OCD Lesions Research Articles

Internal Fixation of Unstable OCD Lesions with Metal Compression Screws: Techniques and Outcomes

Internal Fixation of Unstable OCD Lesions with Metal Compression Screws: Techniques and Outcomes

Age as a Prognostic Factor in Arthroscopic Drilling of Juvenile Osteochondritis Dissecans of the Knee: A National Database Review

Background: Juvenile Osteochondritis Dissecans (JOCD) is a common knee condition that can cause significant morbidity if the lesion does not heal. Arthroscopic drilling is a common surgical treatment for low-grade intact lesions, but its success rate and complications have not been well defined in a large series.Purpose: This study seeks to determine the reoperation rate and the incidence of major complications following arthroscopic drilling of JOCD lesions of the knee.Methods: A query of patients in the Pediatric Health Information System (PHIS) database from 2013 to 2018 was performed for the diagnosis and billing codes specific for arthroscopic drilling of an intact JOCD lesion. Subsequent surgical procedures on ipsilateral and contralateral knees were then analyzed for evidence of additional surgical procedures related to non-healing of the lesion.Results: We identified 1027 patients, 6-17 years of age, who underwent arthroscopic drilling as their initial surgical treatment for a diagnosis of JOCD of the knee. Within 6 months of the original surgery, 27 patients (3%) had a secondary surgery on the ipsilateral knee, and 27 patients (3%) had surgery on the contralateral knee. By 2 years, 84 patients (8%) had a secondary surgery on the ipsilateral knee and 38 patients (4%) had surgery on the contralateral knee. Patient age was a significant factor in both the frequency and distribution of secondary surgeries, with older patients requiring repeat procedures and tending to have more invasive procedures more frequently. Less than 1% of patients underwent another surgical procedure of the knee not specifically to treat the JOCD lesion.Conclusions: The 2-year reoperation rate following drilling of an intact juvenile OCD lesion was 8%. Younger patients (<13 years old) were less likely to undergo a subsequent procedure compared to older patients. In addition, if they did require a second procedure, the majority of older patients required a salvage-type cartilage procedure. The rate of complications requiring additional knee surgeries was less than 1%.Level of Evidence: Level III, Prognostic Study Key Concepts•Arthroscopic drilling in the treatment of juvenile OCD of the knee is very effective, and only 3% of patients require a second surgery in the first 6 months and 8% in the first 2 years.•Younger patients were not as likely to require subsequent arthroscopic drilling for osteochondritis dissecans of the knee.•Intact lesions with low rates of anticipated healing may lead to favorable outcomes if treated sooner.

Association of Radiographic Alignment, Degree of Ankle Instability, Concomitant Pathology, and VAS Pain Scores after the Brostrom-Gould Procedure for Chronic Ankle Instability

