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Deutsches Arzteblatt International May 2020
Topics: Humans; Osteochondritis
PubMed: 32616147
DOI: 10.3238/arztebl.2020.0343 -
International Journal of Surgery... Dec 2015Extracorporeal shockwave therapy (ESWT) has gained acceptance in the medical field and in the treatment of non-unions and delayed bone healing. ESWT has been used... (Review)
Review
Extracorporeal shockwave therapy (ESWT) has gained acceptance in the medical field and in the treatment of non-unions and delayed bone healing. ESWT has been used effectively for many years as a noninvasive surgical procedure. The idea of treating Osteochondritis dissecans of knee and talus arose in the middle of the 1990's. OCD is known as a pre-arthritic factor in the long-term and still there is no consistent treatment. In the literature there is still only a small number of publications but international societies for shockwave treatment are convinced that ESWT on OCD shows to be an effective and safe method in the treatment of OCD in the early stages. We want to summarize the actual data on the treatment of OCD by ESWT.
Topics: Adult; High-Energy Shock Waves; Humans; Magnetic Resonance Imaging; Osteochondritis Dissecans
PubMed: 26455533
DOI: 10.1016/j.ijsu.2015.09.035 -
Journal of Orthopaedic Science :... Mar 2018Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. However, its etiology remains unknown.... (Review)
Review
Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. However, its etiology remains unknown. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. A plain anteroposterior radiograph with the elbow in 45° of flexion is essential for the diagnosis of an OCD lesion. The stability of OCD lesions is evaluated on plain radiographs, computed tomography, and magnetic resonance imaging (MRI). Imaging features of the unstable lesions are an epiphyseal closure of the capitellum or a lateral epicondyle, a displaced fragment, or irregular contours of the articular surface and a high signal interface on T2-weighted MRI. A stable lesion has the potential to be healed with conservative treatment. By contrast, surgical treatment should be considered if there is no radiographic improvement within 3 months. In addition, surgery should be performed for the lesions that cause pain during daily activities, have a locking phenomenon, or which are assessed by imaging as obviously unstable. Arthroscopic debridement/loose body removal can be performed for small lesions (≤12 mm in diameter). For large lesions (>12 mm), preservation and/or reconstruction of the articular surface should be selected, such as bone-peg fixation of the lateral part of the fragment and osteochondral autograft transplantation (OAT) from the knee. In the future directions, there is no comparative study of OAT from the knee and rib. In addition, little is known about its long-term outcome, or resulting osteoarthritis. A recent meta-analysis showed that grafts harvested from the knee may lead to donor site morbidity (7.8%). Thus, a novel cartilage tissue engineering approach is anticipated.
Topics: Adult; Arthralgia; Arthroscopy; Athletic Injuries; Conservative Treatment; Debridement; Elbow Joint; Female; Humans; Humeral Head; Magnetic Resonance Imaging; Male; Osteochondritis Dissecans; Prognosis; Recovery of Function; Risk Assessment; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 29276039
DOI: 10.1016/j.jos.2017.11.013 -
Clinical Orthopaedics and Related... Apr 2013
Topics: Child; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 23404419
DOI: 10.1007/s11999-013-2837-6 -
Cartilage Oct 2018This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an... (Review)
Review
This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an analysis of and outcomes of the treatments available. OCD is seen in children and adolescents with open growth plates (juvenile OCD) and adults with closed growth plates (adult OCD). The etiology of OCD lesions remains unclear and is characterized by an aseptic necrosis in the subchondral bone area. Mechanical factors seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important. Regarding treatment, a tremendous number of publications exist. Spontaneous healing is expected unless there is an unstable fragment, and treatment involves rest and different degrees of immobilization until healing. Patients with open physes and low-grade lesions have good results with conservative therapy. When surgery is necessary, the procedure depends on the stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable. When the cartilage is damaged, several techniques can be used. While techniques such as drilling and microfracturing produce reparative cartilage, other techniques reconstruct the defect with additional osteochondral grafts or cell-based procedures such as chondrocyte transplantation. There is a tendency toward better results when using procedures that reconstruct the bone and the cartilage and there is also a trend toward better long-term results when comorbidities are treated. Severe grades of osteoarthrosis are rare.
