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Journal of Clinical Medicine Dec 2022Juvenile Osteochondritis Dissecans (JOCD) is a common reason for knee pain among children. The aim of this case study was to report on clinical and radiographic outcomes...
Juvenile Osteochondritis Dissecans (JOCD) is a common reason for knee pain among children. The aim of this case study was to report on clinical and radiographic outcomes after fixation of an osteochondral fragment with bioabsorbable pins in children with open growth plates. We hypothesized that surgical treatment with this technique will result in good function, high rates of radiographic healing and high return to sport rates. A total of 13 knees in 12 patients (6 male, 6 female) with a median of 13 years (11, 17) were evaluated retrospectively at a minimum clinical follow-up of 24 months. Inclusion criteria were defined as open growth plates and an unstable osteochondral lesion grade III or IV. The clinical outcome was evaluated utilizing three standardized patient-reported outcome scores (Tegner Activity Scale [TAS], Knee Injury and Osteoarthritis Outcome Score [KOOS], Lysholm Score). All patients underwent magnetic resonance imaging 15 months (3, 34) after surgical treatment and defect healing was evaluated utilizing a modified version of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Due to the small sample size, the data was reported descriptively. The interobserver variability was calculated with the Spearman rank correlation coefficient. Comparisons were made with Wilcoxon sign rank test (or sign test). At final follow-up the median KOOS Score was 98% (79.2%, 100%) and the median Lysholm Score was 94 (69, 100) points. The Tegner Activity Scale was 7 (4, 10) points preoperatively and 7 (4,10) points postoperatively ( = 0.5). Complete bony ingrowth occurred in 9 knees (69%), complete cartilage defect repair in 10 knees (77%) and integration to the border zone was found in 11 knees (85%) 15 (3, 34) months following surgical treatment. Fixation of osteochondral fragments with bioabsorbable pins resulted in good functional and radiographic outcomes, a high return to sport- and a low complication rate among children with open growth plates.
PubMed: 36615076
DOI: 10.3390/jcm12010276 -
Journal of Children's Orthopaedics Oct 2023This study aims to determine the prevalence and characteristics of bilateral osteochondritis dissecans of the knee in patients presenting with unilateral symptoms and...
PURPOSE
This study aims to determine the prevalence and characteristics of bilateral osteochondritis dissecans of the knee in patients presenting with unilateral symptoms and compare this cohort to patients with unilateral disease.
METHODS
Records of patients ≤18 years old from 2003 to 2016 with a diagnosis of osteochondritis dissecans of the knee and strictly unilateral knee pain were identified. Contralateral (asymptomatic) knee imaging within 1 year of initial presentation was required. Lesion characteristics were evaluated by assessing size, location, and Hefti staging. Both surgical and nonoperative treatments were recorded. Patients with unilateral osteochondritis dissecans were compared to those with bilateral disease.
RESULTS
Eighty patients, 63 males (79%) and 17 females (21%), with an average age of 13.1 years old, were included. Twenty (25%) of the presenting/symptomatic lesions were deemed stable on magnetic resonance imaging. A positive correlation between lesion size and Hefti classification was appreciated. Twelve patients (15%) were found to have bilateral osteochondritis dissecans on contralateral imaging. There was no significant difference in skeletal maturity between patients with bilateral versus unilateral disease. Fifty-two patients (77%) with unilateral disease underwent surgical intervention, while 9 (75%) of those with bilateral disease underwent surgery on either knee. In patients with an asymptomatic contralateral lesion, 67% ultimately underwent surgical intervention on the contralateral knee.
CONCLUSIONS
In patients presenting with unilateral osteochondritis dissecans symptoms, there was a 15% prevalence of bilateral disease, with no difference in age, sex, physeal status, or lesion characteristics between patients with unilateral vs bilateral osteochondritis dissecans lesions. Given the prevalence of asymptomatic contralateral lesions and the required intervention, this study supports early bilateral radiologic knee evaluation.
LEVEL OF EVIDENCE
IV, Retrospective Case series.
PubMed: 37799315
DOI: 10.1177/18632521231193711 -
Orthopedic Reviews 2022Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. Knee MRI is...
Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. Knee MRI is indicated in young, active patients who have knee pain and/or effusion, to make an early diagnosis and decide about treatment, according essentially to the MRI stability signs. The choice of treatment should be also tailored, based on the patient's skeletal maturity, as well as the size and location of the lesion. Conservative treatment with restricting sports activities is the first line treatment and often sufficient to ensure healing in patients with open physes. Surgical treatment depends on the persistence of symptoms after 6 months of conservative treatment and/or based on the development of signs of instability of the lesion. Stable lesions with intact articular cartilage may be treated by drilling of the subchondral bone aiming to stimulate vascular ingrowth and subchondral bone healing. Every attempt should be made to retain the osteochondral fragment when possible. Instable lesions should be fixed or "replaced" with salvage procedures to prevent the onset of early osteoarthritis in this young population. Furthers studies are needed to improve the knowledge and optimizing non-operative and surgical treatment and to develop noninvasive diagnostic tools to predict with more accuracy the fragment's stability.
PubMed: 36540072
DOI: 10.52965/001c.38829 -
EFORT Open Reviews May 2019Juvenile osteochondritis dissecans (JOCD) is a joint disorder of the subchondral bone and articular cartilage that affects skeletally immature patients.The aetiology of... (Review)
Review
Juvenile osteochondritis dissecans (JOCD) is a joint disorder of the subchondral bone and articular cartilage that affects skeletally immature patients.The aetiology of JOCD is unknown and the natural history is poorly characterized in part due to inconsistent and largely retrospective literature.Most OCD in children and adolescents presents as a stable lesion amenable to non-operative treatment or minimally invasive drilling. However, unstable forms can require a more aggressive approach.This article reviews the most recent literature available and focuses on the pathophysiology, diagnosis and treatment of JOCD of the knee. Cite this article: 2019;4:201-212. DOI: 10.1302/2058-5241.4.180079.
PubMed: 31191988
DOI: 10.1302/2058-5241.4.180079 -
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 -
Indian Journal of Orthopaedics 2018Osteochondritis dissecans (OCD) is a disorder primarily affecting subchondral bone, with secondary effects on the overlying articular cartilage. Knee joint (75%) and... (Review)
Review
BACKGROUND
Osteochondritis dissecans (OCD) is a disorder primarily affecting subchondral bone, with secondary effects on the overlying articular cartilage. Knee joint (75%) and radiocapitellar joint (6%) are the most common sites for OCD lesions. The presence of an open growth plate differentiates juvenile osteochondritis dissecans from adult form of osteochondritis. Early diagnosis and treatment produce best long term results. The objective of this study is to determine the best mode of management of a Grade I osteochondritis lesion in a young athlete.
MATERIALS AND METHODS
A PubMed search was made using the keywords "OCD" and "athlete". Articles that were based on participants between the ages of 6-24 years (children, adolescent and young adult) and early stages of OCD were included in this study. A total of 25 articles were thus included for the review.
RESULTS
The healing potential is based on the age of the patient, status of physis, and stage of the lesion. Most authors have observed good to excellent results of drilling of early OCD in skeletally mature patients. Similarly, most authors also reported equally successful outcomes of nonoperative treatment for early OCD in skeletally immature patients.
CONCLUSIONS
We recommend initial nonoperative line of management in patients with open physis. In case of progression of the lesion or failure of conservative treatment a reparative, restorative or palliative surgical intervention can be done. For Stage I OCD lesions in patients with closed physis, we advocate reparative surgery either by means of retro- or trans-articular drilling.
PubMed: 30078890
DOI: 10.4103/ortho.IJOrtho_322_17 -
JSES International May 2024The etiology and pathogenesis of osteochondritis dissecans (OCDs) lesions remain controversial. (Review)
Review
BACKGROUND
The etiology and pathogenesis of osteochondritis dissecans (OCDs) lesions remain controversial.
METHODS
This review presents the recent evolution about the healing, imaging, pathogenesis, and how to treat OCD of the capitellum in overhead athletes.
RESULTS
Compressive and shear forces to the growing capitellum can cause subchondral separation, leading to OCD, composed of 3 layers: articular fragment, gap, and underlying bone. Subchondral separation can cause ossification arrest (stage IA), followed by cartilage degeneration (stage IB) or delayed ossification (stage IIA), occasionally leading to osteonecrosis (stage IIB) in the articular fragment. Articular cartilage fracture and gap reseparation make the articular fragment unstable. The mean tilting angle of capitellar OCD is 57.6 degrees in throwers. Anteroposterior radiography of the elbow at 45 degrees of flexion (APR45) can increase the diagnostic reliability, showing OCD healing stages, as follows: I) radiolucency, II) delayed ossification, and III) union. Coronal computed tomography and magnetic resonance imaging with an appropriate tilting angle can also increase the reliability. MRI is most useful to show the instability, although it occasionally underestimates. Sonography contributes to detection of early OCD in adolescent throwers on the field. OCD lesions in the central aspect of the capitellum can be more unstable and may not heal. Cast immobilization has a positive effect on healing for stable lesions. Arthroscopic removal provides early return to sports, although a large osteochondral defect is associated with a poor prognosis. Fragment fixation, osteochondral autograft transplantation, and their hybrid technique have provided better results.
