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International Journal of Environmental... Apr 2023Increased pressure on the heel apophysis is often implicated as a cause of paediatric heel pain. However, there are few reports on the causes of the increased pressure...
Increased pressure on the heel apophysis is often implicated as a cause of paediatric heel pain. However, there are few reports on the causes of the increased pressure and its origin. Therefore, the aim of this study was to analyse the distribution of pressure on the feet in children with heel pain. The study included 33 paediatric patients with non-traumatic heel pain, i.e., 24 boys (73%) and 9 girls (27%), aged on average 11.2 years (±3 years). Pedobarographic diagnostics proved a decrease in the pressure on the heels in relation to the ground and the transfer of the projection of the centre of gravity to the forefoot. While standing, the average contribution of the pressure on the heel was 0.52, SD = 0.14 in children with normal and reduced weight. In overweight children, the average pressure on the heel was higher (0.60, SD = 0.08), but the small number of children with this characteristic ( = 4) did not allow conclusions to be drawn in this area. Heel underload was also demonstrated during gait. However, the assessment of this aspect requires additional observational analyses in the field of propulsion and gait phases. The reduced pressure on the heel promotes apophysis traction, causing intracanal compression. Studies have shown that the causes of apophysis traction may be postural defects (in particular, forward inclination of body posture) and overpronation of the foot, or defects in the metatarsal area.
Topics: Male; Female; Humans; Child; Aged; Heel; Calcaneus; Foot; Foot Diseases; Pain; Gait
PubMed: 37048018
DOI: 10.3390/ijerph20075403 -
Journal of Orthopaedics Mar 2023There is a paucity of data on patient reported outcome measures (PROMs) associated with surgical treatment of osteochondritis dissecans (OCD). As a result, preoperative...
INTRODUCTION
There is a paucity of data on patient reported outcome measures (PROMs) associated with surgical treatment of osteochondritis dissecans (OCD). As a result, preoperative patient and family counseling regarding expected outcomes is difficult. The purpose of this study was to compare pre-to post-operative changes in PROMs amongst cohorts of patients with OCD that underwent one of three lesion-specific surgical treatments: 1) transarticular drilling for stable lesions, 2) drilling and fixation for unstable lesions 3) grafting for unsalvageable lesions.
METHODS
The electronic medical records of pediatric and adolescent patients with knee OCD, at a single institution between January 2017 and August 2019, were reviewed. Patients were categorized into one of three surgical groups, with initial determination confirmed at the time of surgery during diagnostic knee arthroscopy. Differences between groups were assessed with one-way analysis of variance (ANOVA).
RESULTS
Of the 78 patients included in this study, 49 (62.8%) were male with a mean age of 13.5 ± 2.2 years. There was no significant difference between the surgical groups for baseline HSS Pedi-FABS (P = 0.58) or PROMIS Mobility (P = 0.47). There were no significant differences in PROMIS PI scores at baseline (P = 0.32), at latest follow-up (P = 0.72), or in interval change from baseline to follow-up (P = 0.42), between the three surgical groups.
CONCLUSION
Lesion-specific surgical management of OCD led to similar improvements in PROMIS PI at a minimum of one-year follow-up. These results may better allow surgeons to reassure patients and families that outcomes are similar when lesions are treated through a lesion-specific algorithm.
LEVEL OF EVIDENCE
Level IV: Retrospective cohort study.
PubMed: 36974089
DOI: 10.1016/j.jor.2023.02.001 -
Bone Reports Jun 2023Osteochondritis dissecans (OCD) is a disease of the joints characterized by idiopathic focal subchondral lesions. Aggrecan, a proteoglycan encoded by the gene, is...
From "" to "I CAN": Restoring wellness in a boy with severe osteochondritis dissecans through diagnostic precision combined with optimal medical, surgical and rehabilitation management.
