-
Proceedings of the Royal Society of... Jan 1935
PubMed: 19990117
DOI: No ID Found -
Canadian Medical Association Journal Sep 1939
PubMed: 20321457
DOI: No ID Found -
Acta Ortopedica Mexicana 2022Osteochondral lesions of the talus (OLTs) are defined as damage to the talar cartilage, with pathological changes in the underlying bone. They include a group of... (Review)
Review
Osteochondral lesions of the talus (OLTs) are defined as damage to the talar cartilage, with pathological changes in the underlying bone. They include a group of injuries that involve juvenile osteochondritis dissecans (JOCD) and osteochondral fractures of the talus. The etiology of OLT remains not fully clarified but is more common in young and active patients. Treatment strategies for OLTs in skeletally immature populations depend on the magnitude of symptoms, lesion morphology (stability and overlying cartilage integrity), size, nature of the lesion (traumatic versus JOCD), ankle stability, lower extremity alignment, and previous treatment. The aim of this review is to provide an overview of the current evidence for the diagnosis and treatment of OLTs in skeletally immature patients.
Topics: Humans; Talus; Lower Extremity; Treatment Outcome; Magnetic Resonance Imaging
PubMed: 37669651
DOI: No ID Found -
Life (Basel, Switzerland) Nov 2021Osteochondritis dissecans (OCD) is a chronic and painful joint condition that can occur from childhood through to adult life. Microtrauma, vascular insufficiency, or... (Review)
Review
Osteochondritis dissecans (OCD) is a chronic and painful joint condition that can occur from childhood through to adult life. Microtrauma, vascular insufficiency, or abnormal endochondral ossification are the most common causes of OCD. Reconstructive techniques for OCD of the knee are typically necessary when either non-operative or reparative/regenerative operative treatments fail, or when the OCD is irreversible. To analyze the clinical outcomes and failure rates of fresh osteochondral allograft transplantation (FOCA) used as a reconstructive strategy in OCD patients, an in-depth search was carried out on the PubMed, Scopus, and Web of Science databases concerning the existing evidence related to the use of FOCA for OCD patients in the knee joint. A total of 646 studies were found through the search and 2 studies were added after a cross-referenced examination of the articles within the bibliography. Six studies with a total of 303 OCD lesions treated with FOCA, with a mean follow-up of 6.3 years, were included. Although a limited number of low-level evidence studies on this topic are available in previous research, satisfactory clinical results and survival rates of the reconstruction are reported. However, to better define the real advantages of FOCA in the healing process of OCD lesions, comparative studies with different techniques are needed.
PubMed: 34833081
DOI: 10.3390/life11111205 -
Orphanet Journal of Rare Diseases Jun 2016The large chondroitin sulphated proteoglycan aggrecan (ACAN) is the most abundant non-collagenous protein in cartilage and is essential for its structure and function.... (Review)
Review
The large chondroitin sulphated proteoglycan aggrecan (ACAN) is the most abundant non-collagenous protein in cartilage and is essential for its structure and function. Mutations in ACAN result in a broad phenotypic spectrum of non-lethal skeletal dysplasias including spondyloepimetaphyseal dysplasia, spondyloepiphyseal dysplasia, familial osteochondritis dissecans and various undefined short stature syndromes associated with accelerated bone maturation. However, very little is currently known about the disease pathways that underlie these aggrecanopathies, although they are likely to be a combination of haploinsufficiency and dominant-negative (neomorphic) mechanisms. This review discusses the known human and animal aggrecanopathies in the context of clinical presentation and potential disease mechanisms.
Topics: Aggrecans; Bone Diseases, Developmental; Cartilage; Humans; Mutation; Osteochondrodysplasias; Pedigree
PubMed: 27353333
DOI: 10.1186/s13023-016-0459-2 -
Archives of Orthopaedic and Trauma... Jul 2023To report on the long-term prognosis of osteochondritis dissecans (OCD) patients regarding radiological and patient-reported outcomes and to analyze possible risk...
