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.
Osteochondral lesions of the ankle are a more common source of ankle pain than previously recognized. Although the exact pathophysiology
of the condition has not been clearly established, it is ...likely that a variety of etiological factors play a role, with trauma,
typically from ankle sprains, being the most common. Technological advancements in ankle arthroscopy and radiologic imaging,
most importantly magnetic resonance imaging, have improved diagnostic capabilities for detecting osteochondral lesions of
the ankle. Moreover, these technologies have allowed for the development of more sophisticated classification systems that
may, in due course, direct specific future treatment strategies. Nonoperative treatment yields best results when employed
in select pediatric and adolescent patients with osteochondritis dissecans. However, operative treatment, which is dependent
on the size and site of the lesion, as well as the presence or absence of cartilage damage, is frequently warranted in both
children and adults with osteochondral lesions. Arthroscopic microdrilling, micropicking, and open procedures, such as osteochondral
autograft transfer system and matrix-induced autologous chondrocyte implantation, are frequently employed. The purpose of
this article is to review the history, etiology, and classification systems for osteochondral lesions of the ankle, as well
as to describe current approaches to diagnosis and management.
Background
Osteochondritis dissecans (OCD) was first described to provide an explanation for the nontraumatic development of loose bodies within a joint. Despite many reports on the subject, there ...remains no clear understanding of the etiology, natural history, or treatment.
Questions/purposes
This review was undertaken to delineate (1) the etiology of OCD; (2) the presentation and locations; (3) the most appropriate imaging modalities; and (4) the most effective treatment strategies.
Methods
We reviewed the English literature using a database compiled from a Medline search for “osteochondritis dissecans”. We identified 1716 publications, 1246 of which were in English. After exclusions, we reviewed 748 articles and of these cited 85. The observations of each study were then synthesized into this report.
Results
There appears to be no consensus concerning the etiology of OCD lesions. The presentations and locations are variable, but the knee, ankle, and elbow are most commonly involved. Although plain film assessment is important in OCD, there appears to be a trend toward the use of MRI, but the preferred sequences are in evolution. We found no consensus on the treatment of these lesions, related in part to the lack of agreement of methods for assessing outcomes.
Conclusions
Despite more than a century of study, we have made little advancement in our understanding of OCD. A study group has been formed to address this issue and actively seeks to answer these unknown issues regarding OCD.
Background:
The prevalence and clinical characteristics of osteochondritis dissecans (OCD) of the humeral capitellum among adolescent baseball players are unknown.
Purpose:
To determine the OCD ...prevalence in adolescent competitive baseball players and to investigate the clinical characteristics of these patients.
Study Design:
Cross-sectional and case-control study; Level of evidence, 3.
Methods:
A total of 2433 baseball players (mean age, 14.5 ± 1.5 years) belonging to junior high school and high school baseball clubs were enrolled. Players completed a questionnaire, and the elbow of each player’s throwing arm was assessed by ultrasonography. Participants with abnormal results on ultrasonography were further examined through radiographic study. The OCD lesions were classified into stages based on radiographic results, and demographic data were compared between players with and without OCD lesions.
Results:
Osteochondritis dissecans of the humeral capitellum was found in 82 (3.4%) elbows by ultrasonography. Players with an OCD lesion began playing baseball at an earlier age (P = .016), had a longer duration of competitive play (P = .0013), and had experienced more present (P = .0025) and past (P < .0001) elbow pain compared with players without a lesion. There were no differences between the 2 groups in the position played (P = .26). Sixty-eight patients underwent further radiographic examination for OCD (radiography, computed tomography, magnetic resonance imaging). Of these players, 10 (14.7%) were classified as having stage I OCD (radiolucent stage); 26 (38.2%), stage II (fragmentation stage); 9 (13.2%), stage III (loose body stage); 9 (13.2%), stage IV (residual stage); and 14 (23.5%), stage V (postoperative stage).
Conclusion:
The prevalence of OCD of the humeral capitellum, including latent cases, was 3.4% among adolescent baseball players. Players with OCD lesions began playing baseball at earlier ages, had played for longer periods, and had experienced more elbow pain. The player’s current baseball position may not be related to the existence of OCD lesions in adolescents.
Background:
Open reduction and internal fixation (ORIF) has been widely performed because the osteochondral component of the osteochondritis dissecans (OCD) lesion is the most suitable for ...reconstructing the joint structure.
