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Cartilage Oct 2021This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed... (Review)
Review
This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed by an analysis of particular characteristics and outcomes of the treatment. OCD is seen in patients with open growth plates (juvenile OCD [JOCD] and in adults [AOCD] with closed growth plates [adult OCD). The etiology at smaller joints remains as unclear as for the knee. Mechanical factors (throwing activities [capitulum] seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important for the diagnosis. In low-grade and stable lesions, treatment involves rest and different degrees of immobilization until healing. When surgery is necessary, the procedure depends on the OCD stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable while with damaged cartilage, several techniques are used. Techniques such as drilling and microfracturing produce a reparative cartilage while other techniques reconstruct the defect with osteochondral grafts or cell-based procedures such as chondrocyte implantation. There is a tendency toward better results when reconstructive procedures for both the bone and cartilage are used. In addition, comorbidities at the joint have to be treated. Severe grades of osteoarthritis are rare.
Topics: Chondrocytes; Elbow; Elbow Joint; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 31113206
DOI: 10.1177/1947603519847735 -
Orthopaedic Journal of Sports Medicine Feb 2021Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic arthritides presenting in patients aged ≤16 years, with a prevalence of 16 to 150 per 100,000....
BACKGROUND
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic arthritides presenting in patients aged ≤16 years, with a prevalence of 16 to 150 per 100,000. Juvenile osteochondritis dissecans (OCD) is an idiopathic disease of articular cartilage and subchondral bone, has an onset age of 10 to 16 years, and often affects the knee, with a prevalence of 2 to 18 per 100,000. Currently, there are few studies that have evaluated the relationship between JIA and OCD.
HYPOTHESIS
OCD is more prevalent in children with JIA, and when diagnosed in such patients, OCD often presents at an advanced state.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
The medical records of patients with diagnoses of both JIA and OCD treated between January 2008 and March 2019 at a single children's hospital were retrospectively reviewed. Associations between timing of diagnoses, number and types of corticosteroid treatments, category of arthritis, timing of diagnoses, and lesion stability were examined with Spearman correlation coefficients.
RESULTS
A total of 2021 patients with JIA were identified, 20 of whom (19 female, 1 male) had OCD of the knee and/or talus for a prevalence of 1 in 100 or 1000 in 100,000, or approximately 50 to 500 times that of the general population. These 20 patients had a total of 28 OCD lesions: 43% (9 femur, 3 talus) were radiographically stable over time, 50% (10 femur, 2 patella, 2 talus) were unstable at initial diagnosis, and 7% (2 femur) were initially stable but progressed to unstable lesions despite drilling. Twelve patients (60%) underwent surgery: 4 (20%) with stable femoral lesions for persistent symptoms despite prolonged nonoperative treatment and 8 (40%) for treatment of their unstable lesions (femoral and patellar). Within our study design, we could identify no significant associations between lesion stability and timing of diagnoses, number of joint injections, or limb deformities, nor were there associations between timing of JIA and OCD diagnoses and category of arthritis.
CONCLUSION
In our population of patients with JIA, OCD lesions were found to be 50 to 500 times more prevalent when compared with published rates in the general population and often presented at an advanced state, with instability or delayed healing requiring surgery for stabilization or resolution of symptoms.
PubMed: 33718500
DOI: 10.1177/2325967120984139 -
JSES International May 2021Little is known about the optimal timing of early return to sports after which the osteochondritis dissecans (OCD) lesion can completely heal. The aims of this study...
BACKGROUND
Little is known about the optimal timing of early return to sports after which the osteochondritis dissecans (OCD) lesion can completely heal. The aims of this study were to investigate the clinical outcomes of nonoperative treatment and elucidate the relationship between the radiographic findings and the timing for the return to sports.
METHODS
We performed a retrospective review of 32 patients who presented with stable OCD of the capitellum and were treated nonoperatively for a minimum of 3 months. The mean follow-up period was 22.1 months. OCD lesions were assessed qualitatively and quantitatively on anteroposterior radiographs of the elbow at 45° of flexion every 3 months. The width of the OCD lesion (OCDw) and lateral width of the normal capitellum were measured and were associated with return to sports activities.