Increased lesion depth, higher body mass index and older age are risk factors for osteoarthritis during long-term follow-up in patients with osteochondritis dissecans of the knee.
INTRODUCTION
To report on the long-term prognosis of osteochondritis dissecans (OCD) patients regarding radiological and patient-reported outcomes and to analyze possible risk factors.
MATERIALS AND METHODS
All patients diagnosed with knee OCD between 2004 and 2014 with radiographic Kellgren-Lawrence (K-L) grades 0-2 at the time of diagnoses, ability to understand the language of the interview, and willingness to participate in the study were retrospectively reviewed. Current knee radiographs and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were prospectively collected between May 2020 and March 2021. The extent of osteoarthritis (OA) and KOOS questionnaire results were evaluated.
RESULTS
90 patients (103 knees) with a mean age of 21 years (range 6-60) were included. The mean follow-up time was 12 years (range 7-20). 24 knees (23%) were treated conservatively, and 79 knees (77%) operatively. At the time of diagnoses, 90% of the patients had K-L grades of 0-1; during the follow-up period, 45% of the patients showed radiological progression of OA. Patient body mass index (BMI) (p = 0.004; 95% CI 0.25-0.29), age (p = 0.003; 95% CI 0.18-0.30), operative treatment (p = 0.0075; 95% CI 0.41-0.65) and lesion depth (p = 0.0007) were statistically significantly connected to K-L grade change. Patients with no progression in joint space narrowing had statistically significantly better overall KOOS scores (p = 0.03; 95% CI 0.77-0.88) than patients whose K-L grades worsened.
CONCLUSIONS
During the long-term follow-up of 12 years, patients with knee OCD had good clinical results. Lac of radiological progression of cartilage degeneration was noted in 55% of the patients, regardless of treatment method. Lesion depth, higher BMI and older age were associated with the progression of OA. The progression of OA was related to a worsening of functional scores.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Adult; Aged; Child; Humans; Middle Aged; Young Adult; Body Mass Index; Follow-Up Studies; Knee Joint; Osteoarthritis; Osteoarthritis, Knee; Osteochondritis Dissecans; Retrospective Studies; Risk Factors
PubMed: 36169727
DOI: 10.1007/s00402-022-04638-4 -
Orthopaedic Journal of Sports Medicine Sep 2021The association between body mass index (BMI) and severity of osteochondritis dissecans (OCD) of the knee at presentation is poorly understood.
BACKGROUND
The association between body mass index (BMI) and severity of osteochondritis dissecans (OCD) of the knee at presentation is poorly understood.
HYPOTHESIS
We hypothesized that adolescents in higher BMI percentiles for age and sex would have OCD lesions that were more severe at their initial presentation and located more posteriorly on the condyle as compared with adolescents in lower BMI percentiles.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
This study included patients aged 10 to 18 years who were treated for knee OCD at a tertiary care hospital from 2006 to 2017. Patients with noncondylar OCD or missing BMI data within 3 months of presentation were excluded. Patients were stratified per the Centers for Disease Control and Prevention guidelines as underweight, normal weight, overweight, or obese, and the groups were compared according to age, side of lesion, 4 markers of lesion severity (cystic changes, loose fragments, subchondral fluid, and subchondral edema), and surgical treatment. Lesion angle was measured in reference to a line parallel to the femoral axis drawn through the center of a best-fit circle covering the distal condyle. Data were analyzed using chi-square tests, relative risk, Student tests, analysis of variance, and linear regression of cumulative running percentages. Bonferroni correction was performed when applicable.
RESULTS
A total of 77 patients met our inclusion criteria (mean age, 14.2 years; range, 10.1-18.8): 2 were underweight, 50 had normal BMI, 13 were overweight, and 12 were obese. We found correlations between BMI percentile and surgical treatment ( = .732), subchondral fluid ( = .716), subchondral edema ( = .63), loose fragments ( = .835), and the presence of at least 1 marker of lesion severity ( = .857) ( < .0001 for all). No correlation was observed for cystic changes ( = .026). There were significant associations between BMI ≥80th percentile and subchondral edema (risk ratio, 2.5; 95% CI, 1.3-4.8), medial condylar lesions (risk ratio, 1.3; 95% CI, 1.01-1.7), and lesions more anterior on the condyle ( < .05).
