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Tsaknakis K, Afifi FK, Lorenz HM, Hell AK. [Non-traumatic osteochondral lesions of the knee joint during growth : Juvenile osteochondritis dissecans (JOCD) of the knee]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:651-658. [PMID: 39196304 DOI: 10.1007/s00132-024-04552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Juvenile osteochondritis dissecans of the knee joint is the most common osteochondral lesion during growth, usually occurring between the 10th and 14th year of age. PATHOGENESIS Repetitive microtraumata lead to a subchondral osseus lesion, which is commonly located at the medial aspect of the femoral condyle. Sport activities are considered to be the main cause, although genetic and hereditary factors as well as vitamin D3 deficiency also play a role. Current classification systems distinguish between stable and unstable osteochondral lesions, which is decisive for further treatment. TREATMENT Stable lesions may heal through conservative treatment by avoiding weight bearing and sport. Unstable lesions, on the other hand, can lead to a complete defect of the joint surface with the formation of a free joint body. In such cases, various surgical techniques aim at reconstructing the surface of the joint, in order to reduce the risk of secondary arthritis.
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Affiliation(s)
- Konstantinos Tsaknakis
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Faik K Afifi
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Heiko M Lorenz
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Anna K Hell
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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Marth AA, Feuerriegel GC, Marcus RP, Sutter R. How accurate is MRI for diagnosing tarsal coalitions? A retrospective diagnostic accuracy study. Eur Radiol 2024; 34:3493-3502. [PMID: 37855854 PMCID: PMC11126476 DOI: 10.1007/s00330-023-10304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES This study aimed to evaluate the diagnostic accuracy, inter-reader agreement, and associated pathologies on MR images of patients with confirmed TC. METHODS AND MATERIALS In this retrospective study, 168 ankle MRI exams were included, consisting of 56 patients with clinically or surgically confirmed TC and 112 controls without TC, matched for age and sex. Images were analyzed independently by three radiologists blinded to clinical information. The evaluation criteria included the presence, type, and location of TC, as well as associated pathologies. After calculating diagnostic accuracy and the odds ratio of demographic data and anatomic coalition type for associated pathologies, inter-reader agreement was assessed using kappa statistics. RESULTS The majority of TCs were non-osseous (91.1%) and located at the calcaneonavicular (33.9%) or talocalcaneal joint (66.1%). Associated pathologies included adjacent and distant bone marrow edema (57.1% and 25.0%), osteochondral defect of the talar dome (OCD, 19.6%), and joint effusion (10.7%) and accessory anterolateral talar facet (17.9%). Talar OCD was associated with increased patient age (p = 0.03). MRI exhibited a cumulative sensitivity and specificity of 95.8% and 94.3% with almost perfect inter-reader agreement (κ = 0.895). CONCLUSION MRI is a reliable method for detecting tarsal coalition and identifying commonly associated pathologies. Therefore, we recommend the routine use of MRI in the diagnostic workup of patients with foot pain and suspected tarsal coalition. CLINICAL RELEVANCE STATEMENT MRI is an accurate and reliable modality for diagnosing tarsal coalitions and detecting associated pathologies, while improving patient safety compared to computed tomography by avoiding radiation exposure. KEY POINTS • Despite the technological progress in magnetic resonance imaging (MRI), computed tomography (CT) is still regarded as the gold standard for diagnosing tarsal coalition (TC). • MRI had a cumulative sensitivity of 95.8% and specificity of 94.3% for detecting tarsal coalition with an almost perfect inter-reader agreement. • MRI demonstrates high accuracy and reliability in diagnosing tarsal coalitions and is useful for identifying associated pathologies, while also improving patient safety by avoiding radiation exposure.