Category: Sports; Ankle; Arthroscopy Introduction/Purpose: The Brostrom-Gould procedure is the gold standard surgical treatment for patients with chronic ankle instability (CAI) whose symptoms are refractory to conservative treatment. The purpose of this study is to investigate the relationship between preoperative radiographic alignment, intraoperative stress testing, concomitant pathology, and postoperative pain scores in patients undergoing Brostrom-Gould procedures. Specific questions included: 1) Is preoperative radiographic alignment predictive of the degree of lateral ankle instability noted intraoperatively? 2) Is the degree of ankle instability associated with the presence of OCD lesions and peroneal tendon pathology? 3) Is the degree of ankle instability associated with postoperative VAS pain? and 4) Does concomitant pathology affect final VAS pain score? Methods: A retrospective study was performed of all patients who underwent lateral ankle ligament reconstruction by a single surgeon from 2002 to 2020. Patients who underwent concomitant hindfoot fusion procedures or ankle arthroplasty were excluded. Demographic and clinical information was recorded from the electronic medical record. Preoperative radiographic measurements were taken using weightbearing ankle films. Intraoperative stress views were evaluated to determine the talar tilt. All data was tested for normality. Parametric and nonparametric univariate statistics were used to determine the relationship between preoperative weightbearing radiographic measurements, preoperative MRI findings, intraoperative talar tilt measurement, and postoperative outcomes. Results: 181 patients with a median follow-up of 1 year were included. Complications included delayed wound healing in 5.6%, superficial infection in 2.8%, and nerve symptoms in 11%. The reoperation rate was 5%, including revision lateral ankle ligament reconstruction (4/181), debridement for infection (1/181), and wound revision (4/181). Increased preoperative anterior distal tibial angle (ADTA) was associated with an increased intraoperative talar tilt (p=0.0073). Increased intraoperative talar tilt was associated with an increased prevalence of osteochondral lesions of the talus (p=0.0176). Mean VAS scores improved from 4.6 preoperatively to 1.9 postoperatively (p&lt;0.0001). Neither the preoperative radiographic alignment nor the degree of intraoperative instability were predictive of final VAS score. Patients with osteochondral lesions had higher final VAS pain scores than patients without osteochondral lesions (p=0.0134). Conclusion: In patients undergoing lateral ankle ligament reconstruction for CAI, preoperative ankle alignment was associated with the degree of ankle instability. It is unclear if an increased ADTA predisposes to great instability, or if larger anterior distal tibia osteophytes are formed in patients with more severe instability, leading to a larger ADTA. Increased instability was associated with a higher rate of osteochondral lesions, and patients with osteochondral lesions tended to have more pain postoperatively. This information may be helpful in counseling patients regarding surgical treatment and postoperative expectations.

Evaluation of Osteochondritis Dissecans Treatment with Bioabsorbable Implants in Children and Adolescents.

(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%).

Knee Pain-Basketball

HISTORY: 11 yo male basketball player referred to sports medicine for B/L anterior knee pain out of proportion to exam, right worse than left. He denied trauma. It started in his right knee 1 month prior, and he began having similar left knee pain. It was worse with activity including walking. He would feel popping in his knees. They felt unstable. He had failed conservative measures. As a result of his pain, he had to quit his basketball team and wasn’t able to run or play during recess. PHYSICAL EXAMINATION: B/L Knee Exam: Antalgic gait. No swelling. Normal alignment. Tender on medial and lateral joint lines and patella, less tender in patellar and quad tendons. Significant pain with flexion, range normal. Normal extension. Normal ligament and meniscus tests. Pain with patellar compression. Pain and difficulty with single leg hop, R > L. DIFFERENTIAL DIAGNOSIS: Sickle cell disease, OCD, discoid menisci, rheumatologic disorder, SCFE vs LCP TEST AND RESULTS: X-Rays B/L knees: Suggest mild B/L trochlear OCD X-Rays AP pelvis and lateral of both hips: Negative Sickle screen: Absent MRI right knee: Superior trochlea with 2.4 x 1.4 cm osteochondritis dissecans lesion, depth 0.4 cm. Sclerosis and subchondral cysts along the rim worrisome for instability MRI left knee: Superior central trochlea with subchondral sclerosis suggesting 9 mm osteochondritis dissecans lesion. Minimal subchondral sclerosis of the medial tibial plateau weight bearing surface with OCD lesion vs subacute/healing insufficiency fracture in the differential. FINAL WORKING DIAGNOSIS: Bilateral femoral trochlea osteochondritis dissecans TREATMENT AND OUTCOMES: Patient was referred to orthopedics for staged knee arthroscopy with retrograde transcartilaginous subchondral drilling of the trochlea, starting with the right knee. After each respective knee procedure, the patient was given a specific rehab protocol. Symptoms began improving. Intermittent symptoms returned ~9 months after right knee and 4 months after left knee surgery, so B/L knee MRIs were completed and showed significant improvement in the prior pathology. At his most recent visit, the patient was overall doing better noting significant bilateral knee improvement since the surgeries. He was back to playing basketball with his friends with only some post-activity soreness.

Paper 38: Conservative Treatment of Osteochondritis Dissecans of the Humeral Capitellum among Young Baseball Players

Objectives:The goals of treatment of osteochondritis dissecans of the humeral capitellum (OCD) are morphological healing and early return to sports and these are often contradictive. The purpose of this study was to evaluate our conservative treatment of OCD and establish the appropriate treatment.Methods:We retrospectively reviewed 206 patients with OCD who were treated conservatively at first visit our hospital and affiliated institutions from 2009 to 2019. Exclusion criteria were loss and less than 1 year follow-up. Mean age was 12.1 years (8-15). All patients were advised to stop or limit throwing and underwent physical therapy. Depending on the stage and healing process, at least, after waiting for the lateral wall of the capitellum to heal throwing was permitted to resume. Age at first visited, OCD Stage (Ⅰ; radiolucent area, Ⅱ; nondisplaced fragmentation, Ⅲ; loose body), clinical result (complete healing, partial healing, surgery required), and when to return to play were evaluated statistically.Results:A total of 193 patients were enrolled. There were 115 patients that were stageⅠ with a mean age of 11.2 years, 63 patients that were stageⅡ with a mean age of 13.2 years, and 15 patients that were stageⅢ with a mean age of 14.1 years (Table 1), and these differences were statistically significant (p<0.01). Collectively, complete healing was observed in 70.4%, partial healing in 17.4%, surgery in 12.2% of stageⅠ, complete healing in 50.8%, partial healing in 12.7%, surgery in 36.5% of stageⅡ, and complete healing in 0%, partial healing in 26.7%, surgery in 73.3% of stageⅢ (Fig 1). Of the 47 patients who underwent surgery, arthroscopic debridement for OCD lesions was selected for 79%, osteochondral autograft transplantation was selected for 16%, and fixation was selected for 4% (Fig 2). The mean period of return to play was 8.6 months; < 6 months was 42%, 6 months- 1 year was 39%, 1 year-1.5 year was 16%, and 1.5%< was 3%.Conclusions:In this study, OCD lesions likely to heal when the OCD stage were early. Even if surgery was needed after failed conservative treatment, most of the patients were treated by arthroscopic debridement which was a relatively minimally invasive procedure. Conservative treatment of OCD was successful when the treatment is begun in early stage of the disease.UPLOAD-https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/e5e18779-1cc0-4cc6-814b-a97204c6da85/1/file.pdf

Osteocondritis dissecans lesions of the knee restored by bone marrow aspirate concentrate. Clinical and imaging results in 18 patients

BackgroundOsteochondritis dissecans (OCD) is a common cartilage disorder that specifically affects the knees of skeletally immature and young adult patients. There have been a few treatments that have been proposed: fixation of the fragment, drilling, microfractures. The aim of this study was to analyze retrospectively clinical and imaging results obtained by treating it with one-step bone marrow-derived cells Transplantation (BMDCT) technique.MethodsFrom 2007 to 2014, 18 patients (mean-age 19.1 ± 5.0 years) affected by OCD were treated with one-step BMDC transplantation. In our observational study, clinical evaluation was performed at a scheduled follow-up through IKDC, Tegner, KOOS and EQ-VAS. X-rays and MRI were conducted preoperatively and at 12 months. At final follow-up, MRI MOCART Score was evaluated.ResultsIKDC and KOOS clinical scores showed a progressive increase. Tegner Score at final follow-up (5.3 ± 2.7) was significantly lower compared to the pre-injury level (6.5 ± 2.1); however, these results showed a statistically significant improvement that remained over time. EQ-VAS showed a significant improvement in every follow-up measure. MRI Mocart Score showed a complete or almost complete filling of the lesion in 13 patients.Conclusions“One-step” technique allows articular surface restoration with viable physiologic osteochondral tissue with a high clinical efficacy and imaging results. The number of cases is still limited, and further studies with larger sample sizes and greater follow-up evaluations are required to confirm our results. Nevertheless, we believe that BMDCT may represent a suitable option to treat OCD lesion in young adults.

Unestable knee osteochondritis dissecans: Arthroscopic fixation with bio-absorbable device

IntroductionKnee Ostheochondritis Dissecans is an osteochondral disease, whose treatment is still debated. The purpose this study was to analyze the patients attached with bioabsorbable nail, assisted by arthroscopy. Material and methodAnalysis was performed using median and interquartile range (P25–P75), with a follow-up of 9 patients (10 knees) operated for stage III osteochondral lesions. After a minimum of 12 months, the KOOS, IKDC, satisfaction questionnaires were evaluated and a MR control was performed. ResultsBone healing was observed in 80% of patients in the first year, with a delay in union in 20%. The median for age was 15 years. The average follow-up was 5′93 years. All cases were located in the internal condyle. The OCD lesions did not show comminution or necrosis. The 40% of stable lesions, according to preoperative MR, were unestable in arthroscopy and it were attached with internal nail. Two groups of osteochondral lesions were differentiated: juvenile OCD (60%) and adult OCD (40%); all of them were stage III lesions. IKDC questionnaire results were an improvement of 29′5 (22′25, 37′52). In the KOOS questionnaire, an improvement was obtained in symptoms of 18′07, in pain of 29′12, in daily living 25′53, in function (sports, recreational activities) of 35 and in quality of life of 34′42. ConclusionsThe bioabsorbable nail is a valid, reproducible option for unestable entire lesions, with an improvement in function, quality of life, and with a low rate of complications.

COMPLICATIONS OF ARTHROSCOPIC DRILLING IN THE TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE KNEE IN CHILDREN AND ADOLESCENTS

Background:Arthroscopic drilling is a well-established treatment for stable intact OCDs of the knee in children when non-operative treatment fails. The decision to proceed to operative treatment requires a discussion regarding the risks and benefits of surgical intervention. While there is abundant data suggesting that OCD drilling is a highly effective treatment strategy, there is little data specifically evaluating the risks and complications of this procedure.Purpose:The goal of this study was to assess the complications of drilling of stable OCDs of the knee, and the risk factors for developing complications.Methods:In a retrospective chart review from 2009-2017, data from patients <18 years old who underwent arthroscopic drilling for stable intact OCD lesions of knee were collected. Lesions treated with other techniques (fixation, chondroplasty, OATS), and those with <3 months of follow-up were excluded. Characteristics of the lesions, treatment approach, and post-operative course were recorded. For bilateral surgeries, each knee was considered a separate record.Results:139 knees in 131 patients were evaluated, of which 102 (73%) were male. The mean age was 12.7years. 108 knees (77%) had an open physis at the time of operation. Patients were managed conservatively for a mean of 6.76 months pre-operatively (SD=6.6). Average follow-up was 14.8 months after the initial surgery (SD=13.25). 53 patients (38%) were obese or overweight at the time of surgery. All patients regained full ROM within 5° of the contralateral knee at a mean 12.9 weeks post-op (SD=3.2), with all but 7 (5 %) returning to activities of daily living at the 3-month visit. No cases of infection, stiffness, arthrofibrosis, or other procedure-related complications were recorded. 6 knees (4.3%) underwent 7 additional surgeries during the follow-up period, all of which were for treatment failure in non-healing lesions (loose body removals, chondroplasty, or repeat drilling). In a multiple logistic regression model, age, gender, status of the physis at the time of surgery, BMI percentile, and OCD size were not predictive of the need for additional surgeries.Discussion:Our findings suggest that arthroscopic drilling for OCDs of the knee is a safe procedure with minimal risk of complications. The majority of patients return to their pre-operative daily activity level with full ROM by 3 months after surgery. Complications, including reoperation, were related to the progression of the OCD, rather than the surgical procedure.

Osteocondritis disecante inestable de rodilla: fijación artroscópica con implante bioabsorbible

IntroductionKnee ostheochondritis dissecans is an osteochondral disease, whose treatment is still debated. The purpose this study was to analyze the patients attached with bioabsorbable nail, assisted by arthroscopy. Material and methodAnalysis was performed using median and interquartile range (P25-P75), with a follow-up of 9 patients (10 knees) operated for stage III osteochondral lesions. After a minimum of 12 months, the KOOS, IKDC, satisfaction questionnaires were evaluated and a MR control was perfomed. ResultsBone healing was observed in 80% of patients in the first year, with a delay in union in 20%. The median for age was 15 years. The average follow-up was 5.93 years. All cases were located in the internal condyle. The OCD lesions did not show comminution or necrosis. The 40% of stable lesions, according to preoperative MR, were unestable in arthroscopy and it were attached with internal nail. Two groups of osteochondral lesions were differentiated: juvenile OCD (60%) and adult OCD (40%); all of them were stage III lesions. IKDC questionnaire results were an improvement of 29.5 (22.25, 37.52). In the KOOS questionnaire, an improvement was obtained in symptoms of 18.07, in pain of 29.12, in daily living 25.53, in function (sports, recreational activities) of 35 and in quality of life of 34.42. ConclusionsThe bioabsorbable nail is a valid, reproducible option for unestable lesions with lesion integrity, with great improvement in function, quality of life and with few complications.

INCREASED PREVALENCE OF JUVENILE OSTEOCHONDRITIS DISSECANS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Objectives:To determine the prevalence and severity of OCD in patients with JIA.Methods:This was a retrospective review of patients with JIA and OCD treated between January 2008 and March 2019 at one children’s hospital. We queried Department of Rheumatology records for JIA patients treated during this interval as well as Departments of Orthopedics and Radiology records for patients with OCD. Demographic information, classification of the stability of OCD lesions by review of magnetic resonance imaging, and clinical details of treatment were recorded.Results:2,021 JIA patients were identified, 20 of whom (19 girls, 1 boy) had OCD of the knee and/or talus for a prevalence of 1/100 or 1000/100,000, or approximately 30-200x that of the general population. These 20 patients had a total of 28 OCD lesions: 43% (9 femur, 3 talus) were radiographically stable over time, 50% (10 femur, 2 patella, and 2 talus) were unstable at initial diagnosis, and 7% (femur) were initially stable but progressed to unstable lesions despite drilling. Eleven patients (55%) underwent surgery: 5 with stable femoral lesions for persistent symptoms despite prolonged non-operative treatment, and 6 for treatment of their unstable lesions (femur and patella). Of these 11 patients, 3 underwent two or more surgeries for OCDs, and 3 were treated with hemiepiphysiodesis for concomitant genu valgum.Conclusion:OCD lesions are 30-200x more prevalent in JIA compared to the general population. In JIA, OCD often presents at an advanced stage requiring surgery for stabilization. Patients with JIA may benefit by early screening, to potentially allow for treatment of an OCD lesion prior to the progression to instability.

Management of Symptomatic Osteochondritis Dissecans of the Knee

AbstractOsteochondritis dissecans (OCD) is a focal lesion of the subchondral bone that can result in fragmentation, instability, and if untreated, loose body formation with progression to early degenerative changes. Particularly in adolescent male athletes, OCD of the knee is a common source of pain, effusion, and mechanical symptoms with sporting activities. Conservative treatment of athletes with OCD of the knee can entail several months of activity modification and non–weight-bearing restrictions, with varying degrees of healing and return to activity. For unstable OCD lesions not amenable to conservative treatment, previous studies have shown excellent outcomes in patients undergoing osteochondral fixation, with hardware placement and technique being critical determinants of patient outcomes. This infographic reviews the presentation and description of different types of OCD lesions, prognostic factors, surgical indications, and considerations for determining the optimal treatment algorithm. With unstable lesions showing either a “locked door” or “trapdoor” at the time of arthroscopy, subchondral bone preparation and arthroscopic-assisted or open fixation with dual-pitch metal or bio-composite screws can be successful in 67% to 100% of cases. Nonviable or chronically displaced lesions may undergo abrasion chondroplasty, marrow stimulation, or preferably, secondary cartilage restoration.

Encouraging mid-term outcomes for arthroscopic autologous osteochondral transplant (OAT) in capitellum osteochondritis dissecans (OCD).

The primary outcomes are the evaluation and quantification of pain relief and improvement in range of motion after OAT in OCD. The secondary outcomes are: resuming of sport activities, evaluation of the ADL recovery rate and subjective evaluation of the quality of life improvement. Nine patients, affected by an unstable and non-acute OCD lesion of the capitulum humeri, have been treated by the same surgeon. The patient mean age was 22.4 (16-45years). All subjects were treated with the same surgical technique (arthroscopic OAT from the same side knee, a single cylinder of 6.5-9mm in diameter) and underwent the same rehabilitation. The mean follow-up was 48months (30-52months). The authors documented the clinical assessment of each patient and carried out a questionnaire which included the VAS scale, MEPS Score and Quick DASH score. Patients were asked for MRI and radiographs pre- and post-operatively at follow-up. The mean range of motion improvement was 17.9° in extension (range 13°-27°) and 10.6° in flexion (range 0°-20°) The VAS mean improvement was 7.1 (range 6-8) and the mean post-op value 0.6 (range 0-3). The MEPS score mean post-operative value was 98.3 (range 85-100). The Quick-DASH mean post-operative value was 2.5 (range 0-9.1) with a mean improvement of 41.4 points (range 36.4-47.7 points). All patients resumed sports in 6months post-operatively. The autologous transplant of an osteochondral plug is a safe and promising procedure. Despite being more demanding, the arthroscopic approach is a valuable tool if the surgeon aims to reduce the invasiveness of the procedure, with all the consequent advantages. Retrospective case series, therapeutic study.

Bone Peg Fixation for Osteochondritis Dissecans of the Humeral Capitellum in the ICRS classification of OCD lesions III and IV including Lateral Wall of Humerus

Bone Peg Fixation for Osteochondritis Dissecans of the Humeral Capitellum in the ICRS classification of OCD lesions III and IV including Lateral Wall of Humerus

Low rate of return to pre-injury sport level in athletes after cartilage surgery: a 10-year follow-up study

Although articular surface is frequently damaged in athletes, results in terms of return to sport and level of activity after cartilage surgery remain rather unpredictable and poorly documented. The aim of this study is to evaluate the clinical outcome in terms of rate and level of return to sport in a group of competitive athletes who underwent matrix-assisted autologous chondrocyte transplantation (MACT), as well as the impact on their athletic career. Thirty-one male patients (mean age 22.6 ± 6.3years) p racticing sport at competitive level, affected by focal chondral/osteochondral lesions of the distal femur, were enrolled and treated with arthroscopic hyaluronan-based MACT. Patients were evaluated prospectively at 1-year intervals with the IKDC subjective, Tegner, and EuroQol VAS scores during their pre-operative visit and subsequent follow-ups for up to 10years. Return to sport in terms of level, time and maintenance of the activity level was documented, together with surgical or clinical failures. A marked improvement in all scores was found: IKDC increased from 40.3 ± 13.4 to 81.7 ± 14.4 (p < 0.0005) at 12 months; a further improvement was observed at 2years (89.5 ± 11.3; p = 0.008), then results were stable for up to 10years (87.3 ± 13.6). The analysis of return to sport documented that 64.5% of patients were able to return at a competitive level, and 58.1% performed at the same pre-injury level, with activity rates decreasing over time. The rate of patients returning to competitive level was 84% in those without previous surgery (vs. 33% who had undergone previous surgery), 87% for those with traumatic lesions (vs. 33% and 50% for degenerative and OCD lesions, respectively), and 92.3% in younger patients (age < 20years). Among these factors, multivariate analysis demonstrated that previous surgery was the single most influencing factor for returning to the same sport level (p = 0.010). These long-term results showed that chondrocyte-based regenerative approach has some limitations in terms of sport-related outcomes. The level of high functional knee restoration needed for such high-demanding activity level can be challenging to achieve, especially in patients with a more compromised joint homeostasis. Return to sport rate varies significantly according to specific patient and lesion characteristics and best results are obtained in young patients with traumatic lesions without previous surgery, which should be considered when treating athletes affected by cartilage lesions. IV.

Grade I Osteochondritis Dissecans in a Young Professional Athlete.

Background:Osteochondritis dissecans (OCD) is a disorder primarily affecting subchondral bone, with secondary effects on the overlying articular cartilage. Knee joint (75%) and radiocapitellar joint (6%) are the most common sites for OCD lesions. The presence of an open growth plate differentiates juvenile osteochondritis dissecans from adult form of osteochondritis. Early diagnosis and treatment produce best long term results. The objective of this study is to determine the best mode of management of a Grade I osteochondritis lesion in a young athlete.Materials and Methods:A PubMed search was made using the keywords “OCD” and “athlete”. Articles that were based on participants between the ages of 6–24 years (children, adolescent and young adult) and early stages of OCD were included in this study. A total of 25 articles were thus included for the review.Results:The healing potential is based on the age of the patient, status of physis, and stage of the lesion. Most authors have observed good to excellent results of drilling of early OCD in skeletally mature patients. Similarly, most authors also reported equally successful outcomes of nonoperative treatment for early OCD in skeletally immature patients.Conclusions:We recommend initial nonoperative line of management in patients with open physis. In case of progression of the lesion or failure of conservative treatment a reparative, restorative or palliative surgical intervention can be done. For Stage I OCD lesions in patients with closed physis, we advocate reparative surgery either by means of retro- or trans-articular drilling.

Operative And Non-operative Management Of Osteochondritis Dissecans In The Knee Of Skeletally Immature Patients: Rates Of Persistent Knee Pain, Osteoarthritis, And Arthroplasty At Mean 14- Years Follow-up

Objectives:The purpose of this study was to report long-term follow-up of skeletally immature OCD lesions treated operatively and non-operatively and determine risk factors for persistent knee pain at final follow-up.Methods:A large, geographic database of over 500,000 patients was reviewed in this case series to identify and confirm patients with OCD of the knee. Presenting radiographs and MRI were reviewed. Clinical course including operative management, persistent knee pain, and conversion to TKA were obtained and analyzed through review of clinical and operative notes.Results:95 skeletally immature patients (70 males, 25 females) with OCD lesions diagnosed at a mean age of 13 years (range: 7-16) were followed for a mean of 14 years (range: 2-40). 53 patients (56%) were treated operatively and 42 patients (44%) were treated non-operatively. At final follow up, 13 patients with a mean age of 30 years noted persistent knee pain, 8 (15%) treated operatively versus 5 (12%) treated non-operatively. Risk factors for knee pain were female gender, patellar lesion location, and unstable lesions (Table 1). Four patients (8%) treated operatively and two (5%) treated non-operatively developed symptomatic osteoarthritis at a mean of 28.6 years following diagnosis. One patient treated operatively and two treated non-operatively converted to TKA at a mean of 37 years following diagnosis. Mean age at TKA was 52 years, significantly younger than that observed for primary TKA at our institution (p = 0.004).Conclusion:Patients with skeletally immature OCD lesions have an estimated 14% rate of persistent knee pain, 6% risk of symptomatic osteoarthritis, and 3% risk of conversion to TKA at a mean of 14 years following time of diagnosis. Female patients, patellar lesions, and unstable lesions demonstrated increased risk of persistent knee pain at final follow-up. Patients with OCD of the knee convert to TKA at a significantly younger age than that of the general primary TKA population.Table 1.Risk factors for penistent ;met pain at the time of final follow-up Variable HR (95% Confidence Interval) p-value Treatment Non-OperativeReference Operative1.16(0.35 - 3.83)0.81Age at diagnosis <10Reference ≥1010.3(0.11-9.63)0.98Gender FemaleReference Male0.24(0.07-0.81) 0.02 Location MFCReference LFC2.91(0.57-14.97)0.2 Patella5.30(1.37-20.48) 0.02 Trochlea0.00(0.00-0.00)a <0.01a AP Radiograph Lesion Width <20mmReference ≥20mm1.74(0.23-12.97)0.59AP Radiograph Lesion Depth <5mmReference ≥5mm0.68(0.08-6.00)0.73Lateral Radiograph Lesion Width <20mmReference ≥20mm1.75(0.31-10.01)0.53Lateral Radiograph Lesion Depth <5mmReference ≥5mm2.14(0.38-11.95)0.38Lesion Contour ConcaveReference Convex0.45(0.08-2.54)0.37Disruption of subchondral bone NoReference Yes0.73(0.15-3.54)0.7Intra-articular displace fragment NoReference Yes0.85(0.10-7.48)0.88Adjacent Focal Articular Cartilage Defects NoReference Yes0.85(0.10-7.48)0.88Stability StableReference Unstable10.58(1.26-88.63) 0.03 aOf then =2 lesions present on the trochlea, none developed symptomatic Knee pain

Prevalence and severity of osteochondrosis of the free thoracic vertebra in three modern broiler strains and the Athens Canadian Random Bred control broiler

ABSTRACTOsteochondrosis (OCD) results from a disturbance of endochondral ossification in articular cartilage and is an important cause of lameness in several animal species, including chickens. OCD lesions in the free thoracic vertebra (FTV) of chickens are essential to the pathogenesis of pathogenic Enterococcus cecorum. The goal of this study was to determine the prevalence of OCD in the FTV among three modern broiler chicken crosses (strains A/A, A/B, and C/C) and Athens Canadian Random Bred (ACRB) chickens, which served as the control group. The effect of sex, age, strain, body weight, and incubation temperature profile on OCD severity for each group was determined. At 2, 4, 6, and 8 weeks of age, the FTV of 10 male and 10 female birds from each strain exposed to either optimal or low-early, high-late incubation temperature profiles were collected and scored histologically for OCD lesion severity. OCD spectrum lesions were detected in >70% of all strain/sex combinations, including the ACRB controls. No association was observed between mean OCD score and broiler strain, incubation temperature profile, sex, age, or body weight. These findings indicate that OCD of the FTV is common in broiler chickens with similar prevalence observed in broilers with modern genetics and the ACRB broilers which represent 1950s broiler genetics. As the parameters examined did not have a statistical correlation with OCD, additional work is needed to understand factors that contribute to development of OCD in chickens.

Internal Fixation of Osteochondritis Dissecans Lesions in the Patellofemoral Joint.

Osteochondritis dissecans (OCD) lesions of the patellofemoral joint can be difficult to identify and treat. Asymptomatic or stable lesions in skeletally immature patients may be treated nonoperatively, but symptomatic lesions often require surgical intervention. Evidence of instability should be carefully evaluated with preoperative magnetic resonance imaging or computed tomography arthrogram. Careful preoperative planning is necessary to ensure the appropriate surgical approach and implants are selected for surgical management. Multiple techniques have been described, but internal fixation of both "classic" and cartilage-only OCD lesions has been shown to have strong outcomes in managing these difficult cases.

Osteochondritis dissecans—Does platelet rich plasma really help

Osteochondritis dissecans is a common disorder of knee and can be treated by various methods, depending on age of patient and stability of chondral fragment. In Osteochondritis dissecans ICRS type III lesion i.e. articular cartilage discontinuity but no dislocation, variable rate of union as well as high rate of non-union was observed in previous studies when treated with arthroscopic or open reduction and fixation. In previous study it has been also shown that platelet rich plasma help in fracture healing. In this study we are trying to extend the benefit of platelet rich plasma to Osteochondritis dissecans lesion. We took six patients with OCD, ICRS scale of OCD type III lesion. All Patients were operated Arthroscopiclly. Chondral flap of OCD lesion were fixed with stainless steel cannulated cancellous screw. To enhance union we used platelet rich plasma injections. .We access the union of chondral fragment to parent bone and knee function. Chondral fragment united to parent bone in all patients. To access knee function we used Tagner- Lysholm knee scoring system, in this study preoperatively score was 52.8 where as postoperatively it was 91.8. This study showed PRP is helpful in healing of chondral flap as all the chondral flap of osteochondral lesion united in this study.