RESULTS
In 21 patients (66%), the progression of ossification was seen at a mean period of 4.1 months. Eighteen (56%) had partial union at a mean period of 4.3 months. Twenty-nine cases (91%) returned to sports activities after a mean of 4.6 months. Nine cases (28%) achieved complete union after a mean period of 15.0 months. Fifteen (47%) required surgery after a mean period of 11.8 months. The mean OCDw (%) was 10.2 ± 3.9 mm (56%) at the initial presentation and 8.0 ± 6.0 mm (41%) at the final follow-up examination, and the decrease in OCDw was 2.2 ± 3.1 mm (15%). The mean decrease in OCDw in patients with progression of ossification during the first 3 months was significantly larger than in patients without progression of ossification (4.9 ± 4.7 mm and -0.7 ± 4.5 mm, respectively; = .002). In patients who had both an OCDw value of <8.0 mm and a lateral width value of >2.0 mm at the time of the return to sports, the rate of successful nonoperative treatment (86%) and complete union (71%) was significantly higher in comparison with other patients ( = .03 and = .02).
CONCLUSIONS
OCD lesions showed difficult healing in the middle one-third of the capitellum. The progression of ossification during the first 3 months was a significant predictor of successful nonoperative treatment and complete union. Surgery should be considered for lesions without the progression of ossification during the first 3 months. We propose both an OCD lesion width of <8.0 mm and a lateral normal width of >2.0 mm as radiographic landmarks of the timing of the return to sports.
PubMed: 34136870
DOI: 10.1016/j.jseint.2021.01.004 -
Current Reviews in Musculoskeletal... Mar 2019To review the most recent literature on osteochondritis dissecans (OCD) lesions of the capitellum in overhead athletes and describe a treatment algorithm based on... (Review)
Review
PURPOSE OF THE REVIEW
To review the most recent literature on osteochondritis dissecans (OCD) lesions of the capitellum in overhead athletes and describe a treatment algorithm based on current best evidence and surgeon experience.
RECENT FINDINGS
Recent research has included larger cohort studies with longer follow-up as well as quality systematic reviews and meta-analyses. These studies have focused on understanding how lesion characteristics such as size, location, and appearance on advanced imaging can predict treatment success. Current literature continues to support nonoperative management for stable lesions. Operative intervention is generally required for unstable lesions and treatment strategies are largely dictated by lesion size and location: debridement or reparative techniques for small lesions while larger lesions or those in high-stress locations are better served by bone and/or cartilage restoration procedures. There has been a rising interest in the use of allograft materials and cell-based therapies. Overhead athletes are uniquely predisposed to capitellar OCD due to the nature of forces applied to the radiocapitellar joint during repeated activity in the overhead position. Despite improvements in operative techniques, successful use of alternative graft materials, and a better understanding of how lesion characteristics influence results, there is still much to learn about this challenging disorder. Future research should focus on comparing operative techniques, refining their indications, and further developing a reliable treatment algorithm that best serves the overhead athlete.
PubMed: 30645727
DOI: 10.1007/s12178-019-09528-8 -
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 -
Orthopaedic Journal of Sports Medicine Apr 2021Osteochondritis dissecans (OCD) of the humeral capitellum occurs in adolescent overhead athletes, and medial epicondyle (ME) lesions are also common in this population.
BACKGROUND
Osteochondritis dissecans (OCD) of the humeral capitellum occurs in adolescent overhead athletes, and medial epicondyle (ME) lesions are also common in this population.
PURPOSE
To evaluate the association between elbow OCD and ME lesions in adolescent baseball players.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
This study retrospectively evaluated adolescent baseball players with unstable elbow OCD who underwent surgery between January 2000 and February 2020. Patients were excluded if they had osteoarthritis of the elbow. A total of 139 elbows were included in this study (138 male and 1 female athlete; mean ± SD age, 13.6 ± 1.5 years). The patients were first divided into 2 groups based on OCD location: a central lesion group (72 elbows) and a lateral group (67 elbows). Next, patients were divided according to OCD size into a localized group (56 elbows) and a widespread group (83 elbows). Finally, OCD lesions that were both lateral and widespread were defined as lateral-widespread (60 elbows), resulting in 5 groups. ME apophyseal fragmentation and elongation were evaluated and defined as ME lesions. We then compared the relationship between OCD and ME lesions.