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Affiliation(s)
- Adrian A Marth
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland.
| | - Georg C Feuerriegel
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Roy P Marcus
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Rikken QG, Dahmen J, Gianakos AL, Bejarano-Pineda L, Waryasz G, DiGiovanni CW, Stufkens SA, Kerkhoffs GM. Talonavicular Osteochondral Lesions: Surgical Technique and Clinical Outcomes from the Boston and Amsterdam Perspectives. Cartilage 2024; 15:26-36. [PMID: 37750492 PMCID: PMC10985397 DOI: 10.1177/19476035231200334] [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: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE The primary purpose of the present study was to assess the patient-reported outcomes, complications, and reoperation rate of patient who underwent surgical treatment for symptomatic osteochondral lesions of the talonavicular joint (TNJ). METHODS Patients undergoing surgical treatment for symptomatic osteochondral lesions of the TNJ with a minimum of 12-month follow-up were included. Outcomes included clinical patient-reported outcome measures (PROMs), return to sports and work outcomes, and postoperative complications or reoperations. Medical records were screened by 2 independent reviewers. Patients were contacted by phone and underwent an in-depth interview. Additionally, operative techniques for both arthroscopic and open surgical approaches for treating TNJ osteochondral lesions were described. DESIGN Retrospective Case Series (Level IV) and Surgical Technique. RESULTS A total of 7 patients were included with a final follow-up time of 25.4 (SD: 15.2) months follow-up. PROMs were considered satisfactory for 5 out of 7 patients, 6 out of 7 patients returned to any level of sports at a mean of 3.7 (SD: 4.2) months, and 5 out of 6 patients returned to preinjury level of sports at a mean of 14 (SD: 7.5) months. All patients returned to work at an average of 5.4 (SD: 3.6) weeks. No complications or reoperations after index surgery were reported. CONCLUSION Surgical treatment of TNJ osteochondral lesions is a feasible procedure that may offer successful clinical, sport, and work outcomes in the majority of patients. Both open and arthroscopic surgical treatments are available and can be considered in a patient-specific treatment plan.
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Affiliation(s)
- Quinten G.H. Rikken
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arianna L. Gianakos
- Foot & Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher W. DiGiovanni
- Foot & Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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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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Buck TMF, Dahmen J, Altink JN, Rikken QGH, Sierevelt IN, Stufkens SAS, Kerkhoffs GMMJ. Higher Age is Associated with Lower Likelihood of Conversion to Surgery after Primary Nonoperative Treatment for Osteochondral Lesions of the Talus. Cartilage 2024:19476035241227357. [PMID: 38279550 DOI: 10.1177/19476035241227357] [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: 01/28/2024] Open
Abstract
INTRODUCTION The first line of treatment for osteochondral lesions of the talus (OLT) is nonoperative. To date, there is limited evidence on risk factors that may influence conversion to surgery after primary nonoperative treatment for symptomatic OLTs. The aim of this study was therefore to identify risk factors for conversion to surgery after initial nonoperative treatment of OLTs. METHODS For this cohort study, patients with a primary OLT who were nonoperatively treated for at least 6 months between 1990 and 2020 were included. Univariable Cox regression analysis, resulting in hazard ratios (HRs), on the primary outcome (i.e. conversion to surgery after initial nonoperative treatment) was performed for potential risk factors. The following risk factors were analyzed: gender, age, body mass index (BMI), numeric rating scale (NRS), lesion size (depth, sagittal length, coronal length, volume, surface), lesion morphology (presence of fragments and presence of cysts), lesion location (medial/central/lateral), congruency of the ankle joint and trauma in history. Data imputation was conducted according to the multiple data principle with pooling. RESULTS Forty-two patients with primary OLTs were included in this study: 23 (55%) males and 19 (45%) females with a mean age of 39.1 (SD: 14.2). The median overall follow-up time was 66 months (range: 7-188). Around 23% of the patients had a conversion to surgery at the median observation time. The Kaplan-Meier analysis revealed a survival rate of 93% (95% confidence interval [CI]:84-100), 90% (95% CI: 81-99), and 77% (95% CI: 63-91) at 1, 2, and 5 years after the initiation of treatment, respectively. After performing the COX regression analysis, age was the sole risk factor significantly associated with conversion to surgery with an HR of 0.93 (95% CI: 0.87-0.99). The different HRs for all other risk factors were as follows: gender: 0.33 (95% CI: 0.08-1.34), BMI: 0.87 (95% CI 0.76-1.01), depth: 0.97 (95% CI: 0.79-1.18), coronal length: 1.19 (95% CI: 0.97-1.44), sagittal length: 0.98 (95% CI: 0.87-1.12), surface area: 1.17 (95% CI: 0.41-3.31), volume: 0.96 (95% CI: 0.24-3.91), presence of fragments: 4.17 (95% CI: 0.84-20.61). CONCLUSION For primary OLTs, 77% of the patients were successfully treated nonoperatively at a median follow-up of 66 months without the need for a surgical intervention. Survival rates of 93%, 90%, and 77% were found at 1, 2, and 5 years after the initiation of treatment, respectively. We found that a higher age at the moment of diagnosis was significantly associated with a lower likelihood of conversion to surgery with a 7% decrease of likelihood each year the patient is older at the moment of diagnosis. The findings of this study are clinically relevant as it ameliorates the quality of the shared decision-making process between the patient and the treating team as we can advise OLT patients at a higher age with tolerable symptomatology that there is a relatively lower risk of conversion to surgery.