CONCLUSION
Higher BMI in adolescents was strongly correlated with multiple markers of severity of knee OCD at initial presentation as well as with more anterior lesions.
PubMed: 35146035
DOI: 10.1177/23259671211045382 -
Osteochondral Allograft for Unsalvageable Osteochondritis Dissecans in the Skeletally Immature Knee.Orthopaedic Journal of Sports Medicine Feb 2022While an excellent option for osteochondral defects in the adult knee, fresh osteochondral allograft (FOCA) in the skeletally immature adolescent knee has been...
BACKGROUND
While an excellent option for osteochondral defects in the adult knee, fresh osteochondral allograft (FOCA) in the skeletally immature adolescent knee has been infrequently studied.
PURPOSE
To compare radiographic and patient-reported outcomes (PROs) in skeletally mature and immature adolescents after FOCA in the knee for treatment of unsalvageable osteochondritis dissecans (OCD).
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Included were 34 patients (37 knees) who underwent size-matched FOCA of the knee for unsalvageable OCD lesions. All patients were aged ≤19 years and had a minimum of 12 months of follow-up. Patient characteristics, lesion characteristics, reoperations, and PROs were evaluated and compared between patients with open physes (skeletally immature; n = 20) and those with closed physes (skeletally mature; n = 17). Graft failure was defined as the need for revision osteochondral grafting. Postoperative radiographs were analyzed at 1 year and the final follow-up for graft incorporation and classified as A (complete), B (≥50% healed), or C (<50% healed).
RESULTS
The mean patient age was 15.4 years (range, 9.6-17.6 years), and the mean follow-up was 2.1 years (range, 1-5.3 years). The mean graft size was 5.0 cm and did not differ significantly between the study groups. Patients with open physes were younger (14.7 vs 16.2 years; = .002) and more commonly male (80% vs 35%; = .008). At the 1-year follow-up, 85% of immature patients and 82% of mature patients had radiographic healing grades of A or B. Patients with open physes were more likely to achieve complete radiographic union at 1 year (65% vs 15%; = .007) and demonstrated better Knee injury and Osteoarthritis Outcome Score (KOOS) Daily Living (96.8 vs 88.5; = .04) and KOOS Quality of Life (87.0 vs 56.8; = .01) at the final follow-up. Complications were no different in either group, and graft failure occurred in only 1 skeletally mature patient with a trochlear lesion.
CONCLUSION
FOCA treatment for unsalvageable OCD in the young knee may be expected to yield excellent early results. Despite the presence of open physes and immature epiphyseal osteochondral anatomy, equivalent or improved healing and PRO scores compared with those of skeletally mature patients may be expected.
PubMed: 35178463
DOI: 10.1177/23259671211072515 -
BMJ Case Reports Apr 2022We present a case report of a man in his 20s with osteochondritis dissecans of the talus, treated with autologous transplantation of a vascularised osteochondral flap....
We present a case report of a man in his 20s with osteochondritis dissecans of the talus, treated with autologous transplantation of a vascularised osteochondral flap. The patient with high level of activity presented to our orthopaedic outpatient department for progressive limping and pain, mainly related to sports. An osteochondritis dissecans grade IV of the medial talus was identified by MRI. A microvascular transfer of osteochondral tissue was performed successfully. At follow-up 1 year after surgery, the MRI examination revealed vital cartilage; the patient was free of pain and had returned to his previous level of activity.
Topics: Cartilage; Humans; Intra-Articular Fractures; Male; Osteochondritis; Osteochondritis Dissecans; Pain; Talus; Transplantation, Autologous
PubMed: 35393276
DOI: 10.1136/bcr-2021-248150 -
Proceedings of the Royal Society of... Dec 1974
Topics: Adolescent; Erythema; History of Medicine; Humans; Leg; Male; Osteochondritis; Posture; Vascular Diseases
PubMed: 4615322
DOI: No ID Found