Database: Ovid MEDLINE(R) <1966 to January Week 3 2004>
Search Strategy:
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exp OSTEOCHONDRITIS/ (4914)
2
(knee or akle).af. (52356)
3
1 and 2 (726)
4
exp *OSTEOCHONDRITIS/ and 3 (506)
5
limit 4 to (human and english language) (284)
6
limit 5 to yr=1996-2004 (96)
7
osteochondritis.ti. and 6 (54)
8
6 (96)
9
limit 8 to ovid full text available (10)
10
limit 6 to review (15)
11
9 or 10 (23)
12
7 not 11 (43)
13
from 12 keep 1-2,7,9-10,12-22,24-25,27-28,30-31,33,35,37,39-40,43 (28)
14
from 10 keep 3,6,11-13 (5)
15
10 not 14 (10)
16
9 or 13 or 15 (46)
17
from 16 keep 1-46 (46)
18
from 17 keep 1-46 (46)
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<1>
Unique Identifier
11573913
Authors
Kocher MS. Micheli LJ. Yaniv M. Zurakowski D. Ames A. Adrignolo AA.
Institution
Department of Orthopaedic Surgery, Children's Hospital, Harvard Medical
School, Boston, Massachusetts 02115, USA.
Title
Functional and radiographic outcome of juvenile osteochondritis dissecans of
the knee treated with transarticular arthroscopic drilling.
Source
American Journal of Sports Medicine. 29(5):562-6, 2001 Sep-Oct.
Abstract
Management of juvenile osteochondritis dissecans is controversial. The purpose
of this study was to evaluate the functional and radiographic outcomes of
transarticular arthroscopic drilling for isolated stable, juvenile
osteochondritis dissecans lesions of the medial femoral condyle with an intact
articular surface after 6 months of nonoperative management had failed. We
reviewed 30 affected knees in 23 skeletally immature patients (mean age, 12.3
years; range, 8.5 to 16.1) at an average follow-up of 3.9 years (range, 2.0 to
7.2). Functional outcome was determined using the Lysholm score and radiographic
outcome was determined using lesion size, and the radiographic score of
Rodegerdts and Gleissner. There was significant improvement in the mean Lysholm
score (from 58 to 93). There was significant improvement in the mean lesion size
on anteroposterior (4.5 +/- 5.8 mm decrease) and lateral (8.4 +/- 8.1 mm
decrease) radiographs. There was also significant improvement in the mean
radiographic score (from 3.0 to 1.9). Radiographic healing was achieved in all
patients at an average of 4.4 months after drilling (range, 1 to 11 months).
Linear regression analysis revealed that younger age was an independent,
multivariate predictor of Lysholm score improvement. There were no apparent
surgical complications.
<2>
Unique Identifier
9474395
Authors
Paletta GA Jr. Bednarz PA. Stanitski CL. Sandman GA. Stanitski DF.
Kottamasu S.
Institution
Department of Orthopaedic Surgery, Children's Hospital of Michigan, Detroit,
USA.
Title
The prognostic value of quantitative bone scan in knee osteochondritis
dissecans. A preliminary experience.
Source
American Journal of Sports Medicine. 26(1):7-14, 1998 Jan-Feb.
Abstract
We reviewed the records of 12 patients ages 9 to 16 years with knee
osteochondritis dissecans. All patients had clinical histories and examinations,
four radiographic views of the knee, and technetium-99m diphosphonate
quantitative bone scans. Scan results (symmetric, increased, or decreased
activity), clinical course, healing time, and final outcome were correlated to
determine the prognostic value of the scan. We divided the patients into those
with open physes (distal femoral and proximal tibial) and those with closed
physes. Four of the six patients with open physes had increased activity on the
bone scan. All four of these knees healed with nonsurgical treatment. The other
two patients had decreased activity on bone scan, and both required surgical
treatment after nonsurgical treatment failed. Of the six patients with closed
physes, all had increased activity on the bone scan, but only two patients had
healing of the osteochondral lesion without surgery. Quantitative bone scanning
had a 100% predictive value for the prognosis in osteochondritis dissecans
patients with open physes, but for those with closed physes the predictive value
was less. Because the natural history in the adolescent group is less
predictable, it is in this group that the quantitative scan would be most
helpful. In this small group of patients, quantitative bone scanning had limited
prognostic value.