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Affiliation(s)
- Tristan M F Buck
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - J Nienke Altink
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Quinten G H Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Orthopedic Department, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
- Orthopedic Department, Xpert Clinics, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
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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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Bangert Y, Zarembowicz P, Engelleiter K, Gkarilas E, Schmitt H, Renkawitz T, Jaber A. Long-Term Outcome and Athletic Level following Operative Treatment for Osteochondritis Dissecans of the Knee in Pediatric and Adolescent Patients. J Clin Med 2023; 12:4140. [PMID: 37373833 DOI: 10.3390/jcm12124140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Research on the long-term outcomes following surgical therapy for osteochondritis dissecans (OCD) of the knee is scarce. A single-center retrospective cohort study was conducted to investigate surgically treated patients for knee OCD between 1993 and 2007. A total of 37 patients with an average follow-up duration of 14 years (range 8-18) were in the final cohort. IKDC and Lysholm scores were assessed. The duration and types of sport activity were reported. Long-term results were compared with existing midterm data. Knee scores showed a very good outcome with a mean of 91.3 in the IKDC score and 91.7 in the Lysholm score. Compared to midterm outcomes, both IKDC (p = 0.028) and Lysholm scores (p = 0.01) improved on final follow-up. Patients with open physes showed a significantly better Lysholm score compared to patients with closed physes (p = 0.034). Defect localization and size did not influence the outcome, but a defect depth of <0.8 cm2 achieved significantly better scores than ≥0.8 cm2. Of all surgical interventions, refixation achieved the best outcome. Long-term results significantly improved compared to midterm results with a follow-up of 40 months (p = 0.01). Thirty-six out of 37 patients were physically active, with 56% of sports being knee-straining activities. Long-term results following surgically treated OCD fragments show excellent function and a good athletic level. Patients with open physes potentially have better knee outcomes. Midterm results are sustainable and could improve further in the long term.
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Affiliation(s)
- Yannic Bangert
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Patrick Zarembowicz
- Department for Orthopaedic and Trauma Surgery, BG Klinik Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany
| | - Karoly Engelleiter
- Department for Orthopaedic and Trauma Surgery, Helios Clinic, 75175 Pforzheim, Germany
| | - Evangelos Gkarilas
- Department for Orthopaedics, Trauma and Spinal Surgery, Neckar-Odenwald Clinics, 74821 Mosbach, Germany
| | - Holger Schmitt
- German Joint Center, ATOS Clinic Heidelberg, 69115 Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Ayham Jaber
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
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Deichsel A, Palma Kries LK, Raschke MJ, Peez C, Briese T, Glasbrenner J, Herbst E, Kittl C. Refixation of a Large Osteochondral Fragment with Magnesium Compression Screws-A Case Report. Life (Basel) 2023; 13:life13051179. [PMID: 37240824 DOI: 10.3390/life13051179] [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: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Osteochondrosis dissecans (OCD) is a disease affecting the subchondral bone and the overlying articular cartilage. The etiology is most likely a combination of biological and mechanical factors. The incidence is highest in children >12 years old and it predominantly affects the knee. In high-grade OCD lesions, free osteochondral fragments usually are refixed via titanium screws or biodegradable screws or pins. In this case, headless compression screws made from magnesium were used for refixation. CASE REPORT A thirteen-year-old female patient with a two-year history of knee pain was diagnosed with an OCD lesion of the medial femoral condyle. After initial conservative treatment, displacement of the osteochondral fragment occurred. Refixation was performed using two headless magnesium compression screws. At the 6 months follow up, the patient was pain free, and the fragment showed progressive healing while the implants were biodegrading. DISCUSSION Existing implants for refixation of OCD lesions either require subsequent removal or show less stability and possible inflammatory reactions. The new generation of magnesium screws used in this case did not lead to a gas release, as described for previous magnesium implants, while maintaining stability during continuous biodegradation. CONCLUSIONS The data available to date on magnesium implants for the treatment of OCD are promising. However, the evidence on the magnesium implants in refixation surgery of OCD lesions is still limited. Further research needs to be conducted to provide data on outcomes and possible complications.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Lucas Klaus Palma Kries
