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Tsaknakis K, Afifi FK, Lorenz HM, Hell AK. [Non-traumatic osteochondral lesions of the knee joint during growth : Juvenile osteochondritis dissecans (JOCD) of the knee]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:651-658. [PMID: 39196304 DOI: 10.1007/s00132-024-04552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Juvenile osteochondritis dissecans of the knee joint is the most common osteochondral lesion during growth, usually occurring between the 10th and 14th year of age. PATHOGENESIS Repetitive microtraumata lead to a subchondral osseus lesion, which is commonly located at the medial aspect of the femoral condyle. Sport activities are considered to be the main cause, although genetic and hereditary factors as well as vitamin D3 deficiency also play a role. Current classification systems distinguish between stable and unstable osteochondral lesions, which is decisive for further treatment. TREATMENT Stable lesions may heal through conservative treatment by avoiding weight bearing and sport. Unstable lesions, on the other hand, can lead to a complete defect of the joint surface with the formation of a free joint body. In such cases, various surgical techniques aim at reconstructing the surface of the joint, in order to reduce the risk of secondary arthritis.
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Affiliation(s)
- Konstantinos Tsaknakis
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Faik K Afifi
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Heiko M Lorenz
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Anna K Hell
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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Tóth F, Buko EO, Armstrong AR, Johnson CP. Relationship between the extent of vascular injury and the evolution of surgically induced osteochondrosis lesions in a piglet model. PLoS One 2024; 19:e0308641. [PMID: 39116161 PMCID: PMC11309495 DOI: 10.1371/journal.pone.0308641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
Ostechondritis dissecans (OCD) is an orthopaedic disease characterized by formation of osteochondral defects in developing joints. Epiphyseal cartilage necrosis (osteochondrosis [OC]) caused by focal failure of vascular supply is the known precursor lesion of OCD, but it remains to be established how the severity of vascular failure drives lesion healing or progression. In the current study we have implemented a novel piglet model of induced osteochondrosis of the lateral trochlear ridge of the femur to determine the role that the extent of ischemia plays in the development and progression of OC/OCD lesions. Ten 4-week-old Yorkshire piglets underwent surgical interruption of the vascular supply to the entirety (n = 4 pigs) or the distal half (n = 6 pigs) of the lateral trochlear ridge of the femur. At 2, 6, and 12 weeks postoperatively, distal femora were evaluated by magnetic resonance imaging (MRI) to determine the fate of induced OC lesions. At 12 weeks, piglets were euthanized, and the surgical sites were examined histologically. After complete devascularization, lesion size increased between the 6- and 12-week MRI by an average of 24.8 mm2 (95% CI: [-2.2, 51.7]; p = 0.071). During the same period, lesion size decreased by an average of 7.6 mm2 (95% CI: [-24.5, 19.4]; p = 0.83) in piglets receiving partial devascularization. At 12 weeks, average ± SD lesion size was larger (p<0.001) in piglets undergoing complete (73.5 ± 17.6 mm2) vs. partial (16.5 ± 9.8 mm2) devascularization. Our study demonstrates how the degree of vascular interruption determines lesion size and likelihood of healing in a large animal model of trochlear OC.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Erick O. Buko
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Alexandra R. Armstrong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Casey P. Johnson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
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Lu V, Wong TM. Do reconstructive techniques for osteochondritis dissecans of the skeletally mature knee work? A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024; 32:1969-1991. [PMID: 38686565 DOI: 10.1002/ksa.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Osteochondritis dissecans (OCD) is a common cause of knee pain. Management for adult-onset OCD (AOCD) usually involves surgery. Surgical treatments include palliative, reparative and reconstructive techniques. The aim of this systematic review and meta-analysis is to evaluate the efficacy of reconstructive techniques for the treatment of OCD in skeletally mature knees. METHODS A systematic search was carried out on four databases up to November 2023 (Medline, Embase, Cochrane Library, Web of Science). The study was registered on international prospective register of systematic reviews and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Clinical studies on skeletally mature patients were included, which utilised reconstructive techniques such as autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation, osteochondral allograft transplantation surgery or bone marrow-derived cellular transplantation. Demographical data, patient-reported outcome measures and postoperative complications were recorded. Quantitative outcome measures that were comparable across studies were pooled for meta-analysis. A random effects model was used. Heterogeneity was assessed using the I2 statistic and Cochran's Q test. Statistical significance was set at p < 0.05. Risk of bias was assessed using the risk of bias in non-randomised studies - of interventions tool for nonrandomised studies. RESULTS Sixteen studies were included with 458 OCD lesions in 432 patients. The average age was 24.9, and 62.6% were male. The mean follow-up time was 61.5 months. At 36 months follow-up, International Knee Documentation Committee (IKDC) subjective, Tegner and EuroQol-visual analogue scale (EQ-VAS) scores improved from 42.4 to 78.6 (standard mean difference [SMD]: 2.47; p < 0.001), 2.27-4.99 (SMD: 2.363; p = 0.002) and 30.4-57.5 (SMD: 2.390; p < 0.001), respectively. Overall complication rate was 8.9%. Smaller OCD lesion sizes resulted in a greater improvement in IKDC subjective (SMD: 2.64 vs. 2.01; p = 0.038), EQ-VAS (SMD: 3.16 vs. 0.95; p = 0.046) and Tegner scores (SMD: 3.13 vs. 1.05; p = 0.007) and had a lower complication rate (p = 0.008). Males showed a larger improvement in IKDC subjective scores than females (SMD: 2.56 vs. 1.56; p = 0.029), while younger patients had a larger improvement in IKDC subjective scores (SMD: 2.71 vs. 2.12; p = 0.045) and fewer complications than older patients (p = 0.003). There were no significant differences between cohorts treated with ACI and those treated with non-ACI reconstructive techniques. Publication bias was not detected (n.s.). CONCLUSION Reconstructive techniques used to treat OCD in the skeletally mature knee resulted in significant improvements in clinical and functional outcomes, with a low overall complication rate. Since a younger age leads to a greater improvement in IKDC subjective score and a lower complication rate, surgical intervention should not be delayed, especially in AOCD lesions which are more likely to follow a progressive and unremitting clinical course. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Victor Lu
- Department of Trauma and Orthopaedics, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Tak Man Wong
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong
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Cheng JH, Jhan SW, Chen PC, Hsu SL, Wang CJ, Moya D, Wu YN, Huang CY, Chou WY, Wu KT. Enhancement of hyaline cartilage and subchondral bone regeneration in a rat osteochondral defect model through focused extracorporeal shockwave therapy. Bone Joint Res 2024; 13:342-352. [PMID: 38977271 PMCID: PMC11311209 DOI: 10.1302/2046-3758.137.bjr-2023-0264.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Aims To explore the efficacy of extracorporeal shockwave therapy (ESWT) in the treatment of osteochondral defect (OCD), and its effects on the levels of transforming growth factor (TGF)-β, bone morphogenetic protein (BMP)-2, -3, -4, -5, and -7 in terms of cartilage and bone regeneration. Methods The OCD lesion was created on the trochlear groove of left articular cartilage of femur per rat (40 rats in total). The experimental groups were Sham, OCD, and ESWT (0.25 mJ/mm2, 800 impulses, 4 Hz). The animals were euthanized at 2, 4, 8, and 12 weeks post-treatment, and histopathological analysis, micro-CT scanning, and immunohistochemical staining were performed for the specimens. Results In the histopathological analysis, the macro-morphological grading scale showed a significant increase, while the histological score and cartilage repair scale of ESWT exhibited a significant decrease compared to OCD at the 8- and 12-week timepoints. At the 12-week follow-up, ESWT exhibited a significant improvement in the volume of damaged bone compared to OCD. Furthermore, immunohistochemistry analysis revealed a significant decrease in type I collagen and a significant increase in type II collagen within the newly formed hyaline cartilage following ESWT, compared to OCD. Finally, SRY-box transcription factor 9 (SOX9), aggrecan, and TGF-β, BMP-2, -3, -4, -5, and -7 were significantly higher in ESWT than in OCD at 12 weeks. Conclusion ESWT promoted the effect of TGF-β/BMPs, thereby modulating the production of extracellular matrix proteins and transcription factor involved in the regeneration of articular cartilage and subchondral bone in an OCD rat model.
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Affiliation(s)
- Jai-Hong Cheng
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung, Taiwan
| | - Shun-Wun Jhan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Shan-Ling Hsu
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Jen Wang
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Daniel Moya
- Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Yi-No Wu
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chien-Yiu Huang
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Yi Chou
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Ting Wu
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Nammour MA, Mauro CS, Bradley JP, Arner JW. Osteochondritis Dissecans Lesions of the Knee: Evidence-Based Treatment. J Am Acad Orthop Surg 2024; 32:587-596. [PMID: 38295387 DOI: 10.5435/jaaos-d-23-00494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024] Open
Abstract
Osteochondritis dissecans (OCD) of the knee is a potentially disabling condition in adolescent and young adults, which is likely multifactorial in origin. In recent years, there have been notable improvements in identification and treatment. Clinical presentation varies based mostly on OCD lesion stability. Patients with stable lesions generally present with vague knee pain and altered gait while mechanical symptoms and effusion are more common with unstable lesions. Lesions most commonly occur on the lateral aspect of the medial femoral condyle in patients aged 10 to 20 years. Magnetic resonance imaging is vital to diagnose and predict clinical treatment, which is largely based on stability of the fragment. Conservative treatment of stable lesions in patients with open physis is recommended with protected weight-bearing and gradual progression of activities over the course of 3 to 6 months. Stable OCD lesions which failed a nonsurgical course can be treated with transarticular or retrograde drilling while unstable lesions usually require fixation, autologous chondrocyte implantation (ACI), osteochondral autograft transfer (OATS), or osteochondral allograft transplantation. This review highlights the most current understanding of knee OCD lesions and treatment options with the goal of optimizing outcomes in this difficult pathology.
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Affiliation(s)
- Michael A Nammour
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center- Shreveport, Shreveport, LA (Nammour), Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (Mauro, Bradley and Arner)
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Klueh MP, Ren BO, Muscatelli SR, Grant JA. Association of Mechanical Axis With Osteochondritis Dissecans of the Femoral Condyle. Am J Sports Med 2024; 52:2270-2277. [PMID: 39047221 DOI: 10.1177/03635465241255331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) is a condition characterized by abnormal subchondral bone with disturbance of overlying articular cartilage. The role of weightbearing alignment in the pathophysiology of OCD lesion development is not fully understood. HYPOTHESIS Lower extremity mechanical axis would be concordant with femoral condylar OCD lesion location. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Cases were identified from a single, large academic institutional database using International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Terminology codes associated with OCD. Patients were included if they had a magnetic resonance imaging scan demonstrating the OCD lesion and lower extremity alignment radiographs. OCD lesion location was identified using Cahill and Berg zones. The primary outcome was the association of OCD lesion location with weightbearing mechanical axis. Secondary outcomes included the association of mechanical axis with skeletal maturity, OCD lesion stability, and treatment. For unilateral OCD lesions, mechanical axis was compared between affected and unaffected lower extremities. RESULTS A total of 86 patients (95 knees) with an OCD lesion of the femoral condyle were identified. The population was 74% male, and the mean age was 21 years. In total, 65% of knees had closed physes, 82% of lesions were unstable, and 85% underwent a surgical procedure. Mechanical axis was located in the same zone as the OCD lesion in 48% of cases and within the same compartment in 56% of cases. Spearman correlation coefficient demonstrated a moderate positive correlation (rs = 0.59). No significant differences were found in the association of mechanical axis and OCD lesion location in subgroup analysis of medial versus lateral femoral condylar OCD lesions, skeletal maturity, stability of the lesion, or treatment group. For patients with varus alignment and medial femoral condylar OCD lesions, the mean lateral distal femoral angle was 89.9°, and medial proximal tibial angle was 85.4°; for valgus alignment and lateral femoral condylar lesions, the lateral distal femoral angle was 84.8°, and medial proximal tibial angle was 88.8°. Patients with unilateral medial femoral condylar OCD lesions were more likely to have varus alignment of the affected extremity compared with the contralateral extremity (59% vs 36%; P = .01). CONCLUSION This study demonstrated a relationship between lower extremity mechanical weightbearing axis and femoral condylar OCD location. Patients with unilateral medial femoral condylar OCD lesions frequently had asymmetric varus alignment in the affected extremity.
