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At least 19 recordsLinked to original sources
PubMed1985

Treatment of juvenile osteochondritis dissecans and osteochondritis dissecans of the knee.

JOCD and OCD are distinct conditions. The former has a much more favorable prognosis than the latter. Unrecognized trauma cumulating from activities of daily living and sports produces subchondral stress fractures that eventually become symptomatic and are recognized as JOCD. If JOCD does not heal by bony union prior to distal femoral epiphyseal closure, OCD results. Since JOCD is a fracture, any method used to stimulate fracture healing, except joint immobilization, should be employed. Careful monitoring of the patient's progress is essential and is most sensitively accomplished with joint scintigraphy. Historical evidence of the benign nature of JOCD is dubious and not consistent with clinical observations. The surgical precepts for treating patients in whom conservative treatment of JOCD fails and patients with OCD are traditional orthopedic concepts. Revascularization of the fragment followed by joint motion are the dictums of surgical success.

Adolescent↗
PubMed1997

Cartilage and bone morphology in osteochondritis dissecans.

Osteochondritis dissecans (OD) is a syndrome that can be characterized as a non-infectious disturbance of enchondral ossification or as a post-traumatic event. OD occurs in the joint cartilage and physis of long bones, as well as in the talus or metacarpal head especially of young athletes. The medial femoral condyle is the most commonly affected site. The causes of osteochondritis dissecans are poorly understood. Thirty human osteochondral cylinders from patients (aged 16-44 years) with osteochondritis dissecans of the medial femoral condyle (grades IV and V according to Rodegerdts and Gleissner) were harvested intraoperatively from osteochondritic areas as part of a cartilage-bone transplantation. Light microscopy, electron microscopy, and immunohistochemistry using poly- and monoclonal antibodies against collagens and glycosaminoglycans revealed differences between osteochondrotic and normal cartilage. Staining with toluidine blue at pH 1 shows a decrease in acidic glycosaminoglycans in OD. Modified pentachrome staining showed a thinned subchondral growth plate compared to normal osteochondral samples. Borders to the healthy tissue are clearly visible micro- and macroscopically. Scanning electron microscopy revealed structural differences in the subchondral area. Immunohistochemistry found a general decrease in glycosaminoglycan content and a change in composition. Only faint staining for chondroitin and keratan sulfates was observed in osteochondritic cartilage, whereas increased staining was shown for keratan sulfate in bone.

Adolescent↗
PubMed1987

Osteochondritis dissecans.

Osteochondritis dissecans were recognized many years ago, but its cause remains debatable. In a case of osteochondritis dissecans in a 24-year-old black man, hemosiderin was found in the loose body that was removed from the patient's knee. The presence of hemosiderin supports injury as the cause, but the patient had no history to indicate injury was a factor.

Adult↗
PubMed1991

Osteochondritis dissecans.

Osteochondritis dissecans is a rare orthopaedic disorder of unknown etiology. Advances in CT and MRI scanning have increased our knowledge of the disorder, but arthroscopy remains the principle means of monitoring its progress. Arthroscopic surgery has displaced traditional arthrotomy in many instances and is useful in retrieval of loose bodies, drilling of osteochondral fragments, retrograde bone grafting, and abrasion arthroplasty. Arthrotomy continues to be the best method of pinning and bone grafting of detached lesions. Advances in transplant surgery now permit large craters to be patched with osteochondral allografts.

Arthroscopy↗
PubMed1993

Arthroscopic Herbert screw fixation of patellar osteochondritis dissecans.

Osteochondritis dissecans of the patella is a rare cause of anterior knee pain. The lesion is thought to arise from chronic shear stress across the patella articular surface, producing a fragment of cartilage and subchondral bone that may remain in situ or become detached. When attempts at conservative treatment fail to provide satisfactory results, operative intervention is indicated. We present the case of a symptomatic lesion of the patella treated successfully with arthroscopic internal fixation using a retrogradely directed Herbert screw. The literature is reviewed with an emphasis on pathophysiology, diagnosis, and surgical treatment.

Adolescent↗
PubMed1987

Osteochondritis dissecans and osteochondral fragments managed by Herbert compression screw fixation.