Topics: Adolescent; Adult; Arthroscopy; Cartilage, Articular; Child; Chondrocytes; Conservative Treatment; Female; Growth Plate; Humans; Knee Joint; Male; Osteochondritis Dissecans
PubMed: 28639852
DOI: 10.1177/1947603517715736 -
Orthopaedics & Traumatology, Surgery &... Dec 2011Treatment of knee cartilage defect, a true challenge, should not only reconstruct hyaline cartilage on a long-term basis, but also be able to prevent osteoarthritis.... (Review)
Review
Treatment of knee cartilage defect, a true challenge, should not only reconstruct hyaline cartilage on a long-term basis, but also be able to prevent osteoarthritis. Osteochondral knee lesions occur in either traumatic lesions or in osteochondritis dissecans (OCD). These lesions can involve all the articular surfaces of the knee in its three compartments. In principle, this review article covers symptomatic ICRS grade C or D lesions, depth III and IV, excluding management of superficial lesions, asymptomatic lesions that are often discovered unexpectedly, and kissing lesions, which arise prior to or during osteoarthritis. For clarity sake, the international classifications used are reviewed, for both functional assessment (ICRS and functional IKDC for osteochondral fractures, Hughston for osteochondritis) and morphological lesion evaluations (the ICRS macroscopic evaluation for fractures, the Bedouelle or SOFCOT for osteochondritis, and MOCART for MRI). The therapeutic armamentarium to treat these lesions is vast, but accessibility varies greatly depending on the country and the legislation in effect. Many comparative studies have been conducted, but they are rarely of high scientific quality; the center effect is nearly constant because patients are often referred to certain centers for an expert opinion. The indications defined herein use algorithms that take into account the size of the cartilage defect and the patient's functional needs for cases of fracture and the vitality, stability, and size of the fragment for cases of osteochondritis dissecans. Fractures measuring less than 2 cm(2) are treated with either microfracturing or mosaic osteochondral grafting, between 2 and 4 cm(2) with microfractures covered with a membrane or a culture of second- or third-generation chondrocytes, and beyond this size, giant lesions are subject to an exceptional allografting procedure, harvesting from the posterior condyle, or chondrocyte culture on a 3D matrix to restore volume. Cases of stable osteochondritis dissecans with closed articular cartilage can be simply monitored or treated with perforation in cases of questionable vitality. Cases of open joint cartilage are treated with a PLUS fixation if their vitality is preserved; if not, they are treated comparably to osteochondral fractures, with the type of filling depending on the defect size.
Topics: Arthroscopy; Cartilage, Articular; Chondrocytes; Humans; Knee Injuries; Knee Joint; Osteochondritis Dissecans; Transplantation, Autologous
PubMed: 22036244
DOI: 10.1016/j.otsr.2011.09.007 -
The Journal of Bone and Joint Surgery.... Jun 2012Magnetic resonance imaging (MRI) is a common clinical tool used to diagnose and monitor the progression and/or healing of osteochondritis dissecans of the knee. The... (Review)
Review
BACKGROUND
Magnetic resonance imaging (MRI) is a common clinical tool used to diagnose and monitor the progression and/or healing of osteochondritis dissecans of the knee. The purpose of this study was to systematically review the literature relative to the following questions: (1) Is MRI a valid, sensitive, specific, accurate, and reliable imaging modality to identify knee osteochondritis dissecans compared with arthroscopy? (2) Is MRI a sensitive tool that can be utilized to characterize lesion severity and stability of osteochondritis dissecans fragments in the knee?
METHODS
A systematic search was performed in December 2010 with use of PubMed MEDLINE (from 1966), CINAHL (from 1982), SPORTDiscus (from 1985), Scopus (from 1996), and EMBASE (from 1974) databases.
RESULTS
Seven studies, four Level-II and three Level-III investigations, met the specified inclusion criteria. No randomized controlled studies were identified. Because of inconsistencies between imaging techniques and methodological shortcomings of many of the studies, a meta-analysis was not performed.
CONCLUSIONS
The limited available evidence, methodological inconsistencies in imaging techniques, and lack of standardized grading criteria used in current studies prevent clear conclusions regarding the diagnostic and specific staging equivalency of MRI with arthroscopy. However, available evidence supports the use of MRI to detect the stability or instability of the lesion. Given the benefits of the use of MRI as a noninvasive tool to diagnose, predict lesion progression, and assess clinical outcomes of treatment, there is a pressing need for high-level, systematic, sound, and thorough studies related to the clinical utility of MRI for assessing osteochondritis dissecans of the knee.
Topics: Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Osteochondritis Dissecans; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index
PubMed: 22637210
DOI: 10.2106/JBJS.K.00275 -
American Family Physician Jul 2017
Review
Topics: Adolescent; Calcaneus; Child; Humans; Orthotic Devices; Osteochondritis; Pain Measurement; Shoes
PubMed: 28762709
DOI: No ID Found -
BMJ Case Reports Jun 2013
Topics: Adolescent; Female; Humans; Magnetic Resonance Imaging; Metatarsus; Osteochondritis
PubMed: 23780774
DOI: 10.1136/bcr-2013-010121 -
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