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Affiliation(s)
- Michael P Klueh
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Bryan O Ren
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Stefano R Muscatelli
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - John A Grant
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Akkawi I, Zmerly H, Draghetti M, Felli L. Juvenile Osteochondritis Dissecans: Current Concepts. Cureus 2024; 16:e65496. [PMID: 39188433 PMCID: PMC11346800 DOI: 10.7759/cureus.65496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Osteochondritis dissecans (OCD) primarily damages the subchondral bone, leading to damage to the articular cartilage. Juvenile OCD (JOCD) of the knee is limited to skeletally immature and young patients with open growth plates on radiographs. We conducted a review of PubMed articles up until March 16, 2024, using a combination of the following keywords: knee, juvenile, and osteochondritis dissecans. This narrative review included a total of 56 relevant articles that investigated the etiology, incidence, clinical presentation, imaging, classification, and treatment of JOCD of the knee in patients less than 20 years of age. The exact etiology is controversial. Most authors believe that the disease involves multiple theories, such as ischemia, recurrent trauma, and genetic predisposition. Radiographs, the first imaging study in this patient group, cannot determine the stability or instability of the surface cartilage of the OCD lesion. As a result, MRI has become a recommended diagnostic method for determining OCD stability and providing important information for determining a treatment plan. For stable JOCD lesions, nonsurgical treatment is often advised. For unstable and stable lesions that do not respond to nonsurgical treatment, several surgical techniques with good healing rates are available.
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Sangiorgio A, Andriolo L, Gersoff W, Kon E, Nakamura N, Nehrer S, Vannini F, Filardo G. Subchondral bone: An emerging target for the treatment of articular surface lesions of the knee. J Exp Orthop 2024; 11:e12098. [PMID: 39040436 PMCID: PMC11260998 DOI: 10.1002/jeo2.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Purpose When dealing with the health status of the knee articular surface, the entire osteochondral unit has gained increasing attention, and in particular the subchondral bone, which plays a key role in the integrity of the osteochondral unit. The aim of this article was to discuss the current evidence on the role of the subchondral bone. Methods Experts from different geographical regions were involved in performing a review on highly discussed topics about the subchondral bone, ranging from its etiopathogenetic role in joint degeneration processes to its prognostic role in chondral and osteochondral defects, up to treatment strategies to address both the subchondral bone and the articular surface. Discussion Subchondral bone has a central role both from an aetiologic point of view and as a diagnostic tool, and its status was found to be relevant also as a prognostic factor in the follow-up of chondral treatment. Finally, the recognition of its importance in the natural history of these lesions led to consider subchondral bone as a treatment target, with the development of osteochondral scaffolds and procedures to specifically address osteochondral lesions. Conclusion Subchondral bone plays a central role in articular surface lesions from different points of view. Several aspects still need to be understood, but a growing interest in subchondral bone is to be expected in the upcoming future towards the optimization of joint preservation strategies. Level of Evidence Level V, expert opinion.
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Affiliation(s)
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Wayne Gersoff
- Orthopedic Centers of Colorado Joint Preservation Institute, Clinical InstructorUniversity of Colorado Health Sciences CenterAuroraColoradoUSA
| | - Elizaveta Kon
- IRCCS Humanitas Research HospitalRozzanoItaly
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly
- Department of Traumatology, Orthopaedics and Disaster SurgerySechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Norimasa Nakamura
- Institute for Medical Science in SportsOsaka Health Science UniversityOsakaJapan
- Center for Advanced Medical Engineering and InformaticsOsaka UniversitySuitaJapan
| | - Stefan Nehrer
- Faculty Health & MedicineUniversity for Continuing EducationKremsAustria
- Department of Orthopaedics and TraumatologyUniversity Hospital Krems, Karl Landsteiner University of Health SciencesKremsAustria
| | - Francesca Vannini
- Clinica Ortopedica e Traumatologica1 IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of SurgeryEOCLuganoSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera ItalianaLuganoSwitzerland
- Applied and Translational Research (ATR) CenterIRCCS Istituto Ortopedico RizzoliBolognaItaly
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Konarski W, Poboży T, Konarska K, Derczyński M, Kotela I. Understanding Osteochondritis Dissecans: A Narrative Review of the Disease Commonly Affecting Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:498. [PMID: 38671714 PMCID: PMC11049496 DOI: 10.3390/children11040498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) is a joint disorder predominantly affecting the knee, elbow, and ankle of children and adolescents. This comprehensive review delves into the epidemiology, etiology, clinical manifestations, diagnostic approaches, and treatment of OCD. RESULTS The most common cause of OCD is repetitive microtrauma, typically associated with sports activities, alongside other significant factors such as genetic predisposition, ischemia, and obesity. In early stages or when lesions are small, OCD often presents as non-specific, vaguely localized pain during physical activity. As the condition progresses, patients may experience an escalation in symptoms, including increased stiffness and occasional swelling, either during or following activity. These symptom patterns are crucial for early recognition and timely intervention. Diagnosis in most cases is based on radiographic imaging and magnetic resonance imaging. Nonsurgical treatment of OCD in young patients with open growth plates and mild symptoms involves activity restriction, immobilization methods, and muscle strengthening exercises, with a return to sports only after symptoms are fully resolved and at least six months have passed. Surgical treatment of OCD includes subchondral drilling in mild cases. Unstable lesions involve methods like restoring the joint surface, stabilizing fractures, and enhancing blood flow, using techniques such as screws, anchors, and pins, along with the removal of fibrous tissue and creation of vascular channels. The specifics of OCD treatment largely depend on the affected site. CONCLUSIONS This synthesis of current research and clinical practices provides a nuanced understanding of OCD, guiding future research directions and enhancing therapeutic strategies.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland; (T.P.); (M.D.)
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland; (T.P.); (M.D.)
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland;
| | - Michał Derczyński
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland; (T.P.); (M.D.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
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Bausch L, Probst M, Fritsch L, Mehl J, Siebenlist S, Willinger L. Bilateral juvenile osteochondrosis dissecans in monozygotic twins: a case report. J Orthop Surg Res 2024; 19:208. [PMID: 38561825 PMCID: PMC10983665 DOI: 10.1186/s13018-024-04683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The etiology of osteochondrosis dissecans (OCD), a chondropathy associated with detachment of the subchondral bone and the overlaying cartilage, is not yet fully understood. While repetitive physical exercise-related stress is usually assumed to be the main risk factor for the occurrence of OCD, genetic predisposition could have an underestimated influence on the development of the disease. CASE REPORT We report a case of monozygotic twins with almost identical stages of bilateral osteochondrosis dissecans of the knee joint. In both patients, initially, a unilateral lesion occurred; despite restricted physical exercise, in the further course of the disease a lesion also developed on the contralateral side. While the lesion found most recently demonstrated an ongoing healing process at a 6-month follow-up, the other three lesions showed a natural course of healing under conservative treatment with significant clinical as well as radiological improvements after one year and complete consolidation in magnetic resonance imaging (MRI) after 2 years. CONCLUSION There could be a genetic component to the development of OCD, although this has not yet been proven. Based on a two-year MRI follow-up, we were able to show the self-limiting characteristics of juvenile osteochondrosis dissecans.
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Affiliation(s)
- Luca Bausch
- Department of Sports Orthopaedics, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Lorenz Fritsch
- Department of Sports Orthopaedics, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Julian Mehl
- Department of Sports Orthopaedics, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Lukas Willinger
- Department of Sports Orthopaedics, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Rupp MC, Hochberger F, Berthold DP, Muench LN, Imhoff AB, Siebenlist S, Willinger L. Tibiofemoral Subluxation on Radiograph as a Predictor of Location and Size of Osteochondritis Dissecans Lesions of the Knee. Orthop J Sports Med 2024; 12:23259671241232397. [PMID: 38455152 PMCID: PMC10919139 DOI: 10.1177/23259671241232397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/09/2024] Open
Abstract
Background Lower limb malalignment has been associated with osteochondritis dissecans (OCD). However, the location of the OCD lesion often is not concordant with the mechanical leg axis. Other potentially modifiable alignment parameters may influence the propensity for impingement of the femoral condyles. Purpose To assess differences in lower limb alignment (LLA) and relative tibiofemoral position between patients with medial (MFC-OCD) or lateral OCD (LFC-OCD) of the femoral condyle. Study Design Cohort study; Level of evidence, 3. Methods Patients ≤30 years old who were diagnosed with unicondylar OCD between January 2010 and January 2020 were eligible for this study. Included were 55 patients (age, 20.8 ± 4.5 years)-46 with MFC-OCD and 9 with LFC-OCD. Preoperative standing long-leg radiographs were studied to obtain primary outcomes-including LLA and mechanical alignment analyses-and secondary outcomes-including knee joint obliquity angle; rotation angle; medial, central (c-subluxation), and lateral subluxation (L-subluxation) of the tibia relative to the femur in the coronal plane; and tibiofemoral joint line center distance (TFJCD). Results With regard to primary outcomes, LLA was significantly different between MFC-OCD (1.7°± 3.1° varus) and LFC-OCD (2.7 ± 3.1° valgus) (P < .001), and 78% (36/46) of patients with MFC-OCD had varus alignment, whereas 78% (7/9) of patients with LFC-OCD had valgus alignment (P < 0.002). With regard to secondary outcomes, patients with MFC-OCD had a more medial tibial position in relation to the femur, with a significantly smaller rotation angle (5.6°± 2.4° vs 9.6°± 3.6°; P < .001), a smaller C-subluxation (7.2 ± 6.6 vs 14.9 ± 8.8 mm; P < .01), a smaller L-subluxation (2.3 ± 2.6 vs 4.4 ± 2.7 mm; P < .05), and reduced TFJCD (3.5 ± 1.7 vs 6.6 ± 1.8 mm; P < .001) compared with the LFC-OCD group. For patients with MFC-OCD, the size of the OCD was significantly correlated with C-subluxation (r = 0.412; P = .006). Conclusion LLA was significantly different according to OCD location. In patients with MFC-OCD, the tibia was subluxated medially, resulting in a change of joint geometry by approximation of the medial tibial eminence toward the medial femoral condyle, potentially causing excessive pressure overload and microtrauma of the cartilage. Interestingly, the extent of subluxation was correlated with OCD size.