Purpose:
To evaluate radiological healing in terms of reconstructed bony structure after ORIF with bone graft by computed tomography (CT), to identify preoperative prognostic factors for failure, and to determine the cutoff value of radiological healing for risk of failure.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
A retrospective cohort study of 42 patients (44 knees) who underwent internal fixation with bone graft for OCD lesions of the knee from 2004 to 2018 was conducted. All patients were evaluated 6 months postoperatively, and if not healed 6 months after surgery, they were evaluated by CT periodically thereafter. Radiological healing was judged according to the following 3 criteria: (1) reossification of the OCD lesion, (2) bony continuity between the OCD lesion and basal floor, and (3) reconstructed bony surface of the femoral condyle reconstructed to match the normal joint. Then, the percentage of the radiological healing area was calculated as the ratio of the healing length to the total lesion length. The nonhealing area was calculated by multiplying the sum of the total nonhealing length. Clinical failure was defined as any definitive reoperation for the same OCD lesion, such as fragment excision, or a cartilage restoration procedure. After 6 months, all eligible patients underwent arthroscopy to check for protrusion of the absorbable pin into the joint; the removal of an absorbable pin protruding into the joint was not considered a failure.
Results:
Clinical failure was recorded for 4 cases (9.1%). The mean overall percentage of the radiological healing area of OCD 6 months after ORIF with bone graft was 79.5% ± 24.4%, and the mean overall nonhealing area at 6 months was 87.8 ± 107.9 mm2. The percentages of radiological healing area of stable (International Cartilage Regeneration & Joint Preservation Society OCD II) lesions and femoral condylar (lateral femoral condyle + medial femoral condyle) lesions were significantly lower than unstable lesions and femoral groove lesions, respectively (P = .01 and P = .03, respectively). On receiver operating characteristic curve analysis, the cutoff points for predicting a significantly increased risk of failure were 33.9% (sensitivity, 100%; specificity, 100%; area under the curve, 1) for the percentage of radiological healing area and 222.9 mm2 (sensitivity, 95%; specificity, 100%; area under the curve, 0.956) for the nonhealing area 6 months postoperatively.
Conclusion:
A stable lesion and a femoral condylar lesion were the predictors of poor radiological healing on CT images 6 months after ORIF with bone graft. The risk of failure was increased significantly in cases with only approximately one-third of the lesion healed or in cases with large nonhealing areas at 6 months postoperatively.
Previous research on patellar and trochlear groove osteochondritis dissecans (OCD) is limited by small sample sizes. This study aims to describe the presentation of patients with OCD lesions of the ...patella and trochlea and characterize the outcomes of operative and nonoperative treatments.
This retrospective cohort study identified all patients from a single institution from 2008 to 2021 with patellar and/or trochlear OCD lesions. Patients were excluded from the study if surgical records were unavailable or if the patient had knee surgery for a different injury at index surgery or in the 12 months postoperative. Minimum follow-up was 12 months. Outcomes included a return to sports (RTS), pain resolution, radiographic healing, and treatment "success" (defined as full RTS, complete pain resolution, and full healing on imaging).
A total of 68 patients (75 knees) were included-45 (60%) with patellar OCD and 30 (40%) with trochlear. Of the patients, 69% were males. The median age at knee OCD diagnosis was 14 years. At the final follow-up, 62% of knees (n = 44) recovered sufficiently to allow a full RTS and 54% of knees (n = 39) had full pain resolution. Of the 46 knees with radiographic imaging at least 1 year apart, 63% had full healing of the lesion. There was no significant difference in RTS, pain resolution, radiographic healing, or overall success when comparing treatments.
This study provides valuable epidemiologic demographic and outcome data regarding the scarcely reported patellar and trochlear OCD. While over half of patients fully returned to sports and reported full pain resolution, a large proportion continued to experience symptoms over a year after presentation. Future research should aim to better define the treatment algorithms for these OCD subtypes.
Level III.
Background:
Osteochondritis dissecans (OCD) of the knee is a rare but potentially incapacitating disorder in which subchondral bone detaches, leading to an osteochondral fragment that can become ...unstable and progress into a loose body. The exact cause is unknown, although several biological and mechanical factors have been described.
Purpose:
To provide insight into epidemiological data of a large cohort of patients affected by OCD of the knee and to identify potential factors contributing to the cause of this disorder.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A total of 236 patients (259 knees) affected by OCD were included in our Knee Registry (2005-2022) and retrospectively analyzed. Patient characteristics were extracted from the medical records. Location and International Cartilage Regeneration & Joint Preservation Society grade (1-4) of OCD were assessed using magnetic resonance imaging. If available, a full-leg standing radiograph was used to assess alignment. Additionally, a statistical scoring system for instability risk was created.
