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Nguyen JC, Patel V, Kiani SN, Guzek R, Williams BA, Ganley TJ. Patellar osteochondritis dissecans: maturation-dependent patellofemoral joint characteristics. Pediatr Radiol 2024; 54:977-987. [PMID: 38573353 DOI: 10.1007/s00247-024-05914-8] [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: 11/26/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The likelihood of healing of osteochondritis dissecans decreases with skeletal maturity and there are theories that abnormal biomechanical forces contribute to the development and progression of these lesions. OBJECTIVE To characterize, according to regional skeletal maturity, the morphology and alignment indices of the patellofemoral joint on MRI in patients with patellar osteochondritis dissecans. MATERIALS AND METHODS MRI examinations of patients with patellar osteochondritis dissecans obtained between January 2008 and May 2023 were retrospectively reviewed to determine regional skeletal maturity, osteochondritis dissecans lesion size and location, patellar and trochlear morphology (Wiberg/Dejour classifications), and to calculate trochlear sulcus angles, trochlear depth index, lateral trochlear inclination, Insall-Salvati index, Caton-Deschamps index, patellar tendon-lateral trochlear ridge, and tibial tubercle-trochlear groove distances. Values were compared between skeletally immature and mature groups. RESULTS Sixty-eight children (22 girls, 46 boys, age: 14.0 ± 1.7 years) yielded 74 knees with patellar osteochondritis dissecans lesions, 14 (19%) of which were skeletally mature. The most common anatomic location was over the central patella [median ridge (34/74 - 46%) on the axial images and over the middle third (45/74 - 61%) on the sagittal images]. Overall, mean trochlear sulcus angle (high, 151 ± 11°), trochlear depth index (low, 2.8 ± 1.4 mm), and Insall-Salvati index (borderline, 1.3 ± 0.1) were abnormal for the entire sample. Skeletally mature knees were significantly more likely to have higher (more dysplastic) Dejour types when compared to skeletally immature knees (p < 0.01). Knees in the mature group, compared to immature, had significantly more abnormal mean lateral trochlear inclination (15 ± 8° vs. 19 ± 6°, p = 0.03) and patellar tendon-lateral trochlear ridge distance (5.55 ± 4.31 mm vs. 2.89 ± 4.69 mm, p = 0.04). Half of the knees had ≥ 4 abnormal features that predispose to patellofemoral maltracking; mature knees were significantly (p = 0.02) more likely to have a higher number of abnormal features (> 6 features, 7/14, 50.0%) versus immature knees (0-3 features, 33/60, 55.0%). CONCLUSION In children with patellar osteochondritis dissecans, abnormal patellofemoral morphology and alignment indices were common in all patients and more severe in mature knees.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Vandan Patel
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sara N Kiani
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ryan Guzek
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brendan A Williams
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Theodore J Ganley
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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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. [PMID: 38686565 DOI: 10.1002/ksa.12214] [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] [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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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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Tóth F, Nissi MJ, Armstrong AR, Buko EO, Johnson CP. Epiphyseal cartilage vascular architecture at the distal humeral osteochondritis dissecans predilection site in juvenile pigs. J Orthop Res 2024; 42:737-744. [PMID: 37971288 PMCID: PMC10978299 DOI: 10.1002/jor.25732] [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: 05/21/2023] [Revised: 09/08/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Failure of endochondral ossification due to interruption of the vascular supply to the epiphyseal cartilage is a critical step in the development of osteochondritis dissecans (OCD). Herein we describe the vascular architecture of the distal humeral epiphyseal cartilage in pigs and identify characteristic features that have been associated with sites predisposed to OCD development across species. Distal humeral specimens were harvested from pigs (n = 5, ages = 1, 10, 18, 30, and, 42 days old) and imaged at 9.4T magnetic resonance imaging (MRI) using a 3D gradient recalled echo sequence. The MRI data were processed using a quantitative susceptibility mapping (QSM) pipeline to visualize the vascular architecture. Specimens were also evaluated histologically to identify the presence of ischemic epiphyseal cartilage necrosis (osteochondrosis [OC]-latens) and associated failure of endochondral ossification (OC-manifesta). The QSM data enabled visualization of two distinct vascular beds arising from the perichondrium at the lateral and medial aspects of the distal humeral epiphysis. Elongated vessels originating from these beds coursed axially to supply the lateral and medial thirds of epiphyseal cartilage. At 18 days of age and older, a shift from perichondrial to transosseous blood supply was noted axially, which appeared more pronounced on the lateral side. This shift coincided with histologic identification of OC-latens (30- and 42-day-old specimens) and OC-manifesta (18- and 42-day-old specimens) lesions in the corresponding regions. The vascular anatomy and its evolution at the distal humeral epiphysis closely resembles that previously reported at predilection sites of knee OCD, suggesting a shared pathophysiology between the knee and elbow joints.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
| | - Mikko J Nissi
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Alexandra R Armstrong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
| | - Erick O Buko
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Casey P Johnson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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Leal J, Hones KM, Hao KA, Slaton PT, Roach RP. Arthroscopy and Microfracture for Osteochondritis Dissecans of the Capitellum in Adolescent Athletes Shows Favorable Return to Sport: A Systematic Review. Arthroscopy 2024; 40:1325-1339. [PMID: 37714441 DOI: 10.1016/j.arthro.2023.08.075] [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: 04/29/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To assess return to sport (RTS) in the high-risk young athlete population with capitellar osteochondritis dissecans (OCD) undergoing arthroscopic microfracture (MFX) with or without debridement as well as associated indications, clinical outcomes, radiographic outcomes, and complications. METHODS A literature search of all published literature in the English language from PubMed, EMBASE, Scopus, and Cochrane from database inception to April 4, 2022, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies presented demographics and outcomes for adolescent (<21 years old) patients diagnosed with capitellar OCD who underwent arthroscopic MFX (or drilling/subchondral drilling) or MFX (or drilling/subchondral drilling) with debridement (or loose body removal/chondroplasty). Studies containing multiple surgical techniques that did not distinguish characteristics and outcomes of individual patients by surgical technique were excluded. Additionally, if there was overlap in patient populations between 2 studies, the study with less outcome data was excluded. Extracted data included study properties, patient demographics, lesion characteristics, surgery details, and patient outcomes, including range of motion, outcome scores, and RTS rates. Bias was assessed via the Methodological Index for Non-Randomized Studies (MINORS). RESULTS Nine studies of 136 patients and 138 elbows met criteria. Included articles were published between 2005 and 2020 with MINORS scores of 8 to 14 (50% to 88%). The age ranged from 12.7 to 15.7 years with most patients being involved in baseball or gymnastics and a rate of dominant elbow involvement of 55% to 100%. Patient follow-up ranged from 16 to 138 months. All 9 studies reported RTS, ranging from 65% to 100%. Six of these studies categorized the level to which the patient returned, with patients RTS at the same level of competition ranging from 60% to 100%. Six studies reported complications, with a range rate of 0% to 43%; there were a total of 10 complications, 7 of which required reoperations. CONCLUSIONS Arthroscopic MFX with or without arthroscopic debridement is a safe and effective treatment for OCD lesions of the capitellum in young, athletic patients. Included studies reported improved clinical, radiographic, and patient-reported outcomes. Aside from 1 study reporting an RTS of 65%, the rate of RTS ranged from 86% to 100%. The percentage of patients returning to sport at the same level of competition ranged from 60% to 100% with a time to RTS ranging from 4.1 to 5 months. A single study reported a complication rate of 43%, while remaining studies reported complication rates between 0% and 19%, with loose bodies being the most common complication requiring reoperation. Follow-up ranged from 16 to 138 months. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Justin Leal
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A..
| | - Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A
| | | | - Ryan P Roach
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
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De Nordenflycht D, Matus G, Aravena JP, Toloza H. Osteochondritis dissecans of the temporomandibular joint: a scoping review. Oral Maxillofac Surg 2024; 28:29-38. [PMID: 36631710 DOI: 10.1007/s10006-022-01134-2] [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: 04/13/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ). METHODS An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'Temporomandibular Joint Disorders', 'Osteochondritis Dissecans', 'Joint Loose Bodies' and 'Temporomandibular Joint'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS Ten articles were included in the analysis - six case reports, one case series, one retrospective study, one comparative study and one correlational study - with a total of 39 patients. The most frequently reported clinical presentation involved TMJ pain, locked jaw and articular noises (clicking and crepitus). The imaging methods used to identify OCD were radiographs, tomography, arthrography and magnetic resonance imaging. The reported imaging findings varied widely, but the most frequent were (single or multiple) calcified intra-articular loose bodies, signs of degenerative osseous changes, disc displacements, widening of the joint space and alterations in condylar morphology. Seven articles reported treatments (surgical or conservative), but the treatment outcome was not reported in all of the articles, which makes it difficult to make comparisons. CONCLUSION OCD of the TMJ may present various non-specific clinical characteristics, and given the heterogeneous imaging findings, multiplanar images are required for an accurate diagnosis. Finally, the results do not allow recommending a standard treatment for OCD of the TMJ.
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Affiliation(s)
- Diego De Nordenflycht
- Universidad Andres Bello, Faculty of Dentistry, Quillota # 980 Torre E, Viña del Mar, Chile.
| | | | | | - Héctor Toloza
- Universidad Andres Bello, Faculty of Dentistry, Quillota # 980 Torre E, Viña del Mar, Chile
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Oeding JF, Graden NR, Krych AJ, Sanchez-Sotelo J, Barlow JD, Camp CL. Early Arthroscopic Debridement May Be More Cost-Effective Than Nonoperative Management for Symptomatic Osteochondritis Dissecans Lesions of the Capitellum. Arthrosc Sports Med Rehabil 2024; 6:100836. [PMID: 38162589 PMCID: PMC10756960 DOI: 10.1016/j.asmr.2023.100836] [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: 07/12/2023] [Accepted: 10/31/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose To compare the cost-effectiveness of an initial trial of nonoperative treatment to that of early arthroscopic debridement for stable osteochondritis dissecans (OCD) lesions of the capitellum. Methods A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 simulated patients undergoing nonoperative management versus early arthroscopic debridement for stable OCD lesions of the capitellum. Health utility values, treatment success rates, and transition probabilities were derived from the published literature. Costs were determined on the basis of the typical patient undergoing each treatment strategy at our institution. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results Mean total costs resulting from nonoperative management and early arthroscopic debridement were $5,330 and $21,672, respectively. On average, early arthroscopic debridement produced an additional 0.64 QALYS, resulting in an ICER of $25,245/QALY, which falls well below the widely accepted $50,000 willingness-to-pay (WTP) threshold. Overall, early arthroscopic debridement was determined to be the preferred cost-effective strategy in 69% of patients included in the microsimulation model. Conclusion Results of the Monte Carlo microsimulation and probabilistic sensitivity analysis demonstrated early arthroscopic debridement to be a cost-effective treatment strategy for the majority of stable OCD lesions of the capitellum. Although early arthroscopic debridement was associated with higher total costs, the increase in QALYS that resulted from early surgery was enough to justify the cost difference based on an ICER substantially below the $50,000 WTP threshold. Level of Evidence Level III, economic computer simulation model.
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Affiliation(s)
- Jacob F. Oeding
- School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, U.S.A
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Nathan R. Graden
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Jonathan D. Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Killian G, Wagner RD, Plain M, Chhabra AB. A Comparison of Treatment of OCD Lesions of the Capitellum With Osteochondral Autograft and Allograft Transplantation. J Hand Surg Am 2024; 49:150-159. [PMID: 37865912 DOI: 10.1016/j.jhsa.2023.08.012] [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: 04/17/2023] [Revised: 06/12/2023] [Accepted: 08/27/2023] [Indexed: 10/23/2023]
Abstract
Osteochondritis dissecans (OCD) of the capitellum occurs relatively infrequently but can be found in young overhead-throwing athletes, most commonly in baseball players and gymnasts. Although non-operative management can effectively treat stable lesions, unstable lesions can lead to debilitating symptoms of the elbow and diminished quality of life without surgical intervention. This article reviews methods of treating OCD of the capitellum categorized by stability, size, and patient characteristics, and seeks to familiarize the reader with the appropriate selection of osteochondral allograft versus autograft in treating large, unstable lesions. We complement this review with 3 case examples, each using either an osteochondral autograft or allograft, and discuss the decision-making methodology used in each case.
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Affiliation(s)
- Grant Killian
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Ryan D Wagner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Megan Plain
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
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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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11
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Carneiro BC, Ormond Filho AG, Guimarães JB. MRI of Pediatric Foot and Ankle Conditions. Foot Ankle Clin 2023; 28:681-695. [PMID: 37536825 DOI: 10.1016/j.fcl.2023.04.007] [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: 08/05/2023]
Abstract
The increase in competitive sports practice among children and lack of ionizing radiation have resulted in a higher demand for MRI examinations. MRI of the children skeleton has some particularities that can lead orthopedists, pediatricians, and radiologists to diagnostic errors. The foot and ankle have several bones with abundant radiolucent and high signal intensity cartilage in several ossification centers, apophysis and physis, that can make this interpretation even harder. The present revision aims to show, how to differentiate between normal developmental findings and anatomic variants from pathologic conditions, whether mechanical, inflammatory, infectious, or neoplastic.
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Affiliation(s)
- Bruno Cerretti Carneiro
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, SP, Brazil; Department of Diagnostic Imaging, United Health Group Brazil, São Paulo, SP, Brazil
| | - Alípio G Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, SP, Brazil
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, SP, Brazil; Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, SP, Brazil.
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12
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Sylvia SM, Stokes DJ, McCarthy TP, Hassebrock JD, Shinsako KK, Frank RM. Low-Profile Cartilage Repair With Knotless All-Suture Anchors: Surgical Technique. Arthrosc Tech 2023; 12:e1127-e1131. [PMID: 37533926 PMCID: PMC10390841 DOI: 10.1016/j.eats.2023.02.051] [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: 02/06/2023] [Accepted: 02/25/2023] [Indexed: 08/04/2023] Open
Abstract
Osteochondral and pure chondral lesions of the knee are common after patellar dislocations. There are multiple described techniques for the fixation of these lesions, including metallic screws, bioabsorbable screws, bioabsorbable implants, and suture devices. The purpose of this article is to describe a surgical technique for surgical fixation of a lateral condyle chondral lesion using knotless all-suture anchors, with second-look knee arthroscopy illustrating healing of the cartilage repair.