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Affiliation(s)
| | - Felix Hochberger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Daniel P. Berthold
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU Munich), Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | | | - Lukas Willinger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
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12
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Wegmann S, Hackl M, Krane F, Wegmann K, Mueller LP, Leschinger T. Accessibility of osteochondral lesion at the capitellum during elbow arthroscopy: an anatomical study. Arch Orthop Trauma Surg 2024; 144:1297-1302. [PMID: 38172435 PMCID: PMC10896769 DOI: 10.1007/s00402-023-05172-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Osteochondrosis dissecans (OCD) at the capitellum is a common pathology in young patients. Although arthroscopic interventions are commonly used, there is a lack of information about the accessibility of the defects during elbow arthroscopy by using standard portals. MATERIALS AND METHODS An elbow arthroscopy using the standard portals was performed in seven fresh frozen specimens. At the capitellum, the most posterior and anterior cartilage surface reachable was marked with K-wires. Using a newly described measuring method, we constructed a circular sector around the rotational center of the capitellum. The intersection of K-wire "A" and "B" with the circular sector was marked, and the angles between the K-wires and the Rogers line, alpha angle for K-Wire "A" and beta angle for K-wire "B", and the corridor not accessible during arthroscopy was digitally measured. RESULTS On average, we found an alpha angle of 53° and a beta angle of 104°. Leaving a sector of 51° which was not accessible via the standard portals during elbow arthroscopy. CONCLUSION Non-accessible capitellar lesions during elbow arthroscopy should be considered preoperatively, and the informed consent discussion should always include the possibility of open procedures or the use of flexible instruments. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- S Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - M Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - F Krane
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - K Wegmann
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstr. 6, 81369, Munich, Germany
| | - L-P Mueller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - T Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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13
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Thomas ND, Mahler R, Krombholz K, Williams B, Ganley T, Nepple JJ, Shea K. Top 50 Most-Cited Studies about Osteochondritis Dissecans. Arthrosc Sports Med Rehabil 2024; 6:100859. [PMID: 38260824 PMCID: PMC10801260 DOI: 10.1016/j.asmr.2023.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose To determine the 50 most frequently cited studies on osteochondritis dissecans (OCD) and to conduct a bibliometric analysis of these studies. Methods We performed a search within the Clarivate Web of Science database, identifying articles published before December 2022 that encompass topics related to OCD. The search was conducted using the keywords "Osteochondritis Dissecans OR Osteochondritis OR Dissecans."Search results were then filtered using predetermined guidelines and criteria, and the 50 most-cited articles were selected for analysis. Extracted data included title, journal, design, main topic, joint, citations, year, country of origin, and level of evidence. Results The search yielded 3,865 articles. The 50 most-cited articles were published between 1957 and 2018, with the greatest proportion published from 2000 to 2009 (60%). The most frequently studied topic was treatment (68%), followed by etiology (14%) and imaging (8%). The majority of articles had Level IV evidence (36%) and the largest proportion focused on the knee joint (36%), followed by the ankle (32%), and elbow (6%). The mean citation count per article was 287 (range: 157-1,050), with the most-cited articles primarily published from 2000 to 2003. The leading country of origin was the United States, accounting for 19 publications. Conclusions Most of the top 50 most-cited articles regarding OCD are about treatment, and the knee is the most-studied joint. The majority of the articles were Level IV evidence and were published in the United States between 2000 and 2009. Clinical Relevance The top 50 most-cited studies list will provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions regarding osteochondritis dissecans (OCD).
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Affiliation(s)
- Nicholas D. Thomas
- College of Medicine, Florida State University, Tallahassee, Florida, U.S.A
| | - Raegan Mahler
- Morsani College of Medicine, University of South Florida, Tampa, Florida, U.S.A
| | - Kylie Krombholz
- College of Medicine, Florida State University, Tallahassee, Florida, U.S.A
| | - Brendan Williams
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Ted Ganley
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Jeffrey J. Nepple
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Kevin Shea
- Stanford University School of Medicine, Stanford, California, U.S.A
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Konarski W, Poboży T, Konarska K, Śliwczyński A, Kotela I, Krakowiak J. A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review. J Clin Med 2024; 13:287. [PMID: 38202294 PMCID: PMC10780049 DOI: 10.3390/jcm13010287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Musculoskeletal disorders, standing as the fifth leading cause of disability-adjusted life years globally, present significant challenges in orthopedics. Osteochondritis dissecans (OCD) and avascular necrosis (AVN) are distinct but closely related conditions within this spectrum, impacting patients' quality of life with pain, limited mobility, and dysfunction. OCD, involving cartilage and bone detachment in joints, predominantly affects young athletes, but its exact etiology and optimal management remain subjects of ongoing research. Conversely, AVN, marked by bone tissue death due to compromised blood supply, is linked to systemic factors like corticosteroid use and traumatic injuries. Diagnosis for both conditions relies on radiography and magnetic resonance imaging. Conservative treatment for AVN includes the use of a cane or crutches, pharmacological therapy, or physical therapy. On the other hand, in OCD, the primary approach is activity/sports restriction. Surgical treatment options for AVN patients encompass core decompression, bone grafting, or, in the most advanced cases, total hip arthroplasty. OCD may be surgically treated through subchondral drilling or fixation of unstable lesions. Advanced cases of OCD involve cartilage salvage with resurfacing techniques. The presentation of differences between these conditions enhances our understanding, facilitating improved diagnosis and management strategies.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Klaudia Konarska
- Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland;
| | - Andrzej Śliwczyński
- Social Medicine Institute, Department of Social and Preventive Medicine, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Social Medicine Institute, Department of Social and Preventive Medicine, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
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van der Weiden GS, van Cruchten S, van Egmond N, Mastbergen SC, Husen M, Saris DB, Custers RJ. Osteochondritis Dissecans of the Knee Associated With Mechanical Overload. Am J Sports Med 2024; 52:155-163. [PMID: 38164681 PMCID: PMC10762890 DOI: 10.1177/03635465231211497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/15/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) of the knee is a rare but potentially incapacitating disorder in which subchondral bone detaches, leading to an osteochondral fragment that can become unstable and progress into a loose body. The exact cause is unknown, although several biological and mechanical factors have been described. PURPOSE To provide insight into epidemiological data of a large cohort of patients affected by OCD of the knee and to identify potential factors contributing to the cause of this disorder. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 236 patients (259 knees) affected by OCD were included in our Knee Registry (2005-2022) and retrospectively analyzed. Patient characteristics were extracted from the medical records. Location and International Cartilage Regeneration & Joint Preservation Society grade (1-4) of OCD were assessed using magnetic resonance imaging. If available, a full-leg standing radiograph was used to assess alignment. Additionally, a statistical scoring system for instability risk was created. RESULTS A total of 263 OCD lesions were identified in 259 knees, 66.2% on the medial femoral condyle (MFC), 26.6% on the lateral femoral condyle (LFC), 3.8% on the trochlea, 2.7% on the patella, and 0.8% on the lateral tibia plateau. Male patients made up 57.6% of the sample, which had a mean age of 21.8 years. A very high percentage of patients (77.1%; n = 182) practiced sports, of whom 67.6% (n = 123) were engaged in high-impact sports. The location of the OCD lesions and the leg alignment (n = 110) were significantly correlated: MFC lesions were associated with more varus than valgus alignment (47.5% vs 11.3%) and patients with LFC lesions had more valgus than varus alignment (46.7% vs 20.0%; P = .002). Based on age, smoking, sports activity, and preceding trauma, a multivariable scoring system (0-11 points) was created. An increased risk of lesion instability was associated with an increased score: 29.0% at 0 points and 97.0% at 11 points. CONCLUSION This study provides detailed epidemiological data for 236 patients affected by OCD of the knee. Older age, smoking, inactivity, and preceding trauma were predictive for instability of OCD lesions. There was an association between OCD of the MFC and varus malalignment and between OCD of the LFC and valgus malalignment. This finding, in combination with the high percentage of patients practicing high-impact sports, suggests an important role for mechanical overload in the pathogenesis of OCD.
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Affiliation(s)
- Goran S. van der Weiden
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Stijn van Cruchten
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nienke van Egmond
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Simon C. Mastbergen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Martin Husen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniël B.F. Saris
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Roel J.H. Custers
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Bai X, Sun H, Jia L, Xu J, Zhang P, Zhang D, Gu Y, Chen B, Feng L. Chondrocyte targeting gold nanoparticles protect growth plate against inflammatory damage by maintaining cartilage balance. Mater Today Bio 2023; 23:100795. [PMID: 37766899 PMCID: PMC10519832 DOI: 10.1016/j.mtbio.2023.100795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Cartilage destruction caused by inflammation is a clinical challenge. Many studies have investigated cartilage destruction in adults, but little research was conducted on children. In this study, the protective effect of gold nanoparticles (AuNPs) on the cartilage of children was realized by counteracting chondrocyte apoptosis and extracellular matrix (ECM) degradation in a young mouse model of lipopolysaccharide (LPS)-induced growth plate (GP) cartilage damage. Initially, engineered AuNPs can be efficiently absorbed by chondrocytes, approximately 20 times the amount absorbed by macrophages, resulting in a 29% ± 0.05% increase in chondrocyte viability. Then, AuNPs exposure significantly reduced the release of inflammatory cytokines and secretion of ECM degradation factors induced by LPS. Subsequently, AuNPs were applied to resist LPS-induced cartilage destruction in young mice. AuNPs inhibited the formation of gaps, without chondrocytes and extracellular matrix, between the proliferative and hypertrophy zones of the GP cartilage, and the gaps were noticeable in the LPS group. This finding can be attributed to the capability of AuNPs to reduce the LPS-induced apoptosis rate of mouse chondrocytes by 72.38% and the LPS-induced ECM degradation rate by 70.89%. Further analysis demonstrated that remission is partly due to AuNPs' role in maintaining the balance of catabolic and anabolic factors in the ECM. Altogether, these findings indicate that AuNPs can partially protect the cartilage of children from inflammatory damage by suppressing chondrocyte apoptosis and ECM degradation.
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Affiliation(s)
- Xue Bai
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
- Beijing Key Laboratory of Basic Research in Clinical Applied Biomechanics, China
| | - Hongyan Sun
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Lina Jia
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Junjie Xu
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Peng Zhang
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Deyuan Zhang
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Yu Gu
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China
- Beijing Key Laboratory of Basic Research in Clinical Applied Biomechanics, China
| | - Bo Chen
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Lin Feng
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
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17
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Davis J, Doyle B, Ishii H, Jayanthi N. S.P.O.R.R.T.-A Comprehensive Approach to the Assessment and Non-Operative Management of Overuse Knee Conditions in Youth Athletes. Curr Rev Musculoskelet Med 2023; 16:627-638. [PMID: 37999828 PMCID: PMC10733244 DOI: 10.1007/s12178-023-09874-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW The evaluation of a young athlete with an overuse injury to the knee involves a comprehensive approach. There are a number of elements to consider including assessments of skeletal maturity (biologic maturation), workload (training load + competition load), sport specialization status, and biomechanics. The type of injury and treatment, as well as future prognosis, may be influenced by these and other factors. RECENT FINDINGS Calculating the percentage of predicted adult height (PPAH) is a valuable tool in assessing overuse injury patterns and diagnoses in youth athletes. Modifiable and non-modifiable overuse injury risk factors require monitoring from clinicians as young athletes mature and develop over time. Training and rehabilitation programs should be adapted to account for these. In this manuscript, we seek to introduce a novel, comprehensive approach: S.P.O.R.R.T. (Skeletal Maturity, Prior Injury Risk, One Sport Specialization, Rehabilitation, Return to Play, Training Recommendations) (Fig. 1). Overuse, non-traumatic injuries to the knee in youth athletes will be presented in a case-based and evidence-based model to provide a framework for a comprehensive approach to the assessment and treatment of youth athletes with overuse injuries.