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
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Males and Females Exhibit Comparable Outcomes Following Treatment of Osteochondritis Dissecans Lesions of the Knee: A Systematic Review. Arthroscopy 2022; 38:2919-2929. [PMID: 35337959 DOI: 10.1016/j.arthro.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of patient sex on outcomes after treatment of osteochondritis dissecans (OCD) lesions of the knee through a systematic review of current evidence. METHODS This review was conducted according to the PRISMA guidelines using the PubMed, PubMed Central, Embase, Ovid Medline, Cochrane Libraries, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Relevant outcomes included functional (e.g., International Knee Documentation Committee and Subjective Knee Evaluation, Lysholm Knee Score) and clinical outcomes (e.g., symptom/pain resolution, reoperation rates) for males and females after operative or nonoperative treatment of knee OCD lesions. RESULTS Ten articles with a total of 691 (73%) males and 260 (27%) females were included. Mean age ranged from 11.3 ± 2.1 years to 34.5 ± 10.3 years, and follow-up ranged from 6 months to 16.3 years. In four studies reporting functional outcomes, no significant differences were found between males and females in any metric assessed (all P > .05). Seven studies reported clinical outcomes after treatment of knee OCD lesions. One study determined males were more likely to have a successful nonoperative outcome than females (OR: 1.85, 95% CI: 1.00-3.40). Another study found males had a lower risk of developing symptomatic knee pain following operative or nonoperative treatment at a mean 14-year follow-up (HR: 0.24; 95% CI: 0.07-0.81). The remaining 5 studies reported statistically comparable clinical outcomes between males and females (all P > .05). CONCLUSION The present systematic review found mostly comparable clinical and functional outcomes between males and females following treatment of knee OCD lesions. Despite sex-related differences in the prevalence of these lesions and limited evidence of differences in clinical outcomes, these data suggest that sex does not independently predict outcomes after treatment. LEVEL OF EVIDENCE III, systematic review of Level II and III studies.
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Andriolo L, Solaro L, Altamura SA, Carey JL, Zaffagnini S, Filardo G. Classification Systems for Knee Osteochondritis Dissecans: A Systematic Review. Cartilage 2022; 13:19476035221121789. [PMID: 36117427 PMCID: PMC9634996 DOI: 10.1177/19476035221121789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Aim of this systematic review was to describe all classification systems for knee osteochondritis dissecans (OCD) lesions, evaluating their accuracy and reliability, as well as their use in the literature on knee OCD. DESIGN A systematic review of the literature was performed in July 2021 on PubMed, WebOfScience, and Cochrane Collaboration (library) to describe all published classification systems for knee OCD lesions and quantify the use of these classifications in the literature. RESULTS Out of 1,664 records, 30 studies on 33 OCD classifications systems were identified, describing 11 radiographic, 13 MRI, and 9 arthroscopic classifications. The search included 193 clinical studies applying at least one OCD classification, for a total of 7,299 knee OCD cases. Radiographic classifications were applied to 35.8%, MRI to 35.2%, and arthroscopic classifications to 64.2% of the included studies. Among these, in the last two decades, the International Cartilage Repair Society's (ICRS) arthroscopic classification was the most described approach in studies on knee OCD. Overall, there is a lack of data on accuracy and reliability of the available systems. CONCLUSIONS Several classifications are available, with ICRS being the most used system over the time period studied. Arthroscopy allows to confirm lesion stability, but noninvasive imaging approaches are the first line to guide patient management. Among these, radiographic classifications are still widely used, despite being partially superseded by MRI, because of its capability to detect the earliest disease stages and to distinguish stable from unstable lesions, and thus to define the most suitable conservative or surgical approach to manage patients affected by knee OCD. LEVEL OF EVIDENCE Systematic review, level IV.