Results:
A total of 263 OCD lesions were identified in 259 knees, 66.2% on the medial femoral condyle (MFC), 26.6% on the lateral femoral condyle (LFC), 3.8% on the trochlea, 2.7% on the patella, and 0.8% on the lateral tibia plateau. Male patients made up 57.6% of the sample, which had a mean age of 21.8 years. A very high percentage of patients (77.1%; n = 182) practiced sports, of whom 67.6% (n = 123) were engaged in high-impact sports. The location of the OCD lesions and the leg alignment (n = 110) were significantly correlated: MFC lesions were associated with more varus than valgus alignment (47.5% vs 11.3%) and patients with LFC lesions had more valgus than varus alignment (46.7% vs 20.0%; P = .002). Based on age, smoking, sports activity, and preceding trauma, a multivariable scoring system (0-11 points) was created. An increased risk of lesion instability was associated with an increased score: 29.0% at 0 points and 97.0% at 11 points.
Conclusion:
This study provides detailed epidemiological data for 236 patients affected by OCD of the knee. Older age, smoking, inactivity, and preceding trauma were predictive for instability of OCD lesions. There was an association between OCD of the MFC and varus malalignment and between OCD of the LFC and valgus malalignment. This finding, in combination with the high percentage of patients practicing high-impact sports, suggests an important role for mechanical overload in the pathogenesis of OCD.
A 4‐year‐old French bulldog was presented with neck pain and left forelimb lameness. CT scan revealed a bony defect in the craniodorsal rim of the endplate of C5 with a concomitant disc protrusion ...leading to ventral spinal cord compression. Ventral slot at C4‐C5 was performed to remove the protruding material and the fragment. Based on CT and histological findings, this bone defect was consistent with osteochondritis dissecans. Neck pain was absent immediately after the operation and the dog recovered without complication. Only a slight proprioceptive deficit of the left forelimb persisted during the 6‐month of follow‐up. Based on our search of the veterinary literature, this is the first published report of an osteochondritis dissecans of cervical endplate treated surgically.
Purpose
This study aimed to identify the predictive factors for postoperative osteochondritis dissecans (OCD) in juvenile and adolescent knees with discoid lateral meniscus (DLM).
Methods
In total, ...242 patients with symptomatic DLM who underwent surgery were identified. Inclusion criteria were set as follows: (1) age ≤ 17 years with an open growth plate, (2) follow-up magnetic resonance imaging, and (3) absence of preoperative OCD. Consequently, 52 patients were retrospectively investigated. Average age during surgery, body mass index (BMI), and follow-up duration were 12 years 95% confidence interval (CI) 11–13, 19.2 kg/m
2
(95% CI 18.4–20.1), and 27.3 months (95% CI 20.9–33.7), respectively. Age, sex, sports activities, BMI, symptomatic OCD in other joints, postoperative rehabilitation, preoperative shift of DLM by Ahn’s classification, surgical procedures (saucerization alone or with stabilization, and subtotal meniscectomy), and postoperative meniscal width were analyzed as possible predictive factors.
Results
Postoperatively, 42 patients without OCD and 10 with OCD were observed. In univariate analysis, younger age odds ratio (OR) 1.5;
p
= 0.003, subtotal meniscectomy (OR 6.3;
p
= 0.027), and shorter meniscal width (OR 2.7;
p
= 0.005) were predictive factors for postoperative OCD. Multivariate analysis demonstrated that younger age (OR 1.6;
p
= 0.009) and shorter meniscal width (OR 1.5;
p
= 0.003) were predictive factors.
Conclusions
To prevent postoperative OCD after DLM surgeries, achieving stabilization with adequate meniscal width is necessary for juvenile knees.
Level of Evidence
III.
Osteochondritis dissecans of the knee is being seen with increased frequency in pediatric and young adult athletes and is thought to be, in part, owing to earlier and increasingly competitive sports ...participation. Despite much speculation, the cause of both juvenile and adult osteochondritis dissecans remains unclear. Early recognition is essential. Whereas adult osteochondritis dissecans lesions have a greater propensity to instability, juvenile osteochondritis dissecans lesions are typically stable, and those with an intact articular surface have a potential to heal with nonoperative treatment through cessation of repetitive impact loading. The value of adjunctive immobilization, protected weightbearing, and unloader bracing has not been established. Skeletally immature patients with stable lesions that have not healed with nonoperative treatment should have consideration given to arthroscopic drilling to promote healing before the lesion progresses and requires more involved treatment with a less optimistic prognosis. Magnetic resonance imaging may allow early prediction of lesion healing potential. The majority of adult osteochondritis dissecans cases as well as those skeletally immature patients with unstable lesions and secondary loose bodies require fixation and possible bone grafting. Many unstable lesions will heal after stabilization, but long-term prognosis is not clear. Chronic loose fragments can be difficult to fix and have poor healing potential. Results of excision of large lesions from weightbearing zones are poor. Chondral resurfacing techniques have limited long-term data for cases of osteochondritis dissecans in skeletally immature patients.
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