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Affiliation(s)
- Jacob Davis
- Emory Sports Medicine Center, 6335 Hospital Parkway, Suite 302, Johns Creek, GA, 30097, USA
- Georgia Institute of Technology, Sports Medicine, Atlanta, GA, USA
| | - Bridget Doyle
- Emory Sports Medicine Center, 6335 Hospital Parkway, Suite 302, Johns Creek, GA, 30097, USA
| | - Haruki Ishii
- Emory Sports Medicine Center, 6335 Hospital Parkway, Suite 302, Johns Creek, GA, 30097, USA
| | - Neeru Jayanthi
- Emory Sports Medicine Center, 6335 Hospital Parkway, Suite 302, Johns Creek, GA, 30097, USA.
- Emory Sports Performance & Research Center (SPARC), 4450 Falcon Pkwy, Flowery Branch, GA, USA.
- Emory University School of Medicine, Department of Orthopedics and Family Medicine, Atlanta, GA, USA.
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Kelly SR, Mustafa L, Al-Kharabsheh Y, DeFroda SF, Nuelle CW. All-Arthroscopic Bone Grafting and Primary Fixation of a Medial Femoral Condyle Osteochondritis Dissecans Lesion. Arthrosc Tech 2023; 12:e1721-e1725. [PMID: 37942112 PMCID: PMC10627890 DOI: 10.1016/j.eats.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/28/2023] [Indexed: 11/10/2023] Open
Abstract
Treatment of osteochondritis dissecans (OCD) lesions poses a significant challenge for orthopaedic surgeons and can cause debilitating limitations on the activity of patients. Timing of intervention, surgical technique, and selection of graft when needed are all key elements of treatment that need to be considered carefully and discussed with patients. Primary fixation of an OCD fragment with intact subchondral bone has been shown to be beneficial in some cases. There is limited literature, however, on how to approach large chondral lesions in young patients without a large subchondral base attached to the fragment. Treatment of large OCD lesions of the knee with an all-arthroscopic approach provides several benefits, including limited dissection for exposure, improved ability to assess the stability of the OCD lesion during articulation after fixation, and an expedited recovery compared to an open approach. The purpose of this technical note is to detail a technique of performing an all-arthroscopic bone grafting and primary fixation of a medial femoral condyle OCD lesion.
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Affiliation(s)
- Shayne R. Kelly
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Luai Mustafa
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | | | - Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
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Yellin JL, Tysklind RG, Hussain ZB, Zheng ET, Heyworth BE, Kocher MS. Bilateral osteochondritis dissecans of the knee in pediatric and adolescent patients presenting with unilateral symptoms: An epidemiological and radiographic analysis. J Child Orthop 2023; 17:481-488. [PMID: 37799315 PMCID: PMC10549690 DOI: 10.1177/18632521231193711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/22/2023] [Indexed: 10/07/2023] Open
Abstract
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.
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Affiliation(s)
- Joseph L Yellin
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Robert G Tysklind
- Department of Orthopaedics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Zaamin B Hussain
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Evan T Zheng
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Benton E Heyworth
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mininder S Kocher
- Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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20
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Palumbo R, Kuzma SA, Flanigan DC. Failure of osteochondral lesions using bioabsorbable fixation in the adolescent patient: a case report. J ISAKOS 2023; 8:267-272. [PMID: 37271430 DOI: 10.1016/j.jisako.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
Injury to the chondral surface and subchondral bone can be due to osteochondritis dissecans or traumatic injury. These lesions can lead to pain, swelling, and mechanical symptoms causing functional impairments for patients. Treatment can include nonoperative management or surgical intervention including internal fixation. Internal fixation can be performed through multiple methods including the use of bioabsorbable screw fixation, though there is concern for potential early failure of this method. We present three cases of osteochondral lesions treated with internal fixation with bioabsorbable screws, which experienced early failure of the bioabsorbable screws, leading to failure of fixation and requiring revision surgery with advanced cartilage restoration procedures. All patients had resolution of their symptoms and improved function postoperatively. While the use of bioabsorbable screw fixation can potentially decrease cost and morbidity, their mechanical properties may increase the risk of failure before lesion healing. We advocate caution with the use of these screws for the treatment of unstable osteochondritis dissecans lesion and recommend careful patient selection and meticulous surgical technique to avoid failure of fixation of these lesions.
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Affiliation(s)
- Reid Palumbo
- College of Medicine, The Ohio State University, Columbus, OH, 43201, USA
| | - Scott A Kuzma
- Orthopaedic Surgery, Mayo Clinic Health System, La Crosse, WI, 54601, USA
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA.
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Bangert Y, Zarembowicz P, Engelleiter K, Gkarilas E, Schmitt H, Renkawitz T, Jaber A. Long-Term Outcome and Athletic Level following Operative Treatment for Osteochondritis Dissecans of the Knee in Pediatric and Adolescent Patients. J Clin Med 2023; 12:4140. [PMID: 37373833 DOI: 10.3390/jcm12124140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Research on the long-term outcomes following surgical therapy for osteochondritis dissecans (OCD) of the knee is scarce. A single-center retrospective cohort study was conducted to investigate surgically treated patients for knee OCD between 1993 and 2007. A total of 37 patients with an average follow-up duration of 14 years (range 8-18) were in the final cohort. IKDC and Lysholm scores were assessed. The duration and types of sport activity were reported. Long-term results were compared with existing midterm data. Knee scores showed a very good outcome with a mean of 91.3 in the IKDC score and 91.7 in the Lysholm score. Compared to midterm outcomes, both IKDC (p = 0.028) and Lysholm scores (p = 0.01) improved on final follow-up. Patients with open physes showed a significantly better Lysholm score compared to patients with closed physes (p = 0.034). Defect localization and size did not influence the outcome, but a defect depth of <0.8 cm2 achieved significantly better scores than ≥0.8 cm2. Of all surgical interventions, refixation achieved the best outcome. Long-term results significantly improved compared to midterm results with a follow-up of 40 months (p = 0.01). Thirty-six out of 37 patients were physically active, with 56% of sports being knee-straining activities. Long-term results following surgically treated OCD fragments show excellent function and a good athletic level. Patients with open physes potentially have better knee outcomes. Midterm results are sustainable and could improve further in the long term.
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Affiliation(s)
- Yannic Bangert
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Patrick Zarembowicz
- Department for Orthopaedic and Trauma Surgery, BG Klinik Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany
| | - Karoly Engelleiter
- Department for Orthopaedic and Trauma Surgery, Helios Clinic, 75175 Pforzheim, Germany
| | - Evangelos Gkarilas
- Department for Orthopaedics, Trauma and Spinal Surgery, Neckar-Odenwald Clinics, 74821 Mosbach, Germany
| | - Holger Schmitt
- German Joint Center, ATOS Clinic Heidelberg, 69115 Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Ayham Jaber
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
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22
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Korthaus A, Meenen NM, Pagenstert G, Krause M. The "hump" a new arthroscopic phenomenon guiding for reliable therapy of osteochondritis dissecans of variable stability status. Arch Orthop Trauma Surg 2023; 143:1513-1521. [PMID: 35366091 DOI: 10.1007/s00402-022-04409-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/27/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite 150 years of research, there are currently no reliable morphological characteristics that can be used to differentiate between stable and unstable juvenile osteochondritis dissecans (JOCD) lesions in the knee joint. Arthroscopic probing is still the gold standard. In arthroscopic evaluation, a previously undescribed pattern of a cartilaginous convex elevation ("hump") was identified as a new feature and potential sign of JOCD in transition to instability. The aim of the study was to evaluate the clinical outcomes after surgical intervention (drilling) on the "hump". MATERIALS AND METHODS In a retrospective case series of sixteen patients with an arthroscopically detectable "hump", the analysis of clinical function scores (Lysholm, Tegner) and morphological MRI monitoring of radiological healing were performed. The assessment of lesion healing was based on pre- and postoperative MRI examinations. The "hump" was defined as an arthroscopically impressive protrusion of the femoral articular surface with a minimally softened, discolored, but intact cartilage margin that, is not mobile upon in the arthroscopic palpation hook test. The primary therapy of choice was drilling of all "humps". RESULTS The "hump" could be detected arthroscopically in 16 of 59 JOCD lesions. Specific MRI correlations with the "hump" or arthroscopic unstable lesions could not be detected. Not all "humps" showed signs of MRI-based healing after the drilling, and in some a dissection of the osteochondral flap occurred within the first postoperative year. As a result, secondary refixation became necessary. CONCLUSION In the present study, the "hump" was identified as an important differential diagnostic arthroscopic feature of an arthroscopically primarily stable JOCD lesion, potentially placing the lesion at risk of secondary loosening over time. Therefore, drilling alone may not be appropriate in the event of arthroscopic "hump" discovery, but additional fixation may be required to achieve the healing of the lesion. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N M Meenen
- Pediatric Sports Medicine, Sports Traumatology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.
| | - G Pagenstert
- CLARAHOF Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058, Basel, Switzerland
| | - M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Gagliardi AG, Walker G, Dahab K, Pearce S, Howell DR, Albright JC. High healing rate of stable femoral condyle osteochondritis dissecans in young patients placed in a hinged knee brace locked in extension: a retrospective study. J Pediatr Orthop B 2023; 32:170-177. [PMID: 36700964 DOI: 10.1097/bpb.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report the rate of stable femoral condyle osteochondritis dissecans (OCD) lesion healing in adolescents using a locked hinged knee brace for a minimum of 6 weeks or until pain free, followed by physical therapy. Patients aged 5-18 at the time of a primary diagnosis of femoral condyle OCD were reviewed. Patients who presented with an unstable lesion necessitating surgery, lacked follow-up >6 months after diagnosis or before symptoms resolution, or were noncompliant were excluded. We assessed progression to surgery, association between surgery and lesion size, lesion grade, symptoms, laterality, and patient factors. Lesion width and depth and condyle size were measured on X-ray and MRI, and the scaled size of the lesion relative to the condyle was calculated. Sixty-four patients were included: 12.5% (n = 8; 50% female; mean age = 12.5 ± 1.0 years) progressed to surgery and 87.5% (n = 56; 20% female; mean age=11.5 ± 1.9 years) healed. No significant effects were identified between groups. The surgical group compared to the non-surgical group was braced for a similar amount of time (72.6 ± 51.4 vs. 54.9 ± 23.2 days; P = 0.09), presented initially with a similar lesion size (322.5 ± 298.7 vs. 211.2 ± 178.4 mm2; P = 0.14), and had a similar proportion of Grade 1 lesions (63% vs. 85%; P = 0.11). Female sex (P = 0.04) and longer time in the brace (P = 0.04) were associated with progression to surgery.