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Affiliation(s)
- Luca Andriolo
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Solaro
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Luca Solaro, Clinica Ortopedica e
Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1/10, 40136
Bologna, Italy.
| | | | - James L. Carey
- Penn Center for Advanced Cartilage
Repair and Osteochondritis Dissecans Treatment, Hospital of the University of
Pennsylvania, Philadelphia, PA, USA,Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research
(ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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11
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Dee DT, Hung VT, Schamblin CJ, Lupica GM, Hitchens HR, McGarry MH, Lee TQ. Radiocapitellar Contact Characteristics After Osteochondral Defect Repair Using a Novel Hybrid Reconstructive Procedure. Orthop J Sports Med 2022; 10:23259671221083582. [PMID: 35340725 PMCID: PMC8941709 DOI: 10.1177/23259671221083582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Many procedures to reconstruct osteochondral defects of the elbow
radiocapitellar (RC) joint lack versatility or durability or do
not directly address the subchondral bone structure and
function. Purpose/Hypothesis: To biomechanically characterize the RC joint contact area, force,
pressure, and peak pressure before and after reconstruction of
osteochondral defects using a novel hybrid reconstructive
procedure. It was hypothesized that the procedure would restore
the contact characteristics to the intact condition. Study Design: Controlled laboratory study. Methods: A total of 10 cadaveric elbows (mean age 67 ± 2.7 years) were
dissected to isolate the humerus and radial head. RC contact
area, contact force, mean contact pressure, and peak contact
pressure were measured with the elbow at 45° of flexion and
neutral forearm rotation at compressive loads of 25, 50, and 75
N. Osteochondral defects 8 and 11 mm in diameter were created at
the center of the capitellum; the defects were then
reconstructed with a titanium fenestrated threaded implant,
countersunk in the subchondral bone, with an acellular dermal
matrix allograft sutured in place on top of the implant. Five
conditions (intact, 8-mm defect, 8-mm repair, 11-mm defect, and
11-mm repair) were tested and results were compared using
repeated-measures analysis of variance. Results: Both 8- and 11-mm defects significantly increased RC mean contact
pressure at all compressive loads (P ≤ .008)
and significantly increased peak contact pressure at compressive
loads of 50 and 75 N (P < .002) compared
with the intact condition. Repair of the 8-mm defect
significantly decreased RC mean contact pressure at 25- and 50-N
loads (P ≤ .009) and significantly decreased
peak contact pressure at 50- and 75-N loads (P
≤ .035) compared with the defect condition. Repair of the 11-mm
defect decreased mean contact pressure significantly at all
compressive loads (P ≤ .001) and peak contact
pressure at 50- and 75-N loads (P < .044)
compared with the defect condition. Conclusion: RC joint contact pressure was restored to intact conditions while
avoiding increased peak contact pressure or edge loading after
repairing osteochondral defects related to osteochondrosis with
a novel hybrid reconstruction technique. Clinical Relevance: This hybrid procedure that addresses the entire osteochondral unit
may provide a new treatment option for osteochondral
defects.
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Affiliation(s)
- Derek T Dee
- Dee Sports Orthopedics, Huntington Beach, California, USA
| | - Victor T Hung
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Connor J Schamblin
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Gregory M Lupica
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Hunter R Hitchens
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
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12
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Osteochondritis Dissecans Lesion of the Trochlear Groove: A Case of Nonsurgical Management for a Rare Lesion. Case Rep Orthop 2021; 2021:9776362. [PMID: 34938584 PMCID: PMC8687841 DOI: 10.1155/2021/9776362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Osteochondritis dissecans (OCD) lesions are potential causes of knee pain in pediatric patients, with lesions most frequently found on the lateral and medial femoral condyles. This case discusses an OCD lesion of the trochlear groove, a rare location for OCD lesions, in an 11-year-old female athlete. The patient presents after several years of knee pain that had acutely worsened, and both X-ray and MRI demonstrated the lesion, with MRI confirming a stable lesion. While previous literature has leaned towards surgical management, this patient was successfully managed nonoperatively in a locked knee brace for 12 weeks. She then went through 4 weeks of physical therapy and a 4 week progression back into soccer activity with return to full activity in 5 months.