RESULTS
Of the 139 elbows, 63 (45.3%) had ME lesions. The prevalence of ME lesion was higher in the lateral group than the central group (56.7% vs 34.7%; = .009) and higher in the widespread group than the localized group (55.4% vs 30.4%; = .004). Furthermore, the prevalence ratio of ME lesion was significantly higher in the lateral-widespread group than for other lesions (58.3% vs 35.4%; = .007).
CONCLUSION
In patients undergoing surgery for capitellar OCD, the presence of ME lesions was more commonly associated with lateral and widespread capitellar lesions when compared with central and localized lesions.
PubMed: 33889650
DOI: 10.1177/23259671211007741 -
Cartilage Dec 2021The aim of this study was to compare the clinical outcome of cartilage repair with autologous chondrocyte implantation (ACI) in patients with osteochondritis dissecans...
OBJECTIVE
The aim of this study was to compare the clinical outcome of cartilage repair with autologous chondrocyte implantation (ACI) in patients with osteochondritis dissecans (OCD) lesions and full-thickness cartilage lesions.
DESIGN
This study included a cohort of 115 consecutive patients with a cartilage lesion of the knee treated with ACI. Of the patients, 35 had an OCD lesion and 80 a full-thickness cartilage lesion. During a follow-up period from 2 to 13 years all treatment failures were identified. The failure rate between OCD lesions and full-thickness cartilage lesions was compared with Kaplan-Meier analysis. Patient-reported outcome was evaluated 2 years postoperatively with the Lysholm score.
RESULTS
During the follow-up 21 out of 115 patients encountered a treatment failure. The failure rate for full-thickness cartilage lesions was 19.1% and for OCD lesions 43.3% over the 10-year follow-up. Patient-reported outcome improved from baseline to 2 years postoperatively. The improvement from baseline was statistically significant, and the Lysholm score improved more than the minimal clinically important difference. The patient-reported outcome showed no difference between lesion types at 2 years.
CONCLUSIONS
In the presented retrospective study, the failure rate of first-generation ACI was higher in OCD lesions than in large full-thickness cartilage lesions, suggesting that OCD lesions may associate with properties that affect the durability of repair tissue. Future prospective studies are needed to tell us how to best repair OCD lesions with biological tissue engineering.
Topics: Cartilage, Articular; Chondrocytes; Humans; Osteochondritis Dissecans; Retrospective Studies; Transplantation, Autologous
PubMed: 32602351
DOI: 10.1177/1947603520935953 -
Clinical Orthopaedics and Related... Apr 2013Although many etiological theories have been proposed for osteochondritis dissecans (OCD), its etiology remains unclear. Histological analysis of the articular cartilage... (Review)
Review
BACKGROUND
Although many etiological theories have been proposed for osteochondritis dissecans (OCD), its etiology remains unclear. Histological analysis of the articular cartilage and subchondral bone tissues of OCD lesions can provide useful information about the cellular changes and progression of OCD. Previous research is predominantly comprised of retrospective clinical studies from which limited conclusions can be drawn.
QUESTIONS/PURPOSES
The purposes of this study were threefold: (1) Is osteonecrosis a consistent finding in OCD biopsy specimens? (2) Is normal articular cartilage a consistent finding in OCD biopsy specimens? (3) Do histological studies propose an etiology for OCD based on the tissue findings?
METHODS
We searched the PubMed, Embase, and CINAHL databases for studies that conducted histological analyses of OCD lesions of the knee and identified 1560 articles. Of these, 11 met our inclusion criteria: a study of OCD lesions about the knee, published in the English language, and performed a histological analysis of subchondral bone and articular cartilage. These 11 studies were assessed for an etiology proposed in the study based on the study findings.