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Affiliation(s)
| | | | | | | | - David R Howell
- Department of Orthopedics, Children's Hospital Colorado.,University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
| | - Jay C Albright
- Department of Orthopedics, Children's Hospital Colorado.,University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
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24
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Cabral J, Duart J. Osteochondritis dissecans of the knee in adolescents: How to treat them? J Child Orthop 2023; 17:54-62. [PMID: 36755556 PMCID: PMC9900018 DOI: 10.1177/18632521231152269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 02/10/2023] Open
Abstract
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.
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Affiliation(s)
- Joao Cabral
- Serviço de Ortopedia Pediátrica, Hospital Pediátrico—Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Julio Duart
- Complejo Hospitalario de Navarra, Pamplona, Spain
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25
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Turati M, Anghilieri FM, Bigoni M, Rigamonti L, Tercier S, Nicolaou N, Accadbled F. Osteochondritis dissecans of the knee: Epidemiology, etiology, and natural history. J Child Orthop 2023; 17:40-46. [PMID: 36755551 PMCID: PMC9900014 DOI: 10.1177/18632521221149063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/14/2022] [Indexed: 01/29/2023] Open
Abstract
Osteochondritis dissecans of the knee is a disease that typically affects skeletally immature patients. Clinically manifested with knee pain, limping, and joint disfunction, this condition has remained misunderstood and undervalued for a long period. Although being a rare condition, its awareness is of utmost clinical interest because of the possible severe consequences it can bring when misrecognized or inadequately treated. Its etiology remains unclear and is still debated. Many theories have been proposed, including inflammation, local ischemia, subchondral ossification abnormalities, genetic factors, and repetitive mechanical microtrauma, with a likely interplay of the same. This review article aims to deliver and discuss current and up-to-date concepts on epidemiology, etiology, and natural history of this pediatric condition. Level of evidence: level V.
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Affiliation(s)
- Marco Turati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | | | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Luca Rigamonti
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Stephane Tercier
- Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Nicolaou
- Sheffield Children’s Hospital, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Franck Accadbled
- Department of Orthopedics, Children’s Hospital, Toulouse University Hospital, Toulouse, France
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26
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Guevel B, Mathew ST, Coene RP, Maguire KJ, Williams KA, Micheli LJ, Milewski MD. Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee. Arthrosc Sports Med Rehabil 2023; 5:e225-e232. [PMID: 36866308 PMCID: PMC9971866 DOI: 10.1016/j.asmr.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/09/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine whether adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee in pediatric patients. Methods This retrospective matched case-control study was performed at a single tertiary care pediatric hospital between January 2015 and September 2018. Patients who underwent antegrade drilling for stable femoral condyle OCD with greater than 2 years' follow-up were included. Preference was for all to receive postoperative bone stimulation; however, some were denied because of insurance coverage. This enabled us to create 2 matched groups of those who received postoperative bone stimulation and those who did not. Patients were matched on skeletal maturity, lesion location, sex, and age at surgery. The primary outcome measure was the rate of healing of the lesions determined by postoperative magnetic resonance imaging measurements at 3 months. Results Fifty-five patients were identified who met the inclusion and exclusion criteria. Twenty patients from the bone stimulator group (BSTIM) were matched to 20 patients from the no bone stimulator group (NBSTIM). Mean age for BSTIM at surgery was 13.2 years ± 2.0 (range, 10.9-16.7) and for NBSTIM at surgery 12.9 years ± 2.0 (range, 9.3-17.3). At 2 years, 36 patients (90%) in both groups went on to clinical healing without further interventions. In BSTIM, there was a mean decrease of 0.9 (±1.8) mm in lesion on coronal width and 12 patients (63%) had overall improved healing; in NBSTIM there was a mean decrease of 0.8 (±3.6) mm in coronal width and 14 patients (78%) had improved healing. No statistical differences in the rate of healing were found between the 2 groups (P = .706). Conclusion In antegrade drilling of stable knee OCD lesions in pediatric and adolescent patients, adjuvant bone stimulator use did not appear to improve radiographic or clinical healing. Level of evidence Level III, retrospective case-control study.
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Affiliation(s)
- Borna Guevel
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A
| | - Stephen T. Mathew
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A
| | - Ryan P. Coene
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A
| | | | - Kathryn A. Williams
- Boston Children’s Hospital, Biostatistics and Research Design Center, ICCTR Boston, Massachusetts, U.S.A
| | - Lyle J. Micheli
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matthew D. Milewski
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A.,Address correspondence to Matthew Milewski, M.D., Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, 300 Longwood Avenue, Boston, MA 02115, U.S.A.
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27
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Brimmo O, Boeyer ME, Hoernschemeyer DG, Gray A, Duren DL, Gupta SK. Physeal fusion status and lesion size are more important than patient age for healing of juvenile osteochodritis dessicans lesions of the distal femur. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07284-w. [PMID: 36538059 DOI: 10.1007/s00167-022-07284-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the effect of skeletal age and lesion size, location, and grade on the success of nonoperative treatment for juvenile osteochondritis dissecans (OCD). It is hypothesized that skeletal maturity, including a combination of maturation phenotypes, correlates with nonoperative lesion healing. METHODS The clinical and radiographic data on 52 patients aged 7-20 years treated for OCD of the distal femur between 2010 and 2019 were retrospectively reviewed. Knee radiographs were assessed for number of lesions present and lesion location, size, and stage. Assessments of skeletal maturation were performed on all antero-posterior knee radiographs using the Roche, Wainer, and Thissen (RWT) method. Patients were categorized as healed if they demonstrated no pain on clinical examination. The relationship between skeletal maturity and nonoperative lesion healing was determined using Spearman rank correlations on available variables. RESULTS Neither chronological nor skeletal age was associated with surgical status (Rho = 0.03, n.s., and Rho = 0.13, n.s., respectively) or the healing status of nonoperatively treated OCD lesions (Rho = 0.44, n.s., and Rho = 0.03, n.s., respectively). Epiphyseal fusion status of the distal femoral physis was moderately correlated with nonoperative healing, but was not statistically significant (lateral femoral physis: Rho = 0.43, p = 0.05; medial femoral physis: Rho = 0.43, n.s.). Lesion length correlated with surgical status (Rho = - 0.38, p = 0.009). CONCLUSION The extent of fusion of the distal femoral physis (multi-stage grading) may be more strongly correlated with nonoperative healing than other markers of skeletal maturity or chronological age. Clinicians can use this as an additional radiographic sign when considering nonoperative treatment for juvenile OCD lesions in the distal femur. OCD lesion length and physeal fusion status appear to be more important for healing than patient age.
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Affiliation(s)
- Olubusola Brimmo
- Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65201, USA
| | - Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65201, USA
| | - Daniel G Hoernschemeyer
- Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65201, USA
| | - Aaron Gray
- Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65201, USA
| | - Dana L Duren
- Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65201, USA
| | - Sumit K Gupta
- Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave, Columbia, MO, 65201, USA.
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28
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Tudisco C, Bernardi G, Manisera MT, De Maio F, Gorgolini G, Farsetti P. An update on osteochondritis dissecans of the knee. Orthop Rev (Pavia) 2022; 14:38829. [PMID: 36540072 PMCID: PMC9760694 DOI: 10.52965/001c.38829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Cosimo Tudisco
- Unicamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Gabriele Bernardi
- Department of Orthopaedics and TraumatologyNuova Itor Clinic, Rome, Italy
| | - Maria Teresa Manisera
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and TraumatologyUniversity of Rome “Tor Vergata”, Italy
| | - Fernando De Maio
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and TraumatologyUniversity of Rome “Tor Vergata”, Italy
| | - Giulio Gorgolini
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and TraumatologyUniversity of Rome “Tor Vergata”, Italy
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and TraumatologyUniversity of Rome “Tor Vergata”, Italy
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29
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Müller SA, Müller-Lebschi JA, Shotts EE, Bond JR, Tiegs-Heiden CA, Collins MS, O'Driscoll SW. Advantages of CT Versus MRI for Preoperative Assessment of Osteochondritis Dissecans of the Capitellum. Am J Sports Med 2022; 50:3941-3947. [PMID: 36342019 DOI: 10.1177/03635465221129598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is considered to be the gold standard for imaging of osteochondritis dissecans (OCD). PURPOSE/HYPOTHESIS The purpose was to determine the additional value of a preoperative computed tomography (CT) scan in adolescent patients with capitellar OCD of the elbow. Consistent with the fact that OCD is a lesion involving the subchondral bone, the hypothesis was that CT would be superior to MRI for imaging OCD of the capitellum. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS All patients being treated surgically for an OCD of the capitellum between 2006 and 2016 at one institution were reviewed for preoperative imaging. A total of 28 patients met the inclusion criteria. Corresponding MRI and CT scans were compared retrospectively. Multiple parameters were recorded, with special emphasis on OCD lesion size, fragmentation, and tilt as well as joint surface integrity, loose bodies, and osteophytes. RESULTS The OCD lesions were best seen on CT scans, whereas MRI T1-weighted images overestimated and T2-weighted images underestimated the size of defects. A subchondral fracture nonunion was found on CT scans in 18 patients, whereas this was seen on MRI T1-weighted images in only 2 patients (P < .001) and MRI T2-weighted images in 4 patients (P < .001). Fragmentation of the OCD fragment was found on CT scans in 17 patients but on MRI scans in only 9 patients (P = .05). Osteophytes as a sign of secondary degenerative changes were seen on CT scans in 24 patients and were seen on MRI scans in 15 patients (P = .02). Altogether, only 51 of 89 secondary changes including loose bodies, effects on the radial head and ulnohumeral joint, and osteophytes that were seen on CT scans were also seen on MRI scans (P = .002). CONCLUSION OCD fragmentation and secondary changes were more often diagnosed on CT. These factors indicate OCD instability or advanced OCD stages, which are indications for surgery. In an adolescent who is considered at risk for OCD (baseball, gymnastics, weightlifting, tennis) and who has lateral elbow joint pain with axial or valgus load bearing, CT is our imaging modality of choice for diagnosing and staging OCD of the capitellum.
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Affiliation(s)
- Sebastian A Müller
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedic Surgery, University of Basel, Basel, Switzerland
| | - Julia A Müller-Lebschi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedic Surgery, Sonnenhof Spital, Bern, Switzerland
| | - Ezekiel E Shotts
- Department of Radiology, St Bernards Medical Center, Jonesboro, Arkansas, USA
| | - Jeffrey R Bond
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark S Collins
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Brittberg M. Knee osteochondritis dissecans-treatment technical aspects. J Orthop 2022; 34:104-110. [PMID: 36060730 PMCID: PMC9428728 DOI: 10.1016/j.jor.2022.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 01/22/2023] Open
Abstract
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.