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Affiliation(s)
- Stephen M. Sylvia
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Daniel J. Stokes
- Boulder; and the University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Timothy P. McCarthy
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Jeffrey D. Hassebrock
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Kevin K. Shinsako
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
- Boulder; and the University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Rachel M. Frank
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
- Boulder; and the University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
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13
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Anastasio AT, Bagheri K, Peairs EM, Grant C, Adams SB. Juvenile Osteochondral Lesions of the Talus: Current Concepts Review and an Update on the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050884. [PMID: 37238431 DOI: 10.3390/children10050884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Osteochondral lesions of the talus (OLTs) are lesions that occur before the physis closes and are frequently associated with acute ankle trauma. These lesions are often difficult to diagnose due to swelling and inflammation that are present after the initial injury. A growing body of literature has assessed the effects of OLTs in the adult population. However, the literature examining these lesions in the juvenile population is sparse. The purpose of this review is to provide a thorough understanding of OLTs, with a specific focus on the juvenile population. We evaluate the recent literature regarding the outcomes of various surgical treatment; modalities in the pediatric patient. While the outcomes after surgical treatment of pediatric OLTs are generally favorable, the paucity of investigation in this demographic is alarming. Further research is needed to better inform practitioners and families regarding these outcomes, as treatment plans are highly dependent on the individual patient in question.
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Affiliation(s)
- Albert T Anastasio
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kian Bagheri
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA
- Campbell University School of Osteopathic, Lillington, NC 27546, USA
| | - Emily M Peairs
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Caitlin Grant
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA
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14
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Hernandez SG, McQueen RG, Erickson JB. Femoral head osteochondritis dissecans in a child. BMJ Case Rep 2023; 16:16/3/e253375. [PMID: 36931689 PMCID: PMC10030482 DOI: 10.1136/bcr-2022-253375] [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] [Indexed: 03/19/2023] Open
Abstract
This case report describes an early-adolescent boy with an osteochondritis dissecans (OCD) lesion of the left femoral head secondary to significant acetabular dysplasia and coxa valga of the proximal femur. Patient underwent left proximal femur varus osteotomy. Follow-up imaging demonstrates healing and resolution of the OCD lesion. Future plan for left hip is periacetabular osteotomy, following triradiate cartilage closure, to correct acetabular dysplasia. The aim of this case report is to support clinicians in the assessment and treatment of this rare condition.
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Affiliation(s)
- Sean G Hernandez
- Pediatric Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ryan G McQueen
- Pediatric Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John B Erickson
- Pediatric Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Pediatric Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
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15
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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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16
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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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17
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Osteochondritis Dissecans of the Capitellum of the Elbow: Improved Outcomes in Surgically Treated Versus Nonoperatively Treated Patients at Long-Term Follow-up. Arthrosc Sports Med Rehabil 2023; 5:e435-e444. [PMID: 37101861 PMCID: PMC10123431 DOI: 10.1016/j.asmr.2023.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/05/2023] [Indexed: 03/21/2023] Open
Abstract
Purpose To (1) report the long-term outcomes associated with both operative and nonoperative management of capitellar osteochondritis dissecans (OCD), (2) identify factors associated with failure of nonoperative management, and (3) determine whether delay in surgery affects final outcomes. Methods All patients who received a diagnosis of capitellar OCD from 1995-2020 within a geographic cohort were included. Medical records, imaging studies, and operative reports were manually reviewed to record demographic data, treatment strategies, and outcomes. The cohort was divided into 3 groups: (1) nonoperative management, (2) early surgery, and (3) delayed surgery. Delayed surgery (surgery ≥6 months after symptom onset) was considered failure of nonoperative management. Results Fifty elbows with a mean follow-up period of 10.5 years (median, 10.3 years; range, 1-25 years) were studied. Of these, 7 (14%) were definitively treated nonoperatively, 16 (32%) underwent delayed surgery after at least 6 months of failed nonoperative treatment, and 27 (54%) underwent early surgical intervention. When compared with nonoperative management, surgical management resulted in superior Mayo Elbow Performance Index pain scores (40.1 vs 33, P = .04), fewer mechanical symptoms (9% vs 50%, P < .01), and better elbow flexion (141° vs 131°, P = .01) at long-term follow-up. Older patients trended toward increased failure of nonoperative management (P = .06). The presence of an intra-articular loose body predicted failure of nonoperative management (P = .01; odds ratio, 13). Plain radiography and magnetic resonance imaging had poor sensitivities for identifying loose bodies (27% and 40%, respectively). Differences in outcomes after early versus delayed surgical management were not observed. Conclusions Nonoperative management of capitellar OCD failed 70% of the time. Elbows that did not undergo surgery had slightly more symptoms and decreased functional outcomes compared with those treated surgically. The greatest predictors of failure of nonoperative treatment were older age and presence of a loose body; however, an initial trial of nonoperative treatment did not adversely impact the success of future surgery. Level of Evidence Level III, retrospective cohort study.
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18
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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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19
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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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20
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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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21
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Zbýň Š, Kajabi AW, Nouraee CM, Ludwig KD, Johnson CP, Tompkins MA, Nelson BJ, Zhang L, Moeller S, Marette S, Metzger GJ, Carlson CS, Ellermann JM. Evaluation of lesion and overlying articular cartilage in patients with juvenile osteochondritis dissecans of the knee using quantitative diffusion MRI. J Orthop Res 2022. [PMID: 36484124 DOI: 10.1002/jor.25505] [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: 08/01/2022] [Revised: 11/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Current clinical MRI of patients with juvenile osteochondritis dissecans (JOCD) is limited by the low reproducibility of lesion instability evaluation and inability to predict which lesions will heal after nonoperative treatment and which will later require surgery. The aim of this study is to verify the ability of apparent diffusion coefficient (ADC) to detect differences in lesion microstructure between different JOCD stages, treatment groups, and healthy, unaffected contralateral knees. Pediatric patients with JOCD received quantitative diffusion MRI between January 2016 and September 2020 in this prospective research study. A disease stage (I-IV) and stability of each JOCD lesion was evaluated. ADCs were calculated in progeny lesion, interface, parent bone, cartilage overlying lesion, control bone, and control cartilage regions. ADC differences were evaluated using linear mixed models with Bonferroni correction. Evaluated were 30 patients (mean age, 13 years; 21 males), with 40 JOCD-affected and 12 healthy knees. Nine patients received surgical treatment after MRI. Negative Spearman rank correlations were found between ADCs and JOCD stage in the progeny lesion (ρ = -0.572; p < 0.001), interface (ρ = -0.324; p = 0.041), and parent bone (ρ = -0.610; p < 0.001), demonstrating the sensitivity of ADC to microstructural differences in lesions at different JOCD stages. We observed a significant increase in the interface ADCs (p = 0.007) between operative (mean [95% CI] = 1.79 [1.56-2.01] × 10-3 mm2 /s) and nonoperative group (1.27 [0.98-1.57] × 10-3 mm2 /s). Quantitative diffusion MRI detects microstructural differences in lesions at different stages of JOCD progression towards healing and reveals differences between patients assigned for operative versus nonoperative treatment.