<3>
Unique Identifier
10653545
Authors
Peters TA. McLean ID.
Institution
Prahran Sports Medicine Centre, Victoria, Australia.
Title
Osteochondritis dissecans of the patellofemoral joint.[see comment].
Comments
Comment in: Am J Sports Med. 2001 Jan-Feb;29(1):112-3; PMID: 11206248
Source
American Journal of Sports Medicine. 28(1):63-7, 2000 Jan-Feb.
Abstract
Osteochondritis dissecans of the patellofemoral joint is an uncommon condition
that may be the cause of anterior knee pain or crepitus. We present the clinical
features of 37 patients with osteochondritis dissecans lesions of the
patellofemoral joint (24 on the patella, 13 on the trochlear groove), including
two patients with medial trochlear groove lesions, which have not, to our
knowledge, been previously reported. The osteochondral lesions involved the
convex articular surfaces. The median age of patients when first examined was 15
years, and 54% of patients had open epiphyses. These lesions were more common in
male patients than in female patients (four-to-one ratio). Osteochondritis
dissecans of the patellofemoral joint can be overlooked unless quality
radiographs are viewed with care and, at arthroscopy, both the patella and
trochlear groove are assessed. Treatment depends on the symptoms, site, and
nature of the lesion and the patient's age. Nonoperative management includes
patellar taping and vastus medialis obliquus muscle exercises. Operative
intervention is indicated for patients with mechanical symptoms and includes
arthroscopy, consisting of chondroplasty and removal of loose bodies, and
lateral retinacular release. In this study treatment generally improved the
symptoms, but patients with articular cartilage loss had persistent
patellofemoral crepitus and discomfort.
<4>
Unique Identifier
12016089
Authors
Yoshizumi Y. Sugita T. Kawamata T. Ohnuma M. Maeda S.
Institution
Department of Orthopaedic Surgery, Tohoku University Graduate School of
Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Title
Cylindrical osteochondral graft for osteochondritis dissecans of the knee: a
report of three cases.
Source
American Journal of Sports Medicine. 30(3):441-5, 2002 May-Jun.
<5>
Unique Identifier
11206248
Authors
Smith JS.
Title
Osteochondritis dissecans of the patellofemoral joint.[comment].
Comments
Comment on: Am J Sports Med. 2000 Jan-Feb;28(1):63-7; PMID: 10653545
Source
American Journal of Sports Medicine. 29(1):112-3, 2001 Jan-Feb.
<6>
Unique Identifier
11599758
Authors
Blankstein A. Cohen I. Heim M. Diamant L. Salai M. Chechick A. Ganel A.
Institution
Department of Orthopaedic Surgery, Sheba Medical Center, Tel-Hashomer, Israel.
Title
Ultrasonography as a diagnostic modality in Osgood-Schlatter disease. A
clinical study and review of the literature. [Review] [14 refs]
Source
Archives of Orthopaedic & Trauma Surgery. 121(9):536-9, 2001 Oct.
Abstract
Sonographic examination of the knee has been proposed by several authors in
the past as a simple and reliable method to diagnose Osgood-Schlatter disease
(OSD). Ultrasound was used to compare the knees of 25 boys and 10 girls with
typical OSD with 35 symptom-free knees of an aged-matched group of children.
Based on recorded data, patients were categorized (one affected knee in each
individual) according to the classification system proposed by De Flaviis et al.
in 1989. The results included the following pathological findings: pretibial
swelling, fragmentation of the ossification center, insertional thickening of
the patellar tendon, and excessive fluid collection in the infrapatellar bursa.