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Affiliation(s)
- Mats Brittberg
- Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Varberg Hospital, S-43237, Varberg, Sweden
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31
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Osteochondritis Dissecans Lesions of the Pediatric and Adolescent Knee. Orthop Clin North Am 2022; 53:445-459. [PMID: 36208887 DOI: 10.1016/j.ocl.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteochondritis dissecans of the knee in pediatric and adolescent patients remains an incompletely understood entity, with multiple theories proposed for its underlying cause and variable treatment modalities. In addition to the importance of history and examination, treatment is primarily guided by lesion stability, which can be determined by MRI and arthroscopic findings. Other important factors that can influence healing include patient skeletal maturity, lesion location, and the size of the lesion. The purpose of this article is to review the most current epidemiology, classification, and pathoanatomy of the disease and discuss the different treatment options.
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32
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Hurley DJ, Davey MS, Hurley ET, Murawski CD, Calder JDF, D'Hooghe P, van Bergen CJA, Walls RJ, Ali Z, Altink JN, Batista J, Bayer S, Berlet GC, Buda R, Dahmen J, DiGiovanni CW, Ferkel RD, Gianakos AL, Giza E, Glazebrook M, Guillo S, Hangody L, Haverkamp D, Hintermann B, Hogan MV, Hua Y, Hunt K, Jamal MS, Karlsson J, Kearns S, Kerkhoffs GMMJ, Lambers K, Lee JW, McCollum G, Mercer NP, Mulvin C, Nunley JA, Paul J, Pearce C, Pereira H, Prado M, Raikin SM, Savage-Elliott I, Schon LC, Shimozono Y, Stone JW, Stufkens SAS, Sullivan M, Takao M, Thermann H, Thordarson D, Toale J, Valderrabano V, Vannini F, van Dijk CN, Walther M, Yasui Y, Younger AS, Kennedy JG. Paediatric ankle cartilage lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. J ISAKOS 2022; 7:90-94. [PMID: 35774008 DOI: 10.1016/j.jisako.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Pediatric Ankle Cartilage Lesions" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Forty-three international experts in cartilage repair of the ankle representing 20 countries convened to participate in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus: 51-74%; strong consensus: 75-99%; unanimous: 100%. RESULTS A total of 12 statements on paediatric ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Five achieved unanimous support, and seven reached strong consensus (>75% agreement). All statements reached at least 84% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with the management of paediatric ankle cartilage lesions.
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Affiliation(s)
- Daire J Hurley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin S Davey
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher D Murawski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - James D F Calder
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Raymond J Walls
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zakariya Ali
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Nienke Altink
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorge Batista
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steve Bayer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gregory C Berlet
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Roberto Buda
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jari Dahmen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Richard D Ferkel
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arianna L Gianakos
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric Giza
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Glazebrook
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stéphane Guillo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laszlo Hangody
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel Haverkamp
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Beat Hintermann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yinghui Hua
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kenneth Hunt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Shazil Jamal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jón Karlsson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Kearns
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kaj Lambers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Graham McCollum
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nathaniel P Mercer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Conor Mulvin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jochen Paul
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher Pearce
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Helder Pereira
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marcelo Prado
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steven M Raikin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lew C Schon
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yoshiharu Shimozono
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James W Stone
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin Sullivan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Masato Takao
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hajo Thermann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Thordarson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James Toale
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francesca Vannini
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Markus Walther
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Youichi Yasui
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alastair S Younger
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John G Kennedy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Molony JT, Greenberg EM, Weaver AP, Racicot M, Merkel D, Zwolski C. Rehabilitation After Pediatric and Adolescent Knee Injuries. Clin Sports Med 2022; 41:687-705. [DOI: 10.1016/j.csm.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chau MM, Tompkins MA. Osteochondritis Dissecans of the Knee in Young Athletes. Clin Sports Med 2022; 41:579-594. [DOI: 10.1016/j.csm.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wiktor Ł, Tomaszewski R. Evaluation of Osteochondritis Dissecans Treatment with Bioabsorbable Implants in Children and Adolescents. J Clin Med 2022; 11:jcm11185395. [PMID: 36143038 PMCID: PMC9505433 DOI: 10.3390/jcm11185395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This is the first systematic review concerning the treatment of osteochondritis dissecans with the use of bioabsorbable implants. The study was done as a comprehensive review to identify important factors affecting the results of OCD treatment in children and adolescents; (2) Methods: We searched electronic bibliographic databases including PubMed, Cochrane Library, Scopus, and Web of Knowledge until May 2022. This systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PICO (Patients, Interventions, Comparisons, Outcomes) guidelines; (3) Results: We identified 2662 original papers of which 11 were found to be eligible for further analysis. The study group included a total of 164 OCD lesions in 158 patients. In 94.86% of postoperative cases, there was complete healing or local improvement on follow-up CT or MRI scans. The great majority of patients achieved a good clinical effect. Out of 164 OCD lesions, 10 did not heal (6.09%); (4) Conclusions: Surgical treatment of stable and unstable OCD in children with the use of bioabsorbable implants facilitates a high rate of healing and a good clinical outcome; treatment of juvenile OCD is associated with a better outcome compared to adult OCD; the use of bioabsorbable implants for the treatment of humeral capitellum OCD is associated with a more frequent incidence of synovitis (18.2%).
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Affiliation(s)
- Łukasz Wiktor
- Department of Trauma and Orthopaedic Surgery, Upper Silesian Children’s Health Centre, 40-752 Katowice, Poland
- Department of Trauma and Orthopedic Surgery, ZSM Hospital, 41-500 Chorzów, Poland
- Correspondence: ; Tel.: +48-606357016
| | - Ryszard Tomaszewski
- Department of Trauma and Orthopaedic Surgery, Upper Silesian Children’s Health Centre, 40-752 Katowice, Poland
- Faculty of Science and Technology, Institute of Biomedical Engineering, University of Silesia in Katowice, 40-007 Katowice, Poland
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Bradley KE, Allahabadi S, Jansson HL, Pandya NK. Outcomes of bioabsorbable fixation in the treatment of osteochondral lesions of the knee in adolescent patients. Knee 2022; 37:180-187. [PMID: 35809450 DOI: 10.1016/j.knee.2022.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bioabsorbable fixation in managing osteochondral lesions is increasing in popularity. The purpose was to report on outcomes using bioabsorbable fixation nails for osteochondral lesions of the knee in a pediatric and adolescent population. METHODS A retrospective review of pediatric patients undergoing surgery with bioabsorbable fixation for knee osteochondral lesions was performed. Demographic, clinical, and surgical data was collected including symptom duration, lesion location, size, use of bone grafting, and number of implants. Return to activities was documented. Patients recommended revision surgery were compared to those who were not. RESULTS 47 patients with median age 13.9 years and 25.5% female were included with median clinical follow-up of 47.3 weeks. 87.2% of patients were cleared for full activities. Four male patients (8.5%) were recommended revision surgery, of whom three underwent surgery including removal of loose bioabsorbable fixation. Demographic data did not differ between the group with successful versus failed primary surgery (p > 0.05). Symptom duration was more acute (<1 month) in the four recommended revision surgery (75% versus 9.3%, p = 0.008). The group recommended revision also had larger lesion size (median 5.4 cm2 versus 2 cm2, p = 0.04). Distal femoral physeal status, lesion location, necessity for bone grafting, and number of implants did not differ between groups. CONCLUSIONS Adolescents had a high return to activity following bioabsorbable fixation for knee osteochondral lesions with 87.2% cleared for full return. In the 8.5% of patients who were deemed to have failed primary fixation, symptoms were more likely to be acute in nature with larger lesion sizes.
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Affiliation(s)
- Kendall E Bradley
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Sachin Allahabadi
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Hayley L Jansson
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Nirav K Pandya
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA.
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Baghdadi S, Isaacs D, Chan CT, Wells L, Ganley TJ, Lawrence JTR. Arthroscopic Drilling for Stable Juvenile Osteochondritis Dissecans of the Knee Is Safe and Patients Reliably Return to Daily Activities by 3 Months. Arthrosc Sports Med Rehabil 2022; 4:e645-e651. [PMID: 35494308 PMCID: PMC9042903 DOI: 10.1016/j.asmr.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To assess the postoperative timeline for the return to activities of daily living (ADLs) in pediatric patients after arthroscopic drilling of a stable osteochondritis dissecans (OCD) lesion of the knee and to determine the rate of and risk factors for complications after the procedure. Methods In a retrospective chart review, data from all patients aged 18 years or younger who underwent arthroscopic drilling for a stable OCD lesion of either femoral condyle from May 2009 through July 2017 were collected. Demographic data, lesion characteristics, operative data, postoperative course, radiographic outcomes, and complications were recorded. Statistical analysis was performed to determine the risk factors for reoperations. Results A total of 139 knees in 131 patients were evaluated, with a mean age of 12.7 years, of which 102 (73%) were male knees. The average follow-up period was 17.8 ± 13.2 months after surgery. All patients regained full extension and flexion within 5° of the contralateral knee at a mean of 12.9 ± 3.2 weeks postoperatively, with 95% having returned fully to ADLs by the 3-month postoperative visit. No cases of infection, stiffness, arthrofibrosis, or other procedure-related complications were recorded. A total of 133 knees (95.7%) showed healing on radiographs, whereas 6 knees (4.3%) underwent additional surgical procedures, all of which were performed for treatment failure related to nonhealing lesions (including loose body removal, chondroplasty, and repeated drilling). Lesion size was the only significant risk factor for reoperation (P = .02). Conclusions Our findings suggest that arthroscopic drilling for stable, intact OCD lesions in the pediatric knee is a safe procedure with reliable outcomes and return to ADLs and a minimal risk of complications. Most patients return to their preoperative daily activity level with a full range of motion of the knee by 3 months after surgery. Complications, including reoperations, are related to the progression of the OCD lesion rather than to the surgical procedure. Each 1-cm2 increase in lesion size increases the likelihood of reoperation by 2.93 times. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | | | | | | | | | - J. Todd R. Lawrence
- Address correspondence to J. Todd R. Lawrence, M.D., Ph.D., Department of Orthopaedic Surgery, Division of Orthopedics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Second Floor, Wood Bldg, Philadelphia, PA 19104, U.S.A.
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Metz AK, Riederer M, Gagnier J, Crawford EA. Incidence of Subsequent Surgical Intervention at Short-term Follow-up in Previously Healing and Stable Juvenile Osteochondritis Dissecans of the Knee. J Pediatr Orthop 2022; 42:e271-e276. [PMID: 34999630 DOI: 10.1097/bpo.0000000000002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Juvenile osteochondritis dissecans (OCD) of the knee is a defect of subchondral bone seen primarily in active children and adolescents. Studies have evaluated the incidence of surgery in knee OCD, but the incidence of subsequent surgery in patients with stable, healing lesions cleared to return to activities is unknown. This study sought to determine the incidence of surgery in participants with knee OCD lesions cleared to return to activities and evaluate predictors of subsequent surgery. METHODS A single center, retrospective review was performed of participants aged 7 to 18 with knee OCD. Inclusion criteria were stable lesion, skeletal immaturity, no history of previous knee surgery, release to activity without surgery, and at least 12 months of follow-up. Documentation of subsequent surgery was queried in the electronic health record. Participants with no recorded surgery were contacted through phone. Analysis included bivariate and logistic regression. RESULTS Twenty-five individuals were included in this study, with 7 undergoing surgery after returning to activity. Medial femoral condyle lesions were less likely to undergo surgery (B=-2.6, P=0.038). Average lesion size for the Surgery and No Surgery groups was 1.76±0.65 and 1.32±0.81 cm2, respectively, though not significantly different (P=0.21). The Surgery group returned to activity sooner (3.7 mo, range 1.1 to 6.4) than the No Surgery group (8.1 mo, range 1.8 to 35.4), though not significantly different (P=0.18). Mean follow-up time for the study was 42.7 (range 12.6 to 77.6) months. No participants contacted by phone progressed to surgery or reported symptoms that limited their activities. CONCLUSIONS While the majority of participants with stable, healing, and asymptomatic knee OCD lesions have favorable outcomes with nonoperative management, some lesions may progress to surgery. Lesions on the medial femoral condyle may be predictive of lower likelihood of progression to surgery. Our study provides insight on the outcomes of nonoperative management of OCD lesions. LEVEL OF EVIDENCE Level IV-prognostic study.