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Affiliation(s)
- Štefan Zbýň
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abdul Wahed Kajabi
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cyrus M Nouraee
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kai D Ludwig
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Casey P Johnson
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopedic Center, Minneapolis, Minnesota, USA.,Gillette Children's Specialty Healthcare, St. Paul, Minnesota, USA
| | - Bradley J Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopedic Center, Minneapolis, Minnesota, USA
| | - Lin Zhang
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Steen Moeller
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shelly Marette
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gregory J Metzger
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Jutta M Ellermann
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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22
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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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23
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Gillis S, Deltoff MN. Capitellar osteochondritis dissecans in an elite pre-adolescent gymnast: a case report and overview. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2022; 66:282-292. [PMID: 36818357 PMCID: PMC9914824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Objective Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in pediatric athletic trauma, particularly during the pre-puberty through adolescent years of rapid skeletal growth. This paper presents the diagnosis and management of osteochondritis dissecans in its third most common location, the elbow, a presentation of which chiropractors should be aware, including the importance of timely diagnosis and appropriate treatment. Clinical features A 9-year-old elite gymnast presented at a chiropractic clinic with elbow pain and restricted range of motion after a fall during training. Following multidisciplinary involvement, the diagnosis was eventually made as osteochondritis dissecans. Intervention and outcomes The patient underwent successful arthroscopic surgery in order to remove the osteochondral fragment, followed by a specific regimen of rehabilitation exercises, which helped to enhance and accelerate optimal healing for her return to athletic activity. Summary This case reminds the practicing chiropractor of the valuable role he/she can play in a multidisciplinary management of pediatric sports trauma, particularly in diagnosis and post-surgical care. A literature review presents a synopsis of the reported clinical presentations, diagnostic assessment and therapeutic options for capitellar osteochondritis dissecans.
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24
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Nissen C, Bohn DC, Crepeau A, Edmonds E, Ganley T, Kostyun R, Lawrence JTR, Pace JL, Saluan P, Uquillas C, Wall E, Wilson PL, Bae DS. Reliability of Radiographic Imaging Characteristics for Osteochondritis Dissecans of the Capitellum. Am J Sports Med 2022; 50:3948-3955. [PMID: 36326355 DOI: 10.1177/03635465221130452] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND A primary challenge in the treatment of capitellar osteochondritis dissecans (OCD) is accurate imaging assessment. Radiographic classification consensus is not available in the current literature, and correlation of radiographs with lesion stability and resultant best treatment is lacking. PURPOSE To determine the inter- and intrarater reliability of the presence or absence and common radiographic characteristics of capitellar OCD lesions. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS Anteroposterior, lateral, and oblique radiographs for 29 cases were reviewed by 7 orthopaedic surgeons. Images were assessed for elbow anthropometry and morphology, OCD presence, lesion characteristics, the presence of progeny bone and progeny features, and radial head abnormalities. Intra- and interrater reliability was assessed using Fleiss and Cohen kappa for nominal variables and intraclass correlation coefficients (ICCs) for continuous variables. RESULTS Surgeons demonstrated substantial to excellent inter- and intrarater reliability when assessing elbow characteristics: anthropometric (interrater ICC, 0.94-0.99; intrarater ICC, 0.82-0.96) and morphologic (Fleiss, 0.61-0.76; Cohen, 0.68). When the OCD lesion was assessed, fair to moderate interrater agreement was found for classifying the absence or presence of a lesion (Fleiss, 0.28-0.46) and the location of the OCD (Fleiss, 0.24-0.52), poor agreement for assessing the contour of the lesion (Fleiss, 0.00-0.09), and excellent agreement for measuring the size of the lesion (ICC, 0.82-0.94). Poor to fair interrater agreement was found for radial head abnormalities (Fleiss, 0.00-0.27). Progeny bone visualization and fragmentation demonstrated moderate interrater agreement (Fleiss, 0.43-0.47) where displacement of the bone demonstrated poor interrater agreement (Fleiss, 0.11-0.16). Intrarater agreement for OCD lesion characteristics, progeny bone visualization, and progeny bone features was moderate to excellent. CONCLUSION Given only the fair to moderate agreement among raters for identifying OCD on radiographs, this imaging modality may not serve as a dependable screening tool in isolation. Additional imaging should be obtained if the clinical presentation suggests capitellar OCD and a definitive diagnosis is not possible with radiographs. However, clinicians can reliability measure the size of radiographically apparent OCD, suggesting that radiographs may serve as an appropriate imaging modality for follow-up care.
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Affiliation(s)
| | - Carl Nissen
- PRiSM Sports Medicine, Hartford, Connecticut, USA; Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | - Allison Crepeau
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Eric Edmonds
- Rady Children's Hospital, San Diego, California, USA; University of California San Diego, San Diego, California, USA
| | - Theodore Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Regina Kostyun
- Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
| | - J Todd R Lawrence
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J Lee Pace
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
| | | | - Carlos Uquillas
- Cedars Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Eric Wall
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Philip L Wilson
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Donald S Bae
- Boston Children's Hospital, Boston, Massachusetts, USA.,Investigation performed at the Hartford Hospital's Bone and Joint Institute, Hartford, Connecticut, USA
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25
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Uvodich ME, Braig ZV, Reinholz AK, Till SE, O’Driscoll SW, Morrey ME, Sanchez-Sotelo J, Camp CL. Incidence and Epidemiology of Symptomatic Capitellar Osteochondritis Dissecans of the Elbow: A United States Population-Based Study Over a 25-Year Period. Orthop J Sports Med 2022; 10:23259671221135933. [PMID: 36419473 PMCID: PMC9677311 DOI: 10.1177/23259671221135933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background There are limited data on the incidence of capitellar osteochondritis dissecans (OCD) in the United States (US) population. Purpose To determine the incidence of symptomatic capitellar OCD in a representative US subpopulation and identify changes in its incidence over time and to investigate the relationship between the incidence of capitellar OCD and patient sex and age. Study Design Descriptive epidemiology study. Methods A retrospective review was performed of patients aged ≤24 years from Olmsted County, Minnesota, with symptomatic capitellar OCD over a 25-year period (1995-2019). Patients with acute osteochondral injuries, Panner disease, and hereditary arthropathy were excluded. Poisson regression was utilized to identify the predictors of a capitellar OCD diagnosis. Incidence rates (per 100,000) were assessed for changes over time. Age groups of younger (10-15 years) versus older (16-24 years) patients were compared. Results A total of 45 patients (78% male) were identified. The mean age was 14.5 years (range, 10-24 years); 31 patients were in the younger group, and 14 patients were in the older group. Sport participation was seen in 89%of patients; 90% were overhead athletes, and 58% were throwing athletes. The incidence of capitellar OCD was 6.0 per 100,000 overall, 9.5 per 100,000 for male patients, and 2.6 per 100,000 for female patients. The incidence was highest for male patients in the younger group (15.3/100,000) and lowest for female patients in the older group (0.8/100,000). The estimated incidence rate ratio for younger versus older patients was 3.3 (P < .001), and the incidence rate ratio for male versus female patients was 3.5 (P < .001). There were no changes in the incidence of capitellar OCD over time as a continuous or 5-year categorical variable (P = .290 and P = .460, respectively). Overall, 82% of patients were treated surgically. There were no significant changes in surgical rates over time. Conclusion In this US subpopulation, the overall incidence of symptomatic capitellar OCD between the ages of 10 and 24 years was 6.0 per 100,000 over the 25-year period studied, which is higher than previously reported US estimates. Incidence rates and treatment strategies did not change significantly over time.