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13
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Padiolleau G, Amouyel T, Barbier O, De L'Escalopier N, Cordier G, Baudrier N, Benoist J, Dubois-Ferrière V, Leiber F, Morvan A, Mainard D, Maynou C, Lopes R. Safety of malleolar osteotomies in surgery for osteochondral lesions of the talus. Orthop Traumatol Surg Res 2021; 107:103070. [PMID: 34547541 DOI: 10.1016/j.otsr.2021.103070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The talus is a central bone in the hindfoot that is difficult to access surgically. Performing a medial or lateral malleolar osteotomy in the management of an osteochondral lesion of the talus (OLT) is a feared procedure amongst surgeons and their patients. The objective of this study was to assess the complications inherent to malleolar osteotomies in the treatment of OLTs. HYPOTHESIS The use of a standardized protocol concerning the technical performance and osteosynthesis of malleolar osteotomies results in fewer postoperative complications than a non-standardized protocol. MATERIALS AND METHOD This is a comparative study comprising a prospective multicenter non-randomized series with a standardized protocol for performing malleolar osteotomies, and a multicenter retrospective series without a standardized protocol. We included all patients aged 16 to 65 years with symptomatic OLTs, resistant to more than 6-months of well-conducted medical treatment, for whom surgery was considered. The minimum follow-up was 1 year for the prospective study, and 5 years for the retrospective study. A total of 86 and 97 patients were included in the prospective and retrospective studies, respectively. Of these 183 patients, 86 patients (33 prospective and 53 retrospective) underwent medial or lateral malleolar osteotomies as part of their surgery for OLT. Complications specific to the osteotomy procedures such as scar tissue, surgical site infection, non-union, articular malunion, neurological lesions or surgical revision, were investigated. RESULTS No specific complication was found to be associated to the malleolar osteotomy. No surgical revision was directly linked to the osteotomy procedure. No significant difference was found between the two series. DISCUSSION There was no evidence of morbidity related specifically to medial or lateral malleolar osteotomies. A standardized protocol, subject to rigorous technical implementation, does not improve results after malleolar osteotomy. The fear associated with this malleolar osteotomy procedure seems unfounded. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Thomas Amouyel
- Hôpital Salengro, Service de chirurgie orthopédique, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Olivier Barbier
- Hôpital d'Instruction des Armées Sainte Anne, Service de chirurgie orthopédique, 2, boulevard Sainte Anne, 83000 Toulon, France
| | - Nicolas De L'Escalopier
- Hôpital d'Instruction des Armées Percy, service de Chirurgie Orthopédique, Traumatologique et Réparatrice des membres, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Guillaume Cordier
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - Nicolas Baudrier
- Hôpital Ambroise Paré, Service de chirurgie orthopédique, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Jonathan Benoist
- Institut locomoteur de l'ouest, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Victor Dubois-Ferrière
- Centre Assal de Médecine et de Chirurgie du pied, avenue de Beau-Séjour 6, 1206 Genova, Switzerland
| | - Frédéric Leiber
- Clinique de l'Orangerie, 29, allée de la Robertsau, 67000 Strasbourg, France
| | - Antoine Morvan
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - Didier Mainard
- Hôpital Central, 29, avenue du maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Carlos Maynou
- Hôpital Salengro, Service de chirurgie orthopédique, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Ronny Lopes
- Centre PCNA, avenue Claude-Bernard, 44800 Saint-Herblain, France
| | -
- 15, rue Ampère, 92500 Rueil Malmaison, France
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14
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Togher CJ, Sahli H, Butterfield J, Sebag J, Shane AM, Reeves CL. Incidence of Talar Osteochondral Lesions After Acute Ankle Fracture: A Retrospective Analysis. J Foot Ankle Surg 2021; 60:1184-1187. [PMID: 34092459 DOI: 10.1053/j.jfas.2021.05.001] [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] [Received: 05/12/2020] [Revised: 03/16/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023]
Abstract