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Affiliation(s)
| | - Mark Riederer
- Departments of Pediatrics
- Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Joel Gagnier
- Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
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Osteochondrosis dissecans am Kniegelenk beim Sportler. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baldassarri M, Buda R, Perazzo L, Ghinelli D, Sarino R, Grigolo B, Faldini C. Osteocondritis dissecans lesions of the knee restored by bone marrow aspirate concentrate. Clinical and imaging results in 18 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:857-867. [PMID: 35133501 PMCID: PMC10126062 DOI: 10.1007/s00590-022-03214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Abstract
Background
Osteochondritis dissecans (OCD) is a common cartilage disorder that specifically affects the knees of skeletally immature and young adult patients. There have been a few treatments that have been proposed: fixation of the fragment, drilling, microfractures. The aim of this study was to analyze retrospectively clinical and imaging results obtained by treating it with one-step bone marrow-derived cells Transplantation (BMDCT) technique.
Methods
From 2007 to 2014, 18 patients (mean-age 19.1 ± 5.0 years) affected by OCD were treated with one-step BMDC transplantation. In our observational study, clinical evaluation was performed at a scheduled follow-up through IKDC, Tegner, KOOS and EQ-VAS. X-rays and MRI were conducted preoperatively and at 12 months. At final follow-up, MRI MOCART Score was evaluated.
Results
IKDC and KOOS clinical scores showed a progressive increase. Tegner Score at final follow-up (5.3 ± 2.7) was significantly lower compared to the pre-injury level (6.5 ± 2.1); however, these results showed a statistically significant improvement that remained over time. EQ-VAS showed a significant improvement in every follow-up measure. MRI Mocart Score showed a complete or almost complete filling of the lesion in 13 patients.
Conclusions
“One-step” technique allows articular surface restoration with viable physiologic osteochondral tissue with a high clinical efficacy and imaging results. The number of cases is still limited, and further studies with larger sample sizes and greater follow-up evaluations are required to confirm our results. Nevertheless, we believe that BMDCT may represent a suitable option to treat OCD lesion in young adults.
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Cruz P, Bettencourt F, Arneiro G. Osteochondritis dissecans of the patella: a case-report in a juvenile football player. SCI MED FOOTBALL 2022; 5:250-253. [PMID: 35077288 DOI: 10.1080/24733938.2020.1846770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Osteochondritis dissecans (OCD) lesions are a rare cause of joint pain. Most often they occur in the knee, but they can occur in elbow or ankle too. They have a predilection for the immature skeleton and are most commonly seen in male sex, athletically active young children and adolescents.Sport-specific risk factors by anatomic region include sports associated with high frequencies of knee or ankle injuries (e.g., football, basketball) and for the elbow, the overhead throwing athlete (e.g., baseball pitcher) or gymnast.In the knee, they are most commonly seen in the femoral condyles of the knee. OCD of the patella is a rare condition. There are a few reports of it.We present a case of 14-year-old-male patient, football player, with osteochondritis dissecans of the patella (OCP). The clinical presentation, radiographic and MRI findings, treatment and return to player are discussed.
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Affiliation(s)
- Patrícia Cruz
- Physical Medicine and Rehabilitation Section, Orthophysiatry Departament, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Nissen CW, Albright JC, Anderson CN, Busch MT, Carlson C, Carsen S, Chambers HG, Edmonds EW, Ellermann JM, Ellis HB, Erickson JB, Fabricant PD, Ganley TJ, Green DW, Grimm NL, Heyworth BE, Po JHH, Kocher MS, Kostyun RO, Krych AJ, Latz KH, Loveland DM, Lyon RM, Mayer SW, Meenen NM, Milewski MD, Myer GD, Nelson BJ, Nepple JJ, Nguyen JC, Pace JL, Paterno MV, Pennock AT, Perkins CA, Polousky JD, Saluan P, Shea KG, Shearier E, Tompkins MA, Wall EJ, Weiss JM, Willimon SC, Wilson PL, Wright RW, Zbojniewicz AM, Carey JL. Descriptive Epidemiology From the Research in Osteochondritis Dissecans of the Knee (ROCK) Prospective Cohort. Am J Sports Med 2022; 50:118-127. [PMID: 34818065 DOI: 10.1177/03635465211057103] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) occurs most commonly in the knees of young individuals. This condition is known to cause pain and discomfort in the knee and can lead to disability and early knee osteoarthritis. The cause is not well understood, and treatment plans are not well delineated. The Research in Osteochondritis Dissecans of the Knee (ROCK) group established a multicenter, prospective cohort to better understand this disease. PURPOSE To provide a baseline report of the ROCK multicenter prospective cohort and present a descriptive analysis of baseline data for patient characteristics, lesion characteristics, and clinical findings of the first 1000 cases enrolled into the prospective cohort. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients were recruited from centers throughout the United States. Baseline data were obtained for patient characteristics, sports participation, patient-reported measures of functional capabilities and limitations, physical examination, diagnostic imaging results, and initial treatment plan. Descriptive statistics were completed for all outcomes of interest. RESULTS As of November 2020, a total of 27 orthopaedic surgeons from 17 institutions had enrolled 1004 knees with OCD, representing 903 patients (68.9% males; median age, 13.1 years; range, 6.3-25.4 years), into the prospective cohort. Lesions were located on the medial femoral condyle (66.2%), lateral femoral condyle (18.1%), trochlea (9.5%), patella (6.0%), and tibial plateau (0.2%). Most cases involved multisport athletes (68.1%), with the most common primary sport being basketball for males (27.3% of cases) and soccer for females (27.6% of cases). The median Pediatric International Knee Documentation Committee (Pedi-IKCD) score was 59.9 (IQR, 45.6-73.9), and the median Pediatric Functional Activity Brief Scale (Pedi-FABS) score was 21.0 (IQR, 5.0-28.0). Initial treatments were surgical intervention (55.4%) and activity restriction (44.0%). When surgery was performed, surgeons deemed the lesion to be stable at intraoperative assessment in 48.1% of cases. CONCLUSION The multicenter ROCK group has been able to enroll the largest knee OCD cohort to date. This information is being used to further understand the pathology of OCD, including its cause, associated comorbidities, and initial presentation and symptoms. The cohort having been established is now being followed longitudinally to better define and elucidate the best treatment algorithms based on these presenting signs and symptoms.
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Affiliation(s)
- Carl W Nissen
- PRISM Sports Medicine, Hartford, Connecticut; Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | | | | | - Cathy Carlson
- College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Sasha Carsen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Henry G Chambers
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | - Eric W Edmonds
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | | | - Henry B Ellis
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA
| | - John B Erickson
- Children's Hospital of Wisconsin, Greenfield, Wisconsin, USA
| | | | - Theodore J Ganley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | - Regina O Kostyun
- Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | | | | | - Roger M Lyon
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Norbert M Meenen
- Asklepios Hospital St. George, Children's Sports Medicine, Hamburg, Germany
| | | | - Gregory D Myer
- Emory Sport Performance and Research Center, Flowery Branch, Georgia; Emory Sports Medicine Center, Atlanta, Georgia; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jeffrey J Nepple
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jie C Nguyen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J Lee Pace
- Andrew's Institute, Children's Health, Plano, Texas, USA
| | - Mark V Paterno
- Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Pennock
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | | | - John D Polousky
- Akron Children's Hospital Department of Orthopedics, Akron, Ohio, USA
| | | | - Kevin G Shea
- Stanford Children's Hospital, Sunnyvale, California, USA
| | - Emily Shearier
- Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | - Marc A Tompkins
- Gillette Children's Specialty Healthcare; University of Minnesota; TRIA Orthopaedic Center, Minneapolis, Minnesota, USA
| | - Eric J Wall
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer M Weiss
- Southern California Permanente Medical Group, Los Angeles, California, USA
| | | | - Philip L Wilson
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA
| | - Rick W Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew M Zbojniewicz
- Michigan State University; Advanced Radiology Services, Grand Rapids, Michigan, USA
| | - James L Carey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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- Investigation performed at multiple sites
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43
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Bonaspetti G, Dib G, Azzola F, Piovani A. What Do We Currently Know About Patellofemoral Osteochondritis Dissecans? Cartilage 2022; 13:19476035221075948. [PMID: 35125008 PMCID: PMC9137324 DOI: 10.1177/19476035221075948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Knee osteochondritis dissecans (OCD) is a still poorly understood pathological condition of the articular subchondral bone and its overlying cartilage. Patellofemoral involvement accounts for less than 1% of cases; tibial plateau and multifocal involvement is an even rarer instance. The purpose of this study is to review what is currently known about patellofemoral OCD (PF-OCD) and to present an unusual case of PF-OCD which progressed to become multifocal in an adult female patient. METHODS A comprehensive literature search was conducted on PubMed/Medline, Cochrane, Embase, Web of Science, and Scopus databases on September 2021 for all levels of evidence and English language. After duplicate removal, 234 papers pertaining to PF-OCD were retrieved. Thirty-nine studies met inclusion criteria and were included in the review. As an example, a unique case of delamination of patellar cartilage consistent with PF-OCD with progressive involvement of trochlea and both tibial plateau in a 35-year-old woman is also presented. RESULTS PF-OCD is a rare localization of knee OCD. Two hundred eighty-eight cases have been reported in the literature to date. Mean age at time of diagnosis was 16 years and the location could also be bilateral and multifocal. The etiology is still debated but traumatic, vascular, and hereditary mechanisms are likely. Management mirrors that of classical OCD. CONCLUSIONS PF-OCD is an uncommon cause of anterior knee pain but should be considered even when physeal plates are closed. Current available evidence on treatment is of low quality, based on single case reports or small retrospective case series.
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Affiliation(s)
- Giovanni Bonaspetti
- Department of Orthopaedics and Trauma Surgery, Istituto Clinico S. Anna, Brescia, Italy
| | - Giovanni Dib
- Department of Orthopaedics and Trauma Surgery, Istituto Clinico S. Anna, Brescia, Italy
| | - Flavio Azzola
- Department of Orthopaedics and Trauma Surgery, Istituto Clinico S. Anna, Brescia, Italy
| | - Alessia Piovani
- Department of Radiology, Istituto Clinico S. Anna, Brescia, Italy
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Osteochondritis Dissecans Lesion of the Trochlear Groove: A Case of Nonsurgical Management for a Rare Lesion. Case Rep Orthop 2021; 2021:9776362. [PMID: 34938584 PMCID: PMC8687841 DOI: 10.1155/2021/9776362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Osteochondritis dissecans (OCD) lesions are potential causes of knee pain in pediatric patients, with lesions most frequently found on the lateral and medial femoral condyles. This case discusses an OCD lesion of the trochlear groove, a rare location for OCD lesions, in an 11-year-old female athlete. The patient presents after several years of knee pain that had acutely worsened, and both X-ray and MRI demonstrated the lesion, with MRI confirming a stable lesion. While previous literature has leaned towards surgical management, this patient was successfully managed nonoperatively in a locked knee brace for 12 weeks. She then went through 4 weeks of physical therapy and a 4 week progression back into soccer activity with return to full activity in 5 months.