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Affiliation(s)
- Mason E. Uvodich
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Zachary V. Braig
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Sara E. Till
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Shawn W. O’Driscoll
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Mark E. Morrey
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Christopher L. Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic,
Rochester, Minnesota, USA.,Christopher L. Camp, MD, Mayo Clinic, 200 First Street SW,
Rochester, MN 55905, USA (
)
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26
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Ando A, Yamagami N, Koide M, Hagiwara Y. Osteochondritis dissecans of the glenoid in gymnasts: Report of two cases. J Orthop Sci 2022; 27:1349-1353. [PMID: 32107134 DOI: 10.1016/j.jos.2020.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Akira Ando
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumiku, Sendai, 981-3217, Japan
| | - Naoki Yamagami
- Department of Orthopaedic Surgery, Anshin Hospital, 1-4-12 Koutou Minamimachi, Chuoku, Kobe, 650-0047, Japan.
| | - Masashi Koide
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumiku, Sendai, 981-3217, Japan
| | - Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
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27
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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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28
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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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29
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Malik SS, Rasidovic D, Saeed A, Jordan RW, Maclean S, I Bain G. Management of osteochondritis dissecans (OCD) of the elbow trochlea in the adolescent population: A systematic review. Shoulder Elbow 2022; 14:415-425. [PMID: 35846402 PMCID: PMC9284302 DOI: 10.1177/17585732221079585] [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: 11/01/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Abstract
Background Elbow trochlea osteochondritis dissecans (OCD) is rare with limited information on it. The aim of this systematic review is to assess the published evidence on trochlea OCD in terms of presenting symptoms, location of OCD and outcome of management in adolescent patients. Patient & Methods A review of the online databases MEDLINE and Embase was conducted according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting on any aspect of trochlea OCD management were eligible for inclusion and appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results 16 studies were eligible for inclusion with a total of 75 elbow. Mean age was 14 years (8-19) of which 46 were males. The main presenting symptoms were pain (95%). Non-operative care was reported in 86% of elbows with resolution of symptoms in 76%. Surgical management was described in 14%. There were equal number of arthroscopic and open procedures. 94% had successfully resolution of symptoms post-operatively. Conclusion Elbow trochlea OCD is a rare pathology and one that can be managed non-operatively in the majority of cases with good resolution of symptoms. However, if this fails, operative options are available with excellent results reported. Level of evidence Level IV, Systematic review.
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Affiliation(s)
| | | | - Abu Saeed
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Robert W Jordan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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30
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Holwein C, Jungmann P, Suchowierski J, Gersing A, Wörtler K, Brucker P, Angele P, Imhoff A, Vogt S. Sandwich Technique for Large Osteochondral Lesions of the Knee. Cartilage 2022; 13:19476035221102571. [PMID: 35906752 PMCID: PMC9340910 DOI: 10.1177/19476035221102571] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years. DESIGN Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). RESULTS Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up (P < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant (P = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months (P < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months (P < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up (P < 0.05) but did not correlate with clinical scores or defect filling. CONCLUSION MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients' activity levels remain low, even 2 years after surgery.
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Affiliation(s)
- C. Holwein
- Orthopädisch-Unfallchirurgisches Zentrum, Alb Fils Kliniken GmbH, Göppingen, Germany,Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,C. Holwein, Rohrbachstraße 11, 73337 Bad Überkingen, Germany.
| | - P.M. Jungmann
- Zentrales Röntgeninstitut Kantonsspital Graubünden, Spital Davos AG, Davos, Switzerland
| | - J. Suchowierski
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - A.S. Gersing
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,Institut für Neuroradiologie, Klinikum der Universität München, München, Germany
| | - K. Wörtler
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - P.U. Brucker
- MVZ ATOS Klinik München, München, Germany,Orthopädie in der Ottostraße, München, Germany
| | - P. Angele
- Klinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany,Sporthopaedicum Regensburg, Regensburg, Germany
| | - A.B. Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - S. Vogt
- Sportorthopädie und arthroskopische Chirurgie, Hessing Stiftung, Augsburg, Germany
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31
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Zbýň Š, Santiago C, Johnson CP, Ludwig KD, Zhang L, Marette S, Tompkins MA, Nelson BJ, Takahashi T, Metzger GJ, Carlson CS, Ellermann JM. Compositional evaluation of lesion and parent bone in patients with juvenile osteochondritis dissecans of the knee using T 2 * mapping. J Orthop Res 2022; 40:1632-1644. [PMID: 34637164 PMCID: PMC9001743 DOI: 10.1002/jor.25187] [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] [Received: 03/19/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
Juvenile osteochondritis dissecans (JOCD) lesions contain cartilaginous, fibrous and osseous tissues which are difficult to distinguish with clinical, morphological magnetic resonance imaging (MRI). Quantitative T2 * mapping has earlier been used to evaluate microstructure and composition of all aforementioned tissues as well as bone mineral density. However, the ability of T2 * mapping to detect changes in tissue composition between different JOCD lesion regions, different disease stages, and between stable and unstable lesions has not been demonstrated. This study analyzed morphological and T2 * MRI data from 25 patients (median age, 12.1 years) with 34 JOCD-affected and 13 healthy knees. Each lesion was assigned a stage reflecting the natural history of JOCD, with stages I and IV representing early and healed lesion, respectively. T2 * values were evaluated within the progeny lesion, interface and parent bone of each lesion and in the control bone region. T2 * was negatively correlated with JOCD stage in progeny lesion (ρ = -0.871; p < 0.001) and interface regions (ρ = -0.649; p < 0.001). Stage IV progeny showed significantly lower T2 * than control bone (p = 0.028). T2 * was significantly lower in parent bone than in control bone of patients with stable lesions (p = 0.009), but not in patients with unstable lesions (p = 0.14). Clinical significance: T2 * mapping enables differentiation between different stages of JOCD and quantitative measurement of the ossification degree in progeny lesion and interface. The observed T2 * decrease in healed and stable lesions may indicate increased bone density as a result of the active repair process. T2 * mapping provides quantitative information about JOCD lesion composition.
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Affiliation(s)
- Štefan Zbýň
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cassiano Santiago
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Casey P. Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA,Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Kai D. Ludwig
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shelly Marette
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc A. Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA,TRIA Orthopedic Center, Minneapolis, Minnesota, USA,Gillette Children’s Specialty Healthcare, St. Paul, Minnesota, USA
| | - Bradley J. Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA,TRIA Orthopedic Center, Minneapolis, Minnesota, USA
| | - Takashi Takahashi
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gregory J. Metzger
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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Pallamar M, Eder T, Ganger R, Farr S. Surgical treatment of atraumatic osteochondrosis dissecans of the immature talus-Clinical results and prevalence of radiographic joint degeneration after a median follow-up of 72.5 months. Foot Ankle Surg 2022; 28:557-563. [PMID: 34020882 DOI: 10.1016/j.fas.2021.05.007] [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: 02/25/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to assess the clinical and radiographic outcomes of different surgical procedures in atraumatic osteochondrosis dissecans (OCD) of the talus in youth and adolescence. METHODS 32 joints in 30 patients (mean age 14.7 ± 2.2 years) were evaluated. Numeric Rating Scale (NRS), Foot and Functional Index (FFI), American Orthopedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Pediatric Outcome Data Collection Instrument (PODCI), and sport participation were recorded. We compared preoperative and follow-up ankle radiographs to identify specific features in the OCD morphology and any signs of joint degeneration. RESULTS After a median follow-up period of 72.5 months the drilling group showed significantly better scores than the combined fixation and reconstruction groups (AOFAS, p = 0.024; PODCI, p = 0.003; NRS, p = 0.027). Signs of joint degeneration were observed in 50% of all ankles, especially in those treated by OCD-fixation and reconstruction. CONCLUSIONS Advanced fixation and reconstruction procedures in unstable and non-salvageable atraumatic talar OCD resulted in inferior clinical scores and a higher prevalence of joint degeneration than drilling procedures in stable OCD in young patients.