RESULTS
Seven of 11 studies reported subchondral bone necrosis. Four studies reported normal articular cartilage, two studies reported degenerated or irregular articular cartilage, and five studies found a combination of normal and degenerated or irregular articular cartilage. Five studies proposed trauma or repetitive stress and two studies proposed poor blood supply as possible etiologies.
CONCLUSIONS
We found limited research on histological analysis of OCD lesions of the knee. Future studies with consistent methodology are necessary to draw major conclusions about the histology and progression of OCD lesions. Inconsistent histologic findings have resulted in a lack of consensus regarding the presence of osteonecrosis, whether the necrosis is primary or secondary, the association of cartilage degeneration, and the etiology of OCD. Such studies could use a standardized grading system to allow better comparison of findings.
Topics: Biopsy; Cartilage, Articular; Child; Disease Progression; Humans; Knee Joint; Osteochondritis Dissecans
PubMed: 23054514
DOI: 10.1007/s11999-012-2619-6 -
Arthroscopy Techniques Aug 2021Osteochondritis dissecans of the knee is characterized by sterile necrosis of the subchondral bone and typically affects skeletally immature patients. When left...
Osteochondritis dissecans of the knee is characterized by sterile necrosis of the subchondral bone and typically affects skeletally immature patients. When left untreated, osteochondritis dissecans can lead to early-onset osteoarthritis, resulting in pain and disability. This study shows the pearls and pitfalls of an arthroscopic technique of fixation performed successfully using a bioabsorbable nail for unstable osteochondritis dissecans lesions located in the medial femoral condyle of the knee.
PubMed: 34401246
DOI: 10.1016/j.eats.2021.04.028 -
Orthopaedic Journal of Sports Medicine Mar 2016The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described.
BACKGROUND
The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described.
PURPOSE
To assess the frequency of pediatric OCD lesions that progress to surgery based on sex, joint involvement, and age.
STUDY DESIGN
Descriptive epidemiology study.
METHODS
A retrospective chart review (2007-2011) was performed on OCD. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years. Exclusion criteria included traumatic osteochondral fractures or coexistence of non-OCD intra-articular lesions. Differences in progression toward surgery were compared between age groups, sex, and joint location. Logistical regression analysis was performed by sex, age, and ethnicity.
RESULTS
Overall, 317 patients with a total of 334 OCD lesions were found. The majority of lesions (61.7%) were in the knee, with ankle, elbow, shoulder, and foot lesions representing 25.4%, 12.0%, 0.6%, and 0.3% of all lesions, respectively. The majority of joints needing surgery were in the knee (58.5%), with ankle and elbow lesions representing 22.9% and 18.6% of surgeries performed, respectively. The percentage of all OCD lesions progressing to surgery was 35.3%; surgical progression for knee, ankle, and elbow joints was 33.5%, 31.8%, and 55.0%, respectively. Logistic regression analysis found no statistically significant different risk of progressing to surgery for OCD of the knee, elbow, and ankle between sexes. Patients aged 12 to 19 years had a 7.4-times greater risk of progression to surgery for knee OCD lesions than 6- to 11-year-olds. Patients aged 12 to 19 years were 8.2 times more likely to progress to surgery for all OCD lesions than patients aged 6 to 11 years. Progression to surgery of ankle OCD did not significantly differ based on location. Three of 4 trochlear lesions progressed to surgery, along with 1 of 1 tibial, 1 of 3 patellar, 40.3% of lateral femoral condylar, and 28.2% of medial femoral condylar lesions.
CONCLUSION
In this large cohort study of pediatric OCD patients, 35% progressed to surgery. Progression to surgery did not differ significantly between sexes with OCD of any joint. Progression to surgery for OCD of the knee, elbow, and ankle strongly correlated with patient age at the time of diagnosis.
CLINICAL RELEVANCE
The knowledge of likelihood of progression to surgery of OCD by location, sex, and age is useful in counseling patients and in planning treatment. This study confirms a worse prognosis in the nonoperative treatment of older patients with OCD.
PubMed: 27047984
DOI: 10.1177/2325967116635515