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Lee DW, Lee JK, Cho YC, Yang SJ, Cho SI, Kim JG. Internal Fixation of Lateral Trochlear Groove Osteochondritis Dissecans With Simultaneous Lateral Retinacular Lengthening in Adolescent Athletes. Am J Sports Med 2021; 49:3867-3875. [PMID: 34757816 DOI: 10.1177/03635465211047851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The goals of operative treatment for the adolescent athlete with unstable osteochondritis dissecans (OCD) lesion are rigid fixation and prevention of recurrence. PURPOSE To evaluate clinical and radiological outcomes of internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening. STUDY DESIGN Case series; Level of evidence, 4. METHODS Adolescent athletes who had undergone internal fixation and simultaneous lateral retinacular lengthening for an unstable OCD lesion of the lateral trochlear groove were retrospectively reviewed. Subjective assessments included the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity scale, and an athletic questionnaire. Functional tests included isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance. Pre- and postoperative radiographs and magnetic resonance images were reviewed. RESULTS The mean ± SD age of the 17 patients included in this study was 15.9 ± 0.9 years; last clinical follow-up duration was 37.7 ± 8.1 months. At the last follow-up, the Lysholm score improved from 68.7 ± 15.3 to 93.4 ± 12.4 and the IKDC subjective score from 60.2 ± 14.7 to 88.7 ± 12.7 (P < .001). The mean Tegner activity scale score was 9.4 ± 0.5 before injury and 8.9 ± 1.2 at the last follow-up (P = .059). The limb symmetry indices of isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance improved at the last follow-up; the mean limb symmetry index was ≥85% in each functional test. Regarding the athletic questionnaire, 16 (94.1%) patients were satisfied with the surgery. At the last follow-up, 2 patients had higher ability after returning to sports, 11 had the same ability, and 3 had lower ability than the preinjury level. Postoperative magnetic resonance imaging at 12-month follow-up showed that the OCD lesion appeared healed in 7 (41.2%) patients and partially healed in 9 (52.9%). CONCLUSION Internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening in adolescent athletes achieved satisfactory clinical and radiological outcomes. Therefore, this combined surgical technique could be considered an effective treatment for lateral trochlear groove OCD, with a high rate of return to sport.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
| | - Young Chang Cho
- Department of Orthopaedic Surgery, KonKuk University Medical Center, School of Medicine, Konkuk University, Seoul, Korea
| | - Sang Jin Yang
- Department of Health and Exercise Management, TongWon University, Gwangju, Korea
| | - Seung Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Myongji Hospital, Goyang-si, Korea
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46
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Jeuken R, Vles G, Jansen E, Loeffen D, Emans P. The Modified Hedgehog Technique to Repair Pure Chondral Shear-off Lesions in the Pediatric Knee. Cartilage 2021; 13:271S-279S. [PMID: 31215793 PMCID: PMC8808865 DOI: 10.1177/1947603519855762] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The paediatric knee is prone to pure chondral shear-off lesions due to the developing osteochondral unit. Refixation of the chondral fragment is commonly done using metalwork or absorbable biomaterials. Both fixation methods come with biomaterial-related drawbacks. Earlier work on chondral allografts for cartilage repair in adults has shown successful osteochondral integration when the chondral allograft is treated with multiple incisions and then glued to the subchondral bone using fibrin glue. This is commonly referred to as the "hedgehog technique." This study investigates the feasibility of a modification of the hedgehog technique in autologous cartilage to repair shear-off lesions in children. DESIGN Three consecutive patients (aged 11, 12, and 14 years) with shear-off chondral fragments of 2, 5, and 8 cm2 were treated using this modified hedgehog technique. The calcified side of the chondral fragments were multiply incised and trimmed obliquely for an interlocking fit in the defect site. Fibrin glue and, if indicated sutures, were applied to fix the fragment to the defect. In 1 patient, an anterior cruciate ligament (ACL) repair was also performed. Patients were evaluated clinically and by magnetic resonance imaging (MRI) up to 12 months postoperatively. RESULTS Twelve months after surgery, all patients reported no pain and showed complete return to sport and full range of motion. MRI showed no signs of fragment loosening. CONCLUSIONS The modified hedgehog technique is a feasible treatment option to repair pure chondral shear-off lesions in the paediatric knee. This was the first time this technique was used in autografting.
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Affiliation(s)
- R.M. Jeuken
- Department of Orthopaedic Surgery and
Laboratory for Experimental Orthopedics, Maastricht University Medical Center,
Maastricht, The Netherlands,R.M. Jeuken, Department of Orthopaedic
Surgery and Laboratory for Experimental Orthopedics, Maastricht University
Medical Center, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands.
| | - G.F. Vles
- Department of Trauma and Orthopaedics,
University College Hospital London, Fitzrovia, London, UK
| | - E.J.P. Jansen
- Department of Orthopaedic Surgery,
Zuyderland Medical Center, Sittard, Geleen, The Netherlands
| | - D. Loeffen
- Department of Radiology, Maastricht
University Medical Center, Maastricht, The Netherlands
| | - P.J. Emans
- Department of Orthopaedic Surgery and
Laboratory for Experimental Orthopedics, Maastricht University Medical Center,
Maastricht, The Netherlands
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47
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Komnos G, Iosifidis M, Papageorgiou F, Melas I, Metaxiotis D, Hantes M. Juvenile Osteochondritis Dissecans of the Knee Joint: Midterm Clinical and MRI Outcomes of Arthroscopic Retrograde Drilling and Internal Fixation with Bioabsorbable Pins. Cartilage 2021; 13:1228S-1236S. [PMID: 33899529 PMCID: PMC8808801 DOI: 10.1177/19476035211003325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to assess the clinical and radiographic outcomes of juvenile patients who suffered from stage II or III osteochondritis dissecans (OCD) of the knee and underwent arthroscopic retrograde drilling and internal fixation with bioabsorbable pins. DESIGN Medical and radiological records from patients aged 11 to 16 years, who underwent arthroscopic treatment for OCD lesions of the knee in 2 tertiary hospitals, were retrospectively reviewed. The procedure was indicated by persistent pain and by magnetic resonance imaging (MRI). All patients underwent retrograde drilling and arthroscopic fixation of the lesion with bioabsorbable pins. MRI was conducted at least 1 year postoperative in all patients to evaluate healing. Functional outcomes were evaluated through the Visual Analogue Scale (VAS) for pain, Lysholm, and IKDC (International Knee Documentation Committee) scores. RESULTS A total of 40 patients, with an average age of 13.1 years (range = 11-16 years) and an average follow-up of 6.6 years (range = 3-13 years) were reviewed. MRI findings confirmed the healing of the lesion in 36 out of the 40 (90%) patients. In particular, the healing rate was 95% (20/21) and 84% (16/19) for stage II and stage III, respectively. Lysholm, IKDC, and VAS scores revealed a statistically significant improvement (P < 0.05) at final follow-up in comparison to preoperative status. No infection, knee stiffness, or other complication was recorded. CONCLUSIONS Retrograde drilling combined with internal fixation with bioabsorbable pins, of stages II and III OCD lesions of the knee provides good to excellent outcomes to juvenile patients, with a high healing rate.
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Affiliation(s)
| | - Michael Iosifidis
- Geniko Nosokomeio Thessalonikis
Papageorgiou, Thessaloniki, Central Macedonia, Greece
| | | | | | - Dimitrios Metaxiotis
- Geniko Nosokomeio Thessalonikis
Papageorgiou, Thessaloniki, Central Macedonia, Greece
| | - Michael Hantes
- General University Hospital of Larissa,
Larisa, Greece,Michael Hantes, General University Hospital
of Larissa, Mezourlo Area, Larissa 41110, Greece.
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Roberti Di Sarsisa T, Fiore M, Coco V, Govoni M, Vivarelli L, Rani N, Del Piccolo N, Dallari D. Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint. Life (Basel) 2021; 11:life11111205. [PMID: 34833081 PMCID: PMC8622509 DOI: 10.3390/life11111205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 11/05/2021] [Indexed: 02/07/2023] Open
Abstract
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.
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49
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Stinson ZS, Davelaar CMF, Kiebzak GM, Edmonds EW. Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making? Orthop J Sports Med 2021; 9:23259671211046258. [PMID: 34676272 PMCID: PMC8524719 DOI: 10.1177/23259671211046258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Personal and professional biases can affect decision-making regarding
important issues in pediatric sports medicine. Gaining insight into the
opinions of health care professionals who specialize in pediatric sports
medicine will provide information that may be useful for directing ongoing
research in this field. Hypothesis: It was hypothesized that surgeons would demonstrate bias toward early
surgical intervention versus nonsurgeons. In addition, it was hypothesized
that youth sports medicine professionals who were parents of a child with a
previous major sports injury or concussion would be less likely to allow
their child to play American tackle football or return to football after a
concussion. Study Design: Cross-sectional study. Methods: An online survey was provided to the active members of the Pediatric Research
in Sports Medicine Society. We used both professional background information
and responses to questions related to personal experiences with youth sports
injuries to determine potential factors associated with underlying biases.
Survey responses among subgroups were compared using the Fisher exact test.
The Pearson correlation coefficient was used to evaluate years in practice
versus opioid use. Results: Of the survey participants, 62.5% were pediatric surgeons, and 37.5%
represented different nonsurgical youth sports medicine professions.
Surgeons were less likely than nonsurgeons to agree to allow their child to
return to football after sustaining a concussion and completing a concussion
protocol (48% vs 76%, P = .013). Surgeons were more likely
than nonsurgeons to agree to both elective shoulder stabilization after a
first-time dislocation and elective drilling of a stable knee
osteochondritis dissecans (OCD) before nonoperative treatment (41% vs 10%,
P = .003 and 52% vs 23%, P = .013,
respectively). Those who reported having a child with a concussion history
were more likely to support him or her returning to football after a
concussion (65% vs 33%, P = .026). Conclusion: Surgeons were more likely to favor elective shoulder-stabilization surgery
after a first-time dislocation and drilling of a stable knee OCD instead of
nonoperative management. Personal experience of having a child who sustained
a major sports injury or concussion did not demonstrate a bias against
participation in football or return to football after a concussion.
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50
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Nishino K, Hashimoto Y, Nishida Y, Yamasaki S, Nakamura H. An adult case of spontaneous healing of concurrent osteochondritis dissecans of the lateral femoral condyle after saucerization with meniscal repair for discoid lateral meniscus: A case report. Int J Surg Case Rep 2021; 87:106427. [PMID: 34583262 PMCID: PMC8476636 DOI: 10.1016/j.ijscr.2021.106427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear. CASE PRESENTATION A 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points. CONCLUSIONS We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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