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The Journal of Bone and Joint Surgery.... Jun 2021Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to... (Review)
Review
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Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis.
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While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition.
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Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging.
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Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions.
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Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.
Topics: Arthroscopy; Humans; Osteochondritis Dissecans; Radiography
PubMed: 34109940
DOI: 10.2106/JBJS.20.01399 -
Matrix Biology : Journal of the... Oct 2018Hyaline cartilages, fibrocartilages and elastic cartilages play multiple roles in the human body including bearing loads in articular joints and intervertebral discs,... (Review)
Review
Hyaline cartilages, fibrocartilages and elastic cartilages play multiple roles in the human body including bearing loads in articular joints and intervertebral discs, providing joint lubrication, forming the external ears and nose, supporting the trachea, and forming the long bones during development and growth. The structure and organization of cartilage's extracellular matrix (ECM) are the primary determinants of normal function. Most diseases involving cartilage lead to dramatic changes in the ECM which can govern disease progression (e.g., in osteoarthritis), cause the main symptoms of the disease (e.g., dwarfism caused by genetically inherited mutations) or occur as collateral damage in pathological processes occurring in other nearby tissues (e.g., osteochondritis dissecans and inflammatory arthropathies). Challenges associated with cartilage diseases include poor understanding of the etiology and pathogenesis, delayed diagnoses due to the aneural nature of the tissue and drug delivery challenges due to the avascular nature of adult cartilages. This narrative review provides an overview of the clinical and pathological features as well as current treatment options available for various cartilage diseases. Late breaking advances are also described in the quest for development and delivery of effective disease modifying drugs for cartilage diseases including osteoarthritis, the most common form of arthritis that affects hundreds of millions of people worldwide.
Topics: Cartilage Diseases; Cartilage, Articular; Disease Progression; Extracellular Matrix; Humans; Mutation
PubMed: 29803938
DOI: 10.1016/j.matbio.2018.05.005 -
Journal of Orthopaedic Surgery and... Dec 2018The absence of a single, identifiable traumatic cause has been traditionally used as a definition for a causative factor of overuse injury. Excessive loading,... (Review)
Review
BACKGROUND
The absence of a single, identifiable traumatic cause has been traditionally used as a definition for a causative factor of overuse injury. Excessive loading, insufficient recovery, and underpreparedness can increase injury risk by exposing athletes to relatively large changes in load. The musculoskeletal system, if subjected to excessive stress, can suffer from various types of overuse injuries which may affect the bone, muscles, tendons, and ligaments.
METHODS
We performed a search (up to March 2018) in the PubMed and Scopus electronic databases to identify the available scientific articles about the pathophysiology and the incidence of overuse sport injuries. For the purposes of our review, we used several combinations of the following keywords: overuse, injury, tendon, tendinopathy, stress fracture, stress reaction, and juvenile osteochondritis dissecans.
RESULTS
Overuse tendinopathy induces in the tendon pain and swelling with associated decreased tolerance to exercise and various types of tendon degeneration. Poor training technique and a variety of risk factors may predispose athletes to stress reactions that may be interpreted as possible precursors of stress fractures. A frequent cause of pain in adolescents is juvenile osteochondritis dissecans (JOCD), which is characterized by delamination and localized necrosis of the subchondral bone, with or without the involvement of articular cartilage. The purpose of this compressive review is to give an overview of overuse injuries in sport by describing the theoretical foundations of these conditions that may predispose to the development of tendinopathy, stress fractures, stress reactions, and juvenile osteochondritis dissecans and the implication that these pathologies may have in their management.
CONCLUSIONS
Further research is required to improve our knowledge on tendon and bone healing, enabling specific treatment strategies to be developed for the management of overuse injuries.
Topics: Athletic Injuries; Cumulative Trauma Disorders; Humans; Inflammation Mediators; Osteoarthritis; Sports; Tendinopathy
PubMed: 30518382
DOI: 10.1186/s13018-018-1017-5 -
Orthopaedics & Traumatology, Surgery &... Feb 2018Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and... (Review)
Review
Osteochondritis dissecans (OCD) 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 diagnosis is usually made during adolescence. Mechanical factors play a major role in the pathophysiology of OCD. When the radiographic diagnosis is made early in a patient with open physes, healing can often be obtained simply by restricting sports activities. The degree of lesion instability can be assessed by magnetic resonance imaging. When the lesion remains unstable and the pain persists despite a period of rest, surgery is indicated. Arthroscopic exploration is always the first step. Drilling of the lesion produces excellent outcomes if the lesion is stable. Unstable lesions require fixation and, in some cases, bone grafting. Defects must be filled, depending on their surface area. Although many surgical techniques are available, the therapeutic indications are now standardized.
Topics: Arthralgia; Arthroscopy; Humans; Knee Joint; Magnetic Resonance Imaging; Osteoarthritis, Knee; Osteochondritis Dissecans; Radiography
PubMed: 29197636
DOI: 10.1016/j.otsr.2017.02.016 -
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 -
British Journal of Hospital Medicine... Apr 2023Osteochondritis dissecans is a condition characterised by acquired pathological subchondral bone lesions and its incidence is unknown. It has a multifactorial aetiology,...
Osteochondritis dissecans is a condition characterised by acquired pathological subchondral bone lesions and its incidence is unknown. It has a multifactorial aetiology, with a combination of genetic and acquired risk factors. It commonly presents in adolescents and young adults. Patients have variable presentations, including trauma, insidious onset and pain exacerbated by exercise. The joints primarily affected are the knee, ankle and elbow joint. Early identification is key to treatment and to prevent future osteoarthritis of the joint. This article gives an overview of the presentation, assessment and management of the juvenile form of osteochondritis dissecans.
Topics: Adolescent; Young Adult; Humans; Osteochondritis Dissecans; Knee Joint
PubMed: 37127418
DOI: 10.12968/hmed.2023.0044 -
Clinical Orthopaedics and Related... Apr 2013
Topics: Child; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 23404419
DOI: 10.1007/s11999-013-2837-6 -
Journal of Orthopaedics 2022Current treatments of different stages of knee osteochondritis Dissecans (OCD) are depending on the age of the patients and the stability of the diseased osteochondral...
PURPOSE AND OBJECTIVE
Current treatments of different stages of knee osteochondritis Dissecans (OCD) are depending on the age of the patients and the stability of the diseased osteochondral area. The purpose of this paper was to summarize the treatment alternatives in order to simplify the choice for the treating surgeon.
BACKGROUND AND PRINCIPLE RESULTS
Osteochondritis dissecans (OCD) of the knee is an idiopathic and local osteochondral abnormality that affects mainly children and adolescents with risk of loosening of osteochondral fragments. A good clinical result can be expected when the physes are still open, when the osteochondritis is small and when the osteochondritis can be assessed as stable by MRI. Unstable OCD lesions most often need to be treated operatively by different fixation methods and when the osteochondral cannot be refixated, different local chondral and osteochondral repairs are available to fill up the defect area to congruity.
SUMMARY AND MAJOR CONCLUSIONS
The final choice of which treatment to use is depending on fragment viability and forms. Viable fragments are refixated while poor quality fragments are removed followed by a local biological osteochondral repair. Such osteochondral resurfacing may be single bone marrow stimulation with or without scaffold augmentation or different cell seeded grafts.
PubMed: 36060730
DOI: 10.1016/j.jor.2022.08.005