Osteochondritis dissecans (OCD) is a disease of the joints characterized by idiopathic focal subchondral lesions. Aggrecan, a proteoglycan encoded by the gene, is important for cartilage structure and function. We describe the clinical evolution of a patient with short stature, multi-focal OCD, and subchondral osteopenia that appeared linked to a novel pathogenic variant. A multi-disciplinary approach including medical (bisphosphonate) therapy, surgical intervention and rehabilitation were successful in restoring wellness and physical function.
PubMed: 36950254
DOI: 10.1016/j.bonr.2023.101663 -
BMJ Case Reports Mar 2023This case report describes an early-adolescent boy with an osteochondritis dissecans (OCD) lesion of the left femoral head secondary to significant acetabular dysplasia...
This case report describes an early-adolescent boy with an osteochondritis dissecans (OCD) lesion of the left femoral head secondary to significant acetabular dysplasia and coxa valga of the proximal femur. Patient underwent left proximal femur varus osteotomy. Follow-up imaging demonstrates healing and resolution of the OCD lesion. Future plan for left hip is periacetabular osteotomy, following triradiate cartilage closure, to correct acetabular dysplasia. The aim of this case report is to support clinicians in the assessment and treatment of this rare condition.
Topics: Male; Adolescent; Humans; Child; Femur Head; Osteochondritis Dissecans; Femur; Hip Dislocation; Osteotomy; Acetabulum
PubMed: 36931689
DOI: 10.1136/bcr-2022-253375 -
Arthroscopy, Sports Medicine, and... Feb 2023To determine whether adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee...
Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee.
PURPOSE
To determine whether adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee in pediatric patients.
METHODS
This retrospective matched case-control study was performed at a single tertiary care pediatric hospital between January 2015 and September 2018. Patients who underwent antegrade drilling for stable femoral condyle OCD with greater than 2 years' follow-up were included. Preference was for all to receive postoperative bone stimulation; however, some were denied because of insurance coverage. This enabled us to create 2 matched groups of those who received postoperative bone stimulation and those who did not. Patients were matched on skeletal maturity, lesion location, sex, and age at surgery. The primary outcome measure was the rate of healing of the lesions determined by postoperative magnetic resonance imaging measurements at 3 months.
RESULTS
Fifty-five patients were identified who met the inclusion and exclusion criteria. Twenty patients from the bone stimulator group (BSTIM) were matched to 20 patients from the no bone stimulator group (NBSTIM). Mean age for BSTIM at surgery was 13.2 years ± 2.0 (range, 10.9-16.7) and for NBSTIM at surgery 12.9 years ± 2.0 (range, 9.3-17.3). At 2 years, 36 patients (90%) in both groups went on to clinical healing without further interventions. In BSTIM, there was a mean decrease of 0.9 (±1.8) mm in lesion on coronal width and 12 patients (63%) had overall improved healing; in NBSTIM there was a mean decrease of 0.8 (±3.6) mm in coronal width and 14 patients (78%) had improved healing. No statistical differences in the rate of healing were found between the 2 groups ( = .706).
CONCLUSION
In antegrade drilling of stable knee OCD lesions in pediatric and adolescent patients, adjuvant bone stimulator use did not appear to improve radiographic or clinical healing.
LEVEL OF EVIDENCE
Level III, retrospective case-control study.
PubMed: 36866308
DOI: 10.1016/j.asmr.2022.11.018 -
Case Reports in Orthopedics 2023There is widespread use of matrix-induced autologous chondrocyte implantation. Initial use of autologous bone grafting in combination with the matrix-induced autologous...
There is widespread use of matrix-induced autologous chondrocyte implantation. Initial use of autologous bone grafting in combination with the matrix-induced autologous chondrocyte implantation procedure has shown efficacy in small- to medium-sized osteochondral lesions. This case report demonstrates use of the "Sandwich" technique in a large, deep osteochondritis dissecans lesion of the medial femoral condyle. Technical considerations that are key to containment of the lesion and outcomes are reported.
