually complete recovery is expected with closure of the tibial growth plate. Overall prognosis for Osgood Schlatter syndrome is good, except for some discomfort in kneeling and activity restriction in a few cases.
Topics: Adolescent; Child; Female; Humans; Magnetic Resonance Imaging; Male; Osteochondritis; Syndrome; Tomography, X-Ray Computed
PubMed: 17224661
DOI: 10.1097/MOP.0b013e328013dbea -
The Veterinary Clinics of North... Jan 1998Osteochondrosis can occur in the stifle joint(s) of young, rapidly growing large breeds of dogs. Although not as common as osteochondrosis of the shoulder, elbow, and... (Review)
Review
Osteochondrosis can occur in the stifle joint(s) of young, rapidly growing large breeds of dogs. Although not as common as osteochondrosis of the shoulder, elbow, and hock joints, the osteochondral defect in the femoral condyle(s) and stifle joint fragment can cause a clinically apparent lameness. Radiography is beneficial in identifying the lesion(s), and surgical therapy is useful in restoring limb function.
Topics: Animals; Dog Diseases; Dogs; Femur; Femur Head; Osteochondritis; Radiography; Stifle
PubMed: 9463860
DOI: 10.1016/s0195-5616(98)50006-x -
Veterinary and Comparative Orthopaedics... May 2022The aim of this study was to describe the clinical application and outcome of osteochondral autograft transfer using the COR system (COR; DePuy Synthes, Warsaw,...
OBJECTIVES
The aim of this study was to describe the clinical application and outcome of osteochondral autograft transfer using the COR system (COR; DePuy Synthes, Warsaw, Indiana, United States) for the treatment of osteochondritis dissecans (OCD) of the femoral condyle in dogs.
METHODS
Medical records of dogs that were treated for OCD of the femoral condyle using the COR system between February 2013 and March 2020 were retrospectively reviewed. The results of pre- and postoperative clinical and radiographic examinations were evaluated.
RESULTS
Twenty stifles (18 dogs; 15 lateral and 5 medial femoral condyles) met the inclusion criteria. A single graft transfer was done in six stifle joints and mosaicplasty in 14 (2 grafts in 9/14 stifles; 3 grafts in 5/14 stifles). Proper anatomic reconstruction was confirmed intraoperatively and radiographically in all dogs. There were no major and three minor postoperative complications. At 3 months, 15 of 20 stifles (14 of 18 dogs) had no lameness or radiographic signs of inflammation. At 6 months, 12 of 13 dogs had no lameness or discomfort, and four of 13 stifles had radiographic evidence of moderate osteoarthritis.
CLINICAL SIGNIFICANCE
Treatment of OCD of the femoral condyle using the COR system is feasible in dogs, with low complications and provides a satisfactory short-term outcome.
Topics: Animals; Autografts; Dog Diseases; Dogs; Femur; Osteochondritis Dissecans; Retrospective Studies; Stifle
PubMed: 35272365
DOI: 10.1055/s-0042-1744181