Recent literature suggests the majority of osteochondral lesions occur in the ankle joint. Previous studies have suggested that varying incidences of talar osteochondral lesions (OCLT) are associated with ankle fractures. The primary aim of our study was to investigate the incidence of osteochondral lesions associated with acute ankle fractures as observed on computed tomographic (CT) imaging. We also compared the rates of talar osteochondral lesions in patients who had ankle fractures with dislocation and closed manual reduction (CMR) prior to open reduction with internal fixation, to those who did not suffer from ankle joint dislocation. Additionally, a correlation between the location of talar dome lesions with type of ankle fracture as classified by Lauge-Hansen was investigated. Preoperative CT imaging was retrospectively reviewed in 108 patients with acute ankle fractures. A CT-modified version of Berndt Hardy's classification of osteochondral lesions, as previously described by Loomer et al, was used for diagnosis of lesions in our study. The incidence of lesions was calculated across all subjects, and retrospective comparison was performed in those who did and did not undergo closed manual reduction. Supplementary data on location of lesion and its association with ankle fracture type was also recorded. We found an overall incidence of 50.9% OCLT in patients with acute ankle fractures. This number did not significantly differ from those who underwent closed manual reduction (49%). Although a majority of lesions did occur posteriorly, we saw no statistically significant information was seen between either type of fractures or OCLT locations. Careful consideration and thorough evaluation of preoperative CT imaging should be assessed by the performing surgeon, as this could guide both diagnostic and therapeutic treatments for patients with possible osteochondral lesions of the talus undergoing surgical repair of a fractured ankle.
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Affiliation(s)
- Cody J Togher
- Resident, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL.
| | - Hannah Sahli
- Resident, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
| | - Jordan Butterfield
- Resident, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
| | - Josh Sebag
- Resident, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
| | - Amber M Shane
- Chair of Department of Podiatric Surgery, AdventHealth System, Faculty, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
| | - Christopher L Reeves
- Chair of Department of Podiatric Surgery, AdventHealth System, Faculty, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
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15
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Dunleavy ML, Gallo RA, Black KP. Impaction Bone Grafting for Treatment of Unstable Osteochondritis Dissecans (OCD) Lesions. Arthrosc Tech 2021; 10:e2627-e2631. [PMID: 35004141 PMCID: PMC8719055 DOI: 10.1016/j.eats.2021.08.004] [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: 04/15/2021] [Accepted: 08/05/2021] [Indexed: 02/03/2023] Open
Abstract
Although treatment options for unstable and unsalvageable large osteochondral lesions have largely been limited to autologous chondrocyte implantation (ACI) and osteochondral allografts, isolated impaction bone grafting represents a cost-friendly alternative, with predictable outcomes comparable to other options. Furthermore, the procedure can be completed in a single stage on an elective basis. We present our technique for impaction bone grafting of unstable osteochondritis dissecans (OCD) using either cancellous autograft or allograft.
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Affiliation(s)
| | - Robert A. Gallo
- Address correspondence to Robert A. Gallo, M.D., M.H.A., Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, 500 University Dr., Hershey, PA, 17033, U.S.A.
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16
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Chau MM, Klimstra MA, Wise KL, Ellermann JM, Tóth F, Carlson CS, Nelson BJ, Tompkins MA. Osteochondritis Dissecans: Current Understanding of Epidemiology, Etiology, Management, and Outcomes. J Bone Joint Surg Am 2021; 103:1132-1151. [PMID: 34109940 PMCID: PMC8272630 DOI: 10.2106/jbjs.20.01399] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis. ➤ While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition. ➤ Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging. ➤ Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions. ➤ Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.