DISCUSSION
Further studies are needed to prevent problematic complications of capitellar OCD, such as osteoarthritis and chondrolysis.
PubMed: 38707580
DOI: 10.1016/j.jseint.2023.09.010 -
The Knee Aug 2018This study describes the epidemiology and patient reported outcomes following juvenile osteochondritis dissecans (JOCD) of the knee.
BACKGROUND
This study describes the epidemiology and patient reported outcomes following juvenile osteochondritis dissecans (JOCD) of the knee.
METHODS
Medical records and radiographs of patients aged 10-18years diagnosed with JOCD between 2010 and 2016 were retrospectively reviewed. The lesions were classified according to the International Cartilage Repair Society's classification. The results were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and a Visual Analogue Scale (VAS) for pain.
RESULTS
Seventy patients with 87 JOCDs were identified. The annual incidence was 11.5 (95% confidence interval 10.7-12.2) per 100,000 inhabitants younger than 19years. Fifty-two (74.3%) of the 70 patients returned the questionnaires on average 48months (five to 117) after diagnosis. The median Lysholm score was 84 for patients with grade I-II lesions and 80 for patients with grade III-IV lesions. The median Lysholm score was 84.5 for patients who were treated conservatively and 79.5 for patients who were treated operatively. The median VAS score was 2.0 for all groups, except for patients treated conservatively (median score 1.5). Conservative treatment was successful in 78% of grade I-II lesions. There was a fivefold increased risk of failing conservative treatment with a stage III-IV lesion, compared to stage I-II (Odds ratio=5.5, p=0.02).
CONCLUSIONS
The results following JOCD are good to excellent for the majority of patients. Grade I-II lesions are successfully treated conservatively in 78% of cases. Grade III-IV lesions have a high failure rate.
LEVEL OF EVIDENCE
Level III, retrospective cohort.
Topics: Adolescent; Child; Cohort Studies; Conservative Treatment; Female; Humans; Knee Joint; Male; Orthopedic Procedures; Osteochondritis Dissecans; Pain Measurement; Patient Reported Outcome Measures; Retrospective Studies; Treatment Outcome
PubMed: 29793821
DOI: 10.1016/j.knee.2018.02.005 -
Journal of Orthopaedics Jun 2018To assess the longitudinal outcomes of osteochondritis dissecans (OCD) fixation and to detect the influencing factor for the results of OCD.
OBJECTIVE
To assess the longitudinal outcomes of osteochondritis dissecans (OCD) fixation and to detect the influencing factor for the results of OCD.
METHODS
22 OCD fixation using bioabsorbable pins were assessed Lysholm score, Tegner activity scale and KOOS at preoperative, postoperative short (3.0 years) and mid-long (11.9 years) term.
RESULTS
Postoperative Lysholm score was significantly better than the preoperative time. There was no factor influencing KOOS at mid-long term.
CONCLUSION
OCD fixation contributes good results for a long time regardless of skeletal maturity, the size and the severity of OCD.
PubMed: 29881188
DOI: 10.1016/j.jor.2018.01.002 -
Clinics in Sports Medicine Jan 1997Osteochondritis dissecans (OCD) is a pathologic process characterized by a partial or total separation of a fragment of bone with overlying articular cartilage. OCD may... (Review)
Review
Osteochondritis dissecans (OCD) is a pathologic process characterized by a partial or total separation of a fragment of bone with overlying articular cartilage. OCD may affect any joint, but the knee joint is affected most commonly. This article reviews several potential causes of OCD and classification systems for OCD. Diagnosis and treatment strategies are discussed.
Topics: Diagnostic Imaging; Femur; Humans; Osteochondritis Dissecans; Patella; Prognosis; Transplantation, Homologous
PubMed: 9012566
DOI: 10.1016/s0278-5919(05)70012-0