Treatment of osteochondritis dissecans and osteochondral fragments using Herbert compression screw fixation combined with drilling gives satisfactory results. The Herbert screws may be inserted arthroscopically after identifying the lesion. The need for arthrotomy is eliminated in most instances. Management was by drilling and pinning for unseparated lesions and crater preparation with fragment fixation in cases with separated osteochondral fragments. The follow-up period is only four to 28 months. One case required arthrotomy. Ten patients with a four-month to five-year history of knee pain had unseparated lesions. Eight had excellent results with union, one required drilling and removal of sequestrae, and one remains unhealed. Three cases had separated osteochondral fragments. All three appear to have obtained union of the separated fragments without recurrence of separation.

Adolescent↗
PubMed1999

Juvenile osteochondritis dissecans.

Juvenile osteochondritis dissecans is a diagnosis based on plain radiographic appearance. Although it is on occasion difficult to decide whether the observed radiographic abnormality represents osteochondritis dissecans or physiologic irregular ossification, 50% of children should evidence healing with nonoperative activity modification management. In those who fail this regimen, the majority require simple drilling of the lesion through intact articular cartilage.

Cartilage, Articular↗
PubMed1975

Etiological factors in osteochondritis dissecans. An experimental study into the etiological factors in osteochondritis dissecans in the canine humeral head using overloading with and without somatotropin and thyrotropin hormone treatment and mechanical trauma.

The overloaded humeral heads of the six growing Labrador retrievers treated with somatotropin and thyrotropin hormone showed the most pronounced changes of the articular cartilage and subchondral home, resembling changes in the early stage of spontaneous osteochondritis dissecans. The overloading alone used in 16 dogs without hormone treatment produced no changes, except that two Labrador retrievers showed increased radiodensity subchondrally during the first 4-6 weeks of the observation period. The mechanical traumas of the articular cartilage and the epiphyseal bone regenerated and did not result in changes resembling those of spontaneous osteochondritis dissecans.

Animals↗
PubMed2004

Surgical fixation of massive osteochondritis dissecans lesion using cylindrical osteochondral plugs.

Abstract The prognosis of osteochondritis dissecans (OCD) depends on the age of manifestation and the size of the lesion. Before epiphyseal closure, OCD usually responds well to the restriction of the patient's sporting activities. Surgical intervention is not always necessary. However, if the disease manifests after epiphyseal closure, it often needs surgical treatment because the lesion is usually found at an advanced stage (International Cartilage Repair Society [ICR] OCD II or more). Furthermore, if a massive lesion develops to separation (ICR OCD II or III) or displaced loose bodies (ICR OCD IV), despite restriction of sporting activities, the prognosis is poor. This report discusses 2 cases of OCD. One patient had a massive stage ICR I lesion, although the disease was found before epiphyseal closure. In the other patient, a 22-year-old man, a large separated fragment (ICR OCD IV) was found after epiphyseal closure. The separated surfaces of the fragment and the mother bed had become sclerotic. Cylindrical osteochondral grafts using jigs for Mosaicplasty (Smith & Nephew, Andover, MA) were performed on the 2 patients, both of whom made successful recoveries. These cases suggest that cylindrical osteochondral grafting is a useful procedure for difficult cases of large lesion size or late manifestation.

Adult↗
PubMed2006

Results of arthroscopic fixation of osteochondritis dissecans lesion of the knee with cylindrical autogenous osteochondral plugs.

BACKGROUND: In situ fixation of unstable lesions of osteochondral dissecans of the knees with cylindrical osteochondral autograft transplantation has been reported to provide excellent results with healing of the osteochondral dissecans fragment. PURPOSE: To evaluate the clinical results and magnetic resonance imaging findings of the osteochondral dissecans of knees treated with in situ fixation of the osteochondral fragments with osteochondral autograft transplantation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve knees (12 patients; mean age, 16.0 years) with osteochondral dissecans lesions were treated with in situ fixation with autogenous osteochondral plugs. The mean lesion size was 2.4 cm(2) (range, 1.0-4.9 cm(2)). The osteochondral dissecans lesions were located on the medial femoral condyle in 10 patients and on the lateral femoral condyle in 2 patients. Seven lesions were located in the weightbearing area. The International Cartilage Repair Society classification in arthroscopic findings was grade II in 1 patient, grade III in 8 patients, and grade IV in 3 patients. All patients were evaluated with the Hughston Rating Scale form with the mean follow-up at 4.5 years (range, 2.8-5.9 years). The interface between the osteochondral fragment and subchondral bone and changes in donor site of the osteochondral graft were evaluated with T2-weighted magnetic resonance image up to 12 months postoperatively. RESULTS: The Hughston Rating Scale scored 8 knees as excellent, 3 as good, and 1 as fair. The interface between the osteochondral fragment and subchondral bone had disappeared on magnetic resonance image by 3 months postoperatively in all cases. No complications arising from the donor site area were observed. Signal intensity of donor site changed from high signal preoperatively to homogeneous surrounding cancellous bone by 1 year postoperatively. CONCLUSION: Biological fixation of the osteochondral dissecans lesion with cylindrical osteochondral autograft provided healing of the osteochondral fragments.