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Affiliation(s)
- Matthias Pallamar
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstraße 109, 1130 Vienna, Austria.
| | - Theresa Eder
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstraße 109, 1130 Vienna, Austria
| | - Rudolf Ganger
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstraße 109, 1130 Vienna, Austria.
| | - Sebastian Farr
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstraße 109, 1130 Vienna, Austria.
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Swindell HW, Kerzner B, Obioha OA, Fortier LM, Khan ZA, Dasari SP, Mameri ES, Gelber PE, Chahla J. Osteochondral Allograft Transplantation of the Lateral Femoral Condyle and Distal Femoral Osteotomy in the Setting of Failed Osteochondritis Dissecans Fixation. Arthrosc Tech 2022; 11:e1301-e1310. [PMID: 35936851 PMCID: PMC9353333 DOI: 10.1016/j.eats.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 02/03/2023] Open
Abstract
Osteochondritis dissecans (OCD) is a pathologic condition, most commonly affecting the knee joint in adolescents and young adults, although pathology can also be found at the elbow and ankle. Lesions to the medial femoral condyle are classically associated with varus alignment, while lesions to the lateral femoral condyle are seen in patients with valgus malalignment. Common risk factors for failed fixation of OCD lesions include unstable lesions to the lateral femoral condyle, screw breakage, older age, and closed physes. The purpose of this technical note is to describe the preoperative planning and step-by-step surgical approach for treatment of failed fixation of an OCD lesion of the posterior aspect of the lateral femoral condyle in young, active patients using an osteochondral allograft, a lateral opening wedge distal femoral osteotomy to correct malalignment, and a tibial tubercle osteotomy to facilitate access to the lesion.
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Affiliation(s)
- Hasani W. Swindell
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A. Obioha
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Luc M. Fortier
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Suhas P. Dasari
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Enzo S. Mameri
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Pablo E. Gelber
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain,Institut Català de Traumatologia i Medicina de l’Esport, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A,Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL 60612, U.S.A.
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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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35
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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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36
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Elangovan SM, Meyers AB. Pearls and Pitfalls of Imaging of the Developing Pediatric Skeleton: Differentiating Normal and Pathology With MRI. Semin Ultrasound CT MR 2022; 43:73-87. [PMID: 35164912 DOI: 10.1053/j.sult.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Developmental changes occurring in the pediatric skeleton throughout childhood cause imaging appearances that may be confused with pathology. Knowledge of the typical pattern of red to yellow bone marrow conversion and areas of normal developmental irregular ossification is essential for radiologists interpreting musculoskeletal imaging in children to avoid mistaking normal findings for disease. Here we review the normal conversion of hematopoietic to yellow marrow on pediatric MRI and illustrate how MRI can distinguish the normal areas of irregular ossification from various pathology that can occur at and around growth centers in the developing skeleton.
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Affiliation(s)
- Stacey M Elangovan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Preoperative Evaluation and Surgical Simulation for Osteochondritis Dissecans of the Elbow Using Three-Dimensional MRI-CT Image Fusion Images. Diagnostics (Basel) 2021; 11:diagnostics11122337. [PMID: 34943574 PMCID: PMC8700753 DOI: 10.3390/diagnostics11122337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
We used our novel three-dimensional magnetic resonance imaging-computed tomography fusion images (3D MRI-CT fusion images; MCFIs) for detailed preoperative lesion evaluation and surgical simulation in osteochondritis dissecans (OCD) of the elbow. Herein, we introduce our procedure and report the findings of the assessment of its utility. We enrolled 16 men (mean age: 14.0 years) and performed preoperative MRI using 7 kg axial traction with a 3-Tesla imager and CT. Three-dimensional-MRI models of the humerus and articular cartilage and a 3D-CT model of the humerus were constructed. We created MCFIs using both models. We validated the findings obtained from the MCFIs and intraoperative findings using the following items: articular cartilage fissures and defects, articular surface deformities, vertical and horizontal lesion diameters, the International Cartilage Repair Society (ICRS) classification, and surgical procedures. The MCFIs accurately reproduced the lesions and correctly matched the ICRS classification in 93.5% of cases. Surgery was performed as simulated in all cases. Preoperatively measured lesion diameters exhibited no significant differences compared to the intraoperative measurements. MCFIs were useful in the evaluation of OCD lesions and detailed preoperative surgical simulation through accurate reproduction of 3D structural details of the lesions.
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Denis A, Chergui S, Basalom S, Campeau PM, Janelle C, Pauyo T. Variable expressivity in a family with an aggrecanopathy. Mol Genet Genomic Med 2021; 10:e1773. [PMID: 34894100 PMCID: PMC8801139 DOI: 10.1002/mgg3.1773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/13/2021] [Accepted: 07/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background Osteochondritis dissecans is a condition wherein there is a subchondral bone lesion that causes pain, inflammation, and cartilage damage. Dominant Familial Osteochondritis Dissecans is a rare and severe form of osteochondritis dissecans (OCD). It is caused by heterozygous pathogenic variants in the gene encoding Aggrecan; ACAN. Aggrecan, a proteoglycan, is an essential component of the articular and growth plate cartilage. Methods Herein, we report three individuals from one family; the proband who presented with short stature, a lower limb bone exostosis, and bilateral knee and elbow OCD at the age of 13 years old. His twin brother presented with isolated short stature and his father with short stature and lumbar disc herniation. Results Next‐generation sequencing of the ACAN gene in the proband identified a frameshift variant which is also present in the brother and father with short stature. The proband was treated surgically with bilateral elbow microfracture, after the failure of conservative therapy. Conclusion To the best of our knowledge, this is the first patient with an aggrecanopathy who presents with osteochondritis dissecans due to a frameshift variant. This family presents with variable expressivity which might be attributed to modifier genes.
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Affiliation(s)
- Antoine Denis
- Shriners Hospitals for Children, Montreal, Quebec, Canada
| | - Sami Chergui
- Shriners Hospitals for Children, Montreal, Quebec, Canada
| | - Shuaa Basalom
- Shriners Hospitals for Children, Montreal, Quebec, Canada
| | | | | | - Thierry Pauyo
- Shriners Hospitals for Children, Montreal, Quebec, Canada
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Khan SA, Baghdadi S, Carey JL, Moores TS, Sheth NP, Ganley T. Osteochondral Fractures After Patellar Dislocation: Current Concepts. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00001. [PMID: 34860734 DOI: 10.5435/jaaosglobal-d-21-00155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Osteochondral fractures of the knee occur frequently after acute patellar subluxation or dislocation. They can be challenging to manage because of the difficulty in diagnosing and treating these injuries in a timely fashion, in addition to choosing the optimum fixation method. This review presents the background, considerations for patient evaluation, and the best treatment options available for osteochondral fractures.