Of our patients, 26% fell into the type 1 category, 43% were type 2, 20% type 3,
and 11% type 4. This distribution of cases was found to be statistically similar
to the initial findings reported by De Flaviis and colleagues. This study
therefore supports the validity and reproducibility of their classification
method for the ultrasonographic evaluation of children with OSD. This is only
the first step, and further assessment of this classification is still required
to elucidate its clinical as well as its prognostic value. [References: 14]
<7>
Unique Identifier
11536094
Authors
Aglietti P. Ciardullo A. Giron F. Ponteggia F.
Institution
First Orthopaedic Clinic, University of Florence, Florence, Italy.
Title
Results of arthroscopic excision of the fragment in the treatment of
osteochondritis dissecans of the knee.
Source
Arthroscopy. 17(7):741-6, 2001 Sep.
Abstract
PURPOSE: To evaluate clinical and radiological results of arthroscopic
excision of the fragment and debridement of the crater in the treatment of
osteochondritis dissecans of the knee (OCD). Type of Study: Case series.
METHODS: We investigated 20 patients with partial or complete detachment of the
OCD fragment. The average age at surgery was 21 years (range, 12 to 32 years).
All the patients were treated by the same surgeon. They were evaluated at an
average follow-up of 9 years (range, 6 to 17 years). RESULTS: The combined
subjective and objective evaluation showed excellent and good results for 85% of
the patients. Radiographic studies showed 2 grades of worsening (from no
degenerative signs preoperatively to narrowing of the joint line up to 50% at
follow-up) in 1 patient (5%). One grade of worsening (Fairbank's changes without
joint space narrowing) was found in 45% of weight-bearing anteroposterior
radiographic views and in 35% of weight-bearing bent knee posteroanterior views.
Statistical correlations were significant between radiographic degenerative
changes and the size of the osteochondral lesion at surgery, with larger lesions
resulting in greater degenerative changes. CONCLUSIONS: The arthroscopic removal
of an osteochondral fragment and debridement of the crater is a viable option in
the treatment of grade III and IV OCD lesions. Results are better in lesions
less than 2 cm(2).
<8>
Unique Identifier
11447548
Authors
Mizuta H. Nakamura E. Otsuka Y. Kudo S. Takagi K.
Institution
Department of Orthopaedic Surgery, Kumamoto University School of Medicine,
Kumamoto, Japan. mizuta@kaiju.medic.kumamoto-u.ac.jp
Title
Osteochondritis dissecans of the lateral femoral condyle following total
resection of the discoid lateral meniscus.
Source
Arthroscopy. 17(6):608-12, 2001 Jul.
Abstract
PURPOSE: The purpose of this study was to describe the clinical presentation
of 6 athletically active children with symptomatic osteochondritis dissecans
(OCD) of the lateral femoral condyle following total resection for a torn
discoid lateral meniscus and to discuss its cause. TYPE OF STUDY: Case series.
METHODS: Six patients in whom OCD affecting the lateral femoral condyle
developed after total resection of the discoid lateral meniscus participated in
a detailed clinical, radiologic, and arthroscopic review. The average age at the
time of meniscectomy was 9 years (range, 6 to 12 years). At a mean of 50 months
(range, 36 to 65 months) after surgery they developed recurrent pain in the
treated knee; all had radiologic abnormalities at the lateral femoral condyle
consistent with OCD. Before the recurrence of pain, all patients had been
continuously engaged in sports activity. Radiologic and arthroscopic findings of
the OCD lesions were assessed. Clinical outcomes of surgical treatment for OCD
were also documented. RESULTS: The radiographic evaluation showed all lesions to
be in the central portion of the lateral femoral condyle on the anteroposterior
views and posteriorly next to a line extending distally from the posterior
femoral cortex on the lateral views. Arthroscopic evaluation revealed softening
in 2 knees, a separated fragment in 2 knees, and a completely loose fragment in
2 knees. All lesions were treated surgically, including 2 drillings of the
lesion, 2 fixations of separated fragment, and 2 excisions of loose bodies with
drilling. At an average follow-up period of 51 months (range, 22 to 77 months),
all patients but 1 were asymptomatic. CONCLUSIONS: Repeated impaction in sports
activities