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Affiliation(s)
- Michael M Chau
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Mikhail A Klimstra
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Kelsey L Wise
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jutta M Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Bradley J Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- TRIA Orthopedic Center, Bloomington, Minnesota
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- TRIA Orthopedic Center, Bloomington, Minnesota
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17
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Hinckel BB, Baumann CA, Ejnisman L, Cavinatto LM, Martusiewicz A, Tanaka MJ, Tompkins M, Sherman SL, Chahla JA, Frank R, Yamamoto GL, Bicos J, Arendt L, Fithian D, Farr J. Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e20.00083. [PMID: 33986224 PMCID: PMC7537824 DOI: 10.5435/jaaosglobal-d-20-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
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Affiliation(s)
- Betina B Hinckel
- From the Oakland University, Rochester (Dr. Hinckel, and Dr. Cavinatto); Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak (Dr. Hinckel, Dr. Cavinatto), MI; the University of Missouri-School of Medicine, Columbia, MO (Mr. Baumann); the Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR (Dr. Ejnisman); the Shoulder and Elbow Surgery, Beaumont Orthopaedic Associates, Beaumont Health (Dr. Martusiewicz); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Tanaka); the Department of Orthopedic Surgery, TRIA Orthopedic Center, University of Minnesota, Gillette Children's Specialty Healthcare, MN (Dr. Tompkins); the Department of Orthopedic Surgery, Stanford University, CA (Dr. Sherman); the Rush University Medical Center, Chicago, IL (Dr. Chahla); the Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, Aurora, CO (Dr. Frank); the Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Yamamoto); CEGH-CEL, Instituto de Biociências, Universidade de São Paulo (Dr. Yamamoto); DASA Laboratories, Sao Paulo, Brazil (Dr. Yamamoto); the Michigan Orthopedic Surgeons, Fellowship Director William Beaumont Sports Medicine Fellowship, Assistant Professor Oakland University William Beaumont School of Medicine, MI (Dr. Bicos); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Arendt); the Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, CA (Dr. Fithian); and the Knee Preservation, Cartilage Regeneration and OrthoBiologics, Department of Orthopedic Surgery, Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, IN (Dr. Farr)
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18
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Hadeed MM, Dempsey IJ, Tyrrell Burrus M, Werner BC, Walker JB, Perumal V, Park JS. Predictors of Osteochondral Lesions of the Talus in Patients Undergoing Broström-Gould Ankle Ligament Reconstruction. J Foot Ankle Surg 2020; 59:21-26. [PMID: 31882142 DOI: 10.1053/j.jfas.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Indexed: 02/03/2023]
Abstract
Chronic ankle instability is associated with intra-articular and extra-articular ankle pathologies, including osteochondral lesions of the talus. Patients with these lesions are at risk for treatment failure for their ankle instability. Identifying these patients is important and helps to guide operative versus nonoperative treatment. There is no literature examining which patient characteristics may be used to predict concomitant osteochondral lesions of the talus. A retrospective chart review was performed on patients (N = 192) who underwent a primary Broström-Gould lateral ankle ligament reconstruction for chronic ankle instability from 2010 to 2014. Preoperative findings, magnetic resonance imaging, and operative procedures were documented. Patients with and without a lesion were divided into 2 cohorts. Fifty-three (27.6%) patients had 1 lesion identified on preoperative magnetic resonance imaging. Forty (69.0%) of these lesions were medial, 18 (31.0%) were lateral, and 5 patients had both. Female sex was a negative predictor of a concomitant lesion (p = .013). Patients were less likely to have concomitant peroneal tendinopathy (30.2% vs 48.9%; p = .019) in the presence of a lesion. However, sports participation was a positive predictor of a concomitant lesion (p = .001). The remainder of the variables (age, body mass index, smoking, trauma, duration, contralateral instability, global laxity) did not show a significant difference. In patients who underwent lateral ankle ligament reconstruction, females were less likely to have a lesion than males. Patients with peroneal tendinopathy were less likely to have a lesion compared with patients without. Additionally, athletic participation was a positive predictor of a concomitant lesion.
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Affiliation(s)
- Michael M Hadeed
- Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Ian J Dempsey
- Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
| | - M Tyrrell Burrus
- Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Brian C Werner
- Assistant Professor, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - J Brock Walker
- Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Venkat Perumal
- Assistant Professor, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Joseph S Park
- Associate Professor, Foot and Ankle Service, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
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