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Affiliation(s)
- Shehzaad A Khan
- From the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK (Mr. Khan); Children's Hospital of Philadelphia (CHOP), Philadelphia, PA (Dr. Baghdadi and Dr. Ganley); Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Carey and Dr. Sheth); and Walsall Manor Hospital, Moat Road, Walsall, UK (Mr. Moores)
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Sessa A, Romandini I, Andriolo L, Di Martino A, Busacca M, Zaffagnini S, Filardo G. Treatment of Juvenile Knee Osteochondritis Dissecans with a Cell-Free Biomimetic Osteochondral Scaffold: Clinical and MRI Results at Mid-Term Follow-up. Cartilage 2021; 13:1137S-1147S. [PMID: 32909451 PMCID: PMC8808812 DOI: 10.1177/1947603520954500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Osteochondral surgical procedures have been described for the treatment of unfixable osteochondritis dissecans (OCD), but only few of them have been studied for juvenile OCD (JOCD) lesions. A cell-free biomimetic osteochondral scaffold showed positive results in adult patients. The aim of this study was to evaluate the results of this scaffold for the treatment of knee JOCD at mid-term follow-up. DESIGN Twenty patients (14 males, 6 females) were included in this study. Mean age was 16.2 ± 1.4 years, average defect size was 3.2 ± 1.8 cm2, and mean symptoms duration was 20.2 ± 17.9 months. After the implantation of the osteochondral collagen-hydroxyapatite scaffold (Maioregen, Fin-Ceramica, Faenza, Italy), patients were evaluated preoperatively and prospectively at 1, 2, and at final mean follow-up of 6 years (range 5-7 years) with International Knee Documentation Committee (IKDC) subjective and objective, Tegner, and EuroQol visual analogue scale (VAS) scores. MRI evaluation was performed with the MOCART 2.0 score. RESULTS All scores showed a significant improvement. IKDC subjective score went from 50.3 ± 17.4 preoperative score to 75.3 ± 14.6 at 1 year (P = 0.002), 80.8 ± 14.6 at 2 years and 85.0 ± 9.3 at 6 years. The Tegner score improved from the preoperative evaluation of 2.6 ± 1.4 to 5.5 ± 2.0 at 6 years (P < 0.0005), although without reaching the level registered before the onset of symptoms. A longer symptoms duration influenced negatively IKDC subjective and Tegner scores up to 2 years (P = 0.003 and P = 0.002, respectively) but did not affect the final outcome. Lesion size did not affect the final result. The MOCART 2.0 score showed a significant improvement between 1-year and final follow-up, but with persisting subchondral alterations. CONCLUSIONS This study demonstrated a clinical improvement stable over time with a high survival rate, although with persisting abnormal MRI findings, especially at subchondral bone level. This procedure can be considered a suitable option for the treatment of young patients affected by knee OCD. Level of evidence. Case series, level IV.
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Affiliation(s)
- Andrea Sessa
- Shoulder and Elbow Surgery, IRCCS
Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Iacopo Romandini
- II Orthopaedic and Traumatologic Clinic,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- II Orthopaedic and Traumatologic Clinic,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Luca Andriolo, II Orthopaedic and
Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10,
Bologna, 40136, Italy.
| | - Alessandro Di Martino
- II Orthopaedic and Traumatologic Clinic,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Busacca
- Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR)
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Sayani J, Plotkin T, Burchette DT, Phadnis J. Treatment Strategies and Outcomes for Osteochondritis Dissecans of the Capitellum. Am J Sports Med 2021; 49:4018-4029. [PMID: 33886390 DOI: 10.1177/03635465211000763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimum management of osteochondritis dissecans (OCD) of the capitellum is a widely debated subject. PURPOSE To better understand the efficacy of different surgical modalities and nonoperative treatment of OCD as assessed by radiological and clinical outcomes and return to sports. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all treatment studies published between January 1975 and June 2020 was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 76 clinical studies, including 1463 patients, were suitable for inclusion. Aggregate analysis and subgroup analysis of individual patient data were performed to compare the functional and radiographic outcomes between the various nonoperative and surgical treatment options for capitellar OCD. A unified grading system (UGS; grades 1-4) was developed from existing validated classification systems to allow a comparison of patients with similar-grade OCD lesions in different studies according to their treatment. Patient-level data were available for 352 patients. The primary outcome measures of interest were patient-reported functional outcome, range of motion (ROM), and return to sports after treatment. The influences of the capitellar physeal status, location of the lesion, and type of sports participation were also assessed. Each outcome measure was evaluated according to the grade of OCD and treatment method (debridement/microfracture, fragment fixation, osteochondral autograft transplantation [OATS], or nonoperative treatment). RESULTS No studies reported elbow scores or ROM for nonoperatively treated patients. All surgical modalities resulted in significantly increased postoperative ROM and elbow scores for stable (UGS grades 1 and 2) and unstable lesions (UGS grades 3 and 4). There was no significant difference in the magnitude of improvement or overall scores according to the type of surgery for stable or unstable lesions. Return to sports was superior with nonoperative treatment for stable lesions, whereas surgical treatment was superior for unstable lesions. Patients with an open capitellar physis had superior ROM for stable and unstable lesions, but there was no correlation with lesion location and the outcomes of OATS versus fragment fixation for high-grade lesions. CONCLUSION Nonoperative treatment was similar in outcomes to surgical treatment for low-grade lesions, whereas surgical treatment was superior for higher grade lesions. There is currently insufficient evidence to support complex reconstructive techniques for high-grade lesions compared with microfracture/debridement alone.
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Affiliation(s)
| | | | | | - Joideep Phadnis
- Brighton and Sussex University Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
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A high rate of children and adolescents return to sport after surgical treatment of osteochondritis dissecans of the elbow: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:4041-4066. [PMID: 33620512 DOI: 10.1007/s00167-021-06489-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow. METHODS The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score. RESULTS Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10-18.5) and a median follow-up of 39 months (range 5-156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic-assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8-99.5%, I2 = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70-87.1%, I2 = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3-94.5%, I2 = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5-95.1%, I2 = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3-99.6%, I2 = 1%) and for an open procedure was 97.8% (95% CI 93.7-99.9%, I2 = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients). CONCLUSION Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures. LEVEL OF EVIDENCE Level IV.
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Paatela T, Vasara A, Sormaala M, Nurmi H, Kautiainen H, Kiviranta I. Chondral and Osteochondritis Dissecans Lesions Treated by Autologous Chondrocytes Implantation: A Mid- to Long-Term Nonrandomized Comparison. Cartilage 2021; 13:1105S-1112S. [PMID: 32602351 PMCID: PMC8808789 DOI: 10.1177/1947603520935953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the clinical outcome of cartilage repair with autologous chondrocyte implantation (ACI) in patients with osteochondritis dissecans (OCD) lesions and full-thickness cartilage lesions. DESIGN This study included a cohort of 115 consecutive patients with a cartilage lesion of the knee treated with ACI. Of the patients, 35 had an OCD lesion and 80 a full-thickness cartilage lesion. During a follow-up period from 2 to 13 years all treatment failures were identified. The failure rate between OCD lesions and full-thickness cartilage lesions was compared with Kaplan-Meier analysis. Patient-reported outcome was evaluated 2 years postoperatively with the Lysholm score. RESULTS During the follow-up 21 out of 115 patients encountered a treatment failure. The failure rate for full-thickness cartilage lesions was 19.1% and for OCD lesions 43.3% over the 10-year follow-up. Patient-reported outcome improved from baseline to 2 years postoperatively. The improvement from baseline was statistically significant, and the Lysholm score improved more than the minimal clinically important difference. The patient-reported outcome showed no difference between lesion types at 2 years. CONCLUSIONS In the presented retrospective study, the failure rate of first-generation ACI was higher in OCD lesions than in large full-thickness cartilage lesions, suggesting that OCD lesions may associate with properties that affect the durability of repair tissue. Future prospective studies are needed to tell us how to best repair OCD lesions with biological tissue engineering.