PubMed: 36844705
DOI: 10.1155/2023/7612206 -
Capitellar osteochondritis dissecans in an elite pre-adolescent gymnast: a case report and overview.The Journal of the Canadian... Dec 2022Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in...
OBJECTIVE
Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in pediatric athletic trauma, particularly during the pre-puberty through adolescent years of rapid skeletal growth. This paper presents the diagnosis and management of osteochondritis dissecans in its third most common location, the elbow, a presentation of which chiropractors should be aware, including the importance of timely diagnosis and appropriate treatment.
CLINICAL FEATURES
A 9-year-old elite gymnast presented at a chiropractic clinic with elbow pain and restricted range of motion after a fall during training. Following multidisciplinary involvement, the diagnosis was eventually made as osteochondritis dissecans.
INTERVENTION AND OUTCOMES
The patient underwent successful arthroscopic surgery in order to remove the osteochondral fragment, followed by a specific regimen of rehabilitation exercises, which helped to enhance and accelerate optimal healing for her return to athletic activity.
SUMMARY
This case reminds the practicing chiropractor of the valuable role he/she can play in a multidisciplinary management of pediatric sports trauma, particularly in diagnosis and post-surgical care. A literature review presents a synopsis of the reported clinical presentations, diagnostic assessment and therapeutic options for capitellar osteochondritis dissecans.
PubMed: 36818357
DOI: No ID Found -
Journal of Equine Veterinary Science Apr 2023This case series describes an alternative surgical technique to obtain reattachment of osteochondritis dissecans (OCD) lesions in the lateral trochlear ridge of the...
This case series describes an alternative surgical technique to obtain reattachment of osteochondritis dissecans (OCD) lesions in the lateral trochlear ridge of the femur (LTRF) as well as the clinical and radiological outcome of treated cases. Four Standardbred yearlings (6 lesions in total) underwent surgical fixation of large OCD defects in the LTRF under arthroscopic guidance. Reattachment of the OCD lesions was obtained using 3.0/3.7 mm headless bio-compression and absorbable poly-l-lactic acid (PLLA) screws, inserted perpendicularly to the cartilage surface through the lesion. All horses were discharged from the hospital without complications. Clinical and radiological follow-up were collected and reviewed at 6 and 12 months post-operatively. Successful healing of the OCD lesions occurred in all cases based on radiographic evaluations, associated with a reduction of femoro-patellar effusion. All horses presented in this case series were able to enter regular training program as racehorses.
Topics: Animals; Horses; Osteochondritis Dissecans; Absorbable Implants; Femur; Bone Screws; Horse Diseases
PubMed: 36773855
DOI: 10.1016/j.jevs.2023.104242 -
Journal of Children's Orthopaedics Feb 2023Osteochondritis dissecans of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying... (Review)
Review
Osteochondritis dissecans of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The degree of lesion instability is best assessed by magnetic resonance imaging. Unstable lesions require operative management with fragment fixation. : V.
PubMed: 36755561
DOI: 10.1177/18632521221149054 -
Journal of Children's Orthopaedics Feb 2023Osteochondritis dissecans is an acquired condition of the joint that affects the articular surface and the subchondral bone. The juvenile form of osteochondritis... (Review)
Review
BACKGROUND
Osteochondritis dissecans is an acquired condition of the joint that affects the articular surface and the subchondral bone. The juvenile form of osteochondritis dissecans presents in those aged 5-16 years with open growth plates. The causes of osteochondritis dissecans are unknown.
METHODS
The goals of treatment are to promote healing of the subchondral bone and prevent chondral collapse, subsequent fracture, osteochondral defect formation, and early joint degeneration. Treatment modality is influenced on clinical symptoms, skeletal maturity, as well as the size, stability, and location of the lesion. This article will review the treatment strategies of juvenile form of osteochondritis dissecans of medial femoral condyle and of atypical regions, such as lateral femoral condyle, patellofemoral joint, and tibial plateau.
LEVEL OF EVIDENCE
level III.
PubMed: 36755556
DOI: 10.1177/18632521231152269