Adolescent↗
PubMed1998

Osteochondritis dissecans of the knee.

Osteochondritis dissecans is a separation of an articular cartilage subchondral bone segment from the remaining articular surface. This is a different entity from osteonecrosis, with which osteochondritis dissecans is commonly confused. In osteochondritis dissecans, the fragment separates from a vascular normal bony bed, while in osteonecrosis, the fragment typically is more peripheral and separates from an avascular bony bed. Osteochondritis dissecans is more common in adolescents and young adults, with the knee, elbow, and ankle being the most common sites. Injury to an area of fairly tenuous blood supply is the most likely cause. Treatment is typically nonoperative for stable lesions and operative for unstable lesions. Most patients do well with no long-term sequelae, but this depends on a variety of factors including the location and size of the lesion, patient age, and treatment.

Adolescent↗
PubMed1986

Osteochondritis dissecans of the talus.

Osteochondritis dissecans of the body of the talus is a common entity; however, osteochondritis dissecans of the head of the talus has not been found in the orthopaedic literature. The authors report a case of a defect in the talar head following trauma to the ankle, which has radiographic characteristics of osteochondritis dissecans.

Adolescent↗
PubMed2003

Osteochondritis dissecans of the knee in children.

Osteochondritis dissecans is a term used to describe the separation of an articular cartilage subchondral bone segment from the remaining articular surface. Juvenile osteochondritis dissecans describes an osteochondritis dissecans lesion found in skeletally immature children with a maximum incidence occurring between the ages of 10 and 20. It is found more frequently in children who are active athletically and involved in organized sports and is twice as common in males as in females. Although the etiology of these lesions is unclear, it is believed that repetitive microtrauma may interrupt the already tenuous epiphyseal blood supply in the growing child and contribute to the development of osteochondritis dissecans lesions. Treatment is dependent upon age at presentation, fragment size, fragment location, and fragment stability. Stable lesions in skeletally immature patients are generally amenable to conservative management. Failed conservative management or unstable lesions will more likely require surgical intervention. Lesions in skeletally mature patients have a more unpredictable course and may require surgery. This review article discusses the anatomy, etiology, evaluation, classification, treatment, and expected outcome of osteochondritis dissecans lesions.

Adolescent↗
PubMed1999

Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty).

Symptomatic osteochondritis dissecans lesions with minimal fragmentation that may be replaced within their crater have classically been treated by reattachment. The choice for internal fixation is varied. This article reports on the treatment of unstable osteochondritis dissecans lesions using autogenous osteochondral plugs as a means of biological internal fixation. The appearance on magnetic resonance imaging of osteochondral plugs at 6 and 9 months after transplantation is also presented.

Adolescent↗
PubMed1983

Pathogenesis and treatment of osteochondritis dissecans--an experimental study on chondral and osteochondral fractures in adult and young rabbits.

To observe the natural history of chondral injury and clarify the genesis of osteochondritis dissecans, various types of experimental osteochondral or chondral injuries were made on the articular surface of femoral condyles of adult and young rabbits. Pathological features resembling osteochondritis dissecans were frequently observed in young rabbits, especially in the groups in which the injured part was most unstable (58% in rabbits aged from 7 to 14 days, 24% in those aged from 3 to 7 weeks). Therefore, a neglected chondral injury in early childhood and following ossification disturbances may relate to this disease.

Animals↗
PubMed1987

Osteochondritis dissecans of the lunate.

Osteochondritis dissecans of the lunate has not been previously reported in the English-language literature. A case of osteochondritis dissecans of the lunate and an ulnar positive variance in a 16-year-old girl is presented. Several possible causes of the lesion and its surgical treatment are discussed.

Adolescent↗