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Affiliation(s)
- Teemu Paatela
- Department of Orthopaedics and
Traumatology, Helsinki University Hospital, Helsinki, Finland,Teemu Paatela, Department of Orthopaedics
and Traumatology, Helsinki University Hospital, PO Box 900, Topeliuksenkatu 5,
Helsinki FI-00029 HUS, Finland.
| | - Anna Vasara
- Department of Orthopaedics and
Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Markus Sormaala
- Department of Radiology, Helsinki
University Hospital, Helsinki, Finland
| | - Heikki Nurmi
- Department of Orthopaedics and
Traumatology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio
University Hospital, Kuopio, Finland,Folkhälsan Research Center, Helsinki,
Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and
Traumatology, Helsinki University Hospital, Helsinki, Finland,Department of Orthopaedics and
Traumatology, University of Helsinki, Helsinki, Finland
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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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Takata Y, Kitaoka K, Nakase J, Tsuchiya H. Osteochondritis dissecans of the humeral capitellum in identical twin baseball players. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:464-468. [PMID: 37588703 PMCID: PMC10426608 DOI: 10.1016/j.xrrt.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Yasushi Takata
- Department of Orthopaedic Surgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Katsuhiko Kitaoka
- Department of Orthopaedic Surgery, Kijima Hospital, Kanazawa, Ishikawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
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Rotman D, Kwak JM, Rojas Lievano J, Hooke A, Camp CL, Fitzsimmons JS, O'Driscoll SW. Radial Head Lag: A Possible Biomechanical Mechanism for Osteochondritis Dissecans of the Capitellum in Baseball Pitchers. Am J Sports Med 2021; 49:3226-3233. [PMID: 34523371 DOI: 10.1177/03635465211033971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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) of the capitellum is common in throwing athletes and is believed to result from repetitive overloading on the radiocapitellar (RC) joint, although the cause and mechanism remain unclear. The torsional forces (moments) generated by the triceps during elbow extension pull only on the ulna; therefore, the radial head moves passively across the capitellum and is effectively "dragged along" by the ulna. Any laxity in the proximal radioulnar joint could lead to asynchronous motion between the radius and ulna, resulting in the radial head lagging behind the coronoid and possibly malarticulating with the capitellum during such motion. HYPOTHESIS Radial head motion on the capitellum lags behind ulnohumeral joint motion during simulated throwing. STUDY DESIGN Controlled laboratory study. METHODS A total of 8 cadaveric elbows were tested under simulated throwing, including active extension of the elbow generated by pulling of the triceps under valgus stress, as well as during passive extension under valgus stress to serve as a reference. Ulnohumeral motion was tracked using a video camera. Radial head motion was tracked using an intra-articular, thin-film pressure sensor mounted on the capitellum, and the longitudinal movement of the center of force (COF) of the radial head was measured. Radial head motion was compared between passive and active motion for each 10° of elbow extension from 90° to 20°. RESULTS Elbow motion during simulated active extension reached an angular velocity of 366 deg/s. Radial head motion during simulated active extension significantly lagged compared with its motion during passive extension at every elbow extension angle examined between 70° and 20° (P < .001). The maximal lag reached a mean of 4 mm (range, 2-7 mm). In other words, RC and ulnohumeral motion were asynchronous during simulated throwing. CONCLUSION This study describes a novel phenomenon: motion of the radial head across the capitellum during rapid extension, such as in baseball pitching, lags behind that seen during passive elbow motion. According to a new proposed theory of OCD lesion development, this lag should result in RC incongruency and elevated shear forces on the capitellum due to edge loading. CLINICAL RELEVANCE We propose a new biomechanical explanation for OCD of the capitellum in baseball pitchers: radial head lag. Understanding this process is the first step in efforts to prevent this common injury.
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Affiliation(s)
- Dani Rotman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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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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Takatsuji K, Kida Y, Furukawa R, Tachiiri H, Kobayashi Y, Morihara T, Takahashi K. Osteochondritis dissecans of the glenoid in adolescent baseball players: a report of 4 cases. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:265-273. [PMID: 37588960 PMCID: PMC10426610 DOI: 10.1016/j.xrrt.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Kenta Takatsuji
- Department of Orthopaedics, Fukuchiyama City Hospital, Kyoto, Japan
| | - Yoshikazu Kida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Hisakazu Tachiiri
- Department of Orthopedic Surgery, Tachiiri Orthopedic Clinic, Kyoto, Japan
| | - Yusuke Kobayashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toru Morihara
- Rakuwakai Marutamachi Rehabilitation Clinic, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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49
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Kim HHR, Menashe SJ, Ngo AV, Otjen JP, Maloney E, Iyer RS, Thapa M. Uniquely pediatric upper extremity injuries. Clin Imaging 2021; 80:249-261. [PMID: 34375796 DOI: 10.1016/j.clinimag.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
The pediatric population is prone to unique upper extremity injuries that are not typically seen in adults. The normal dynamic maturation pattern of ossification centers and open physis can potentially confuse radiologists who are not familiar with the pediatric patients. In this review article, we discuss the normal anatomy and commonly encountered acute and chronic upper extremity injuries such as supracondylar distal humeral fracture and osteochondritis dissecans, in pediatric patients. Diagnosing the correct type of fracture (e.g., buckle vs Salter-Harris) is important for proper management of the injury. With an increasing number of adolescents participating in competitive sports, specific sports related injuries such as little league shoulder, gymnast wrist, and medial epicondyle apophysitis, are also discussed in this review. We examine late complications of injuries, such as physeal bar formation and fishtail deformity of the distal humerus.
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Affiliation(s)
- Helen H R Kim
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
| | - Sarah J Menashe
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Anh-Vu Ngo
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeffrey P Otjen
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ezekiel Maloney
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramesh S Iyer
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA. https://twitter.com/Iyer_MD
| | - Mahesh Thapa
- Radiology Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA. https://twitter.com/ThapaMD
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50
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Patel NM, Helber AR, Gandhi JS, Shea KG, Ganley TJ. Race Predicts Unsuccessful Healing of Osteochondritis Dissecans in the Pediatric Knee. Orthopedics 2021; 44:e378-e384. [PMID: 34039200 DOI: 10.3928/01477447-20210414-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the effect of race, insurance status, and socioeconomic status on successful or unsuccessful healing of osteochondritis dissecans (OCD) lesions in the pediatric knee. The authors retrospectively reviewed patients younger than 18 years who were treated for a knee OCD lesion between 2006 and 2017. Patients were required to have at least 6 months of clinical and radiographic follow-up to be included, unless complete healing was achieved sooner. The primary outcome of interest was healing of the OCD lesion based on radiographic and clinical examination. A total of 204 OCD lesions in 196 patients with a mean follow-up of 15.8±6.4 months were included. The mean age at initial presentation was 12.4±2.8 years. At most recent follow-up, 28 (13.7%) lesions did not show radiographic or clinical evidence of healing. Nonhealing lesions were found in 25.0% of Black children compared with 9.4% of White children (P=.02). After controlling for age, sex, sports participation, lesion size and stability, skeletal maturity, and operative vs nonoperative treatment in a multivariate model, Black children had 6.7 times higher odds of unsuccessful healing compared with their White counterparts (95% CI, 1.1-41.7; P=.04). In this study, Black children with OCD of the knee were significantly less likely to heal than were White patients, even when controlling for numerous other factors in a multivariate model. Although the exact etiology of this finding is unclear, future work should focus on the social, economic, and cultural factors that may lead to disparate outcomes. [Orthopedics. 2021;44(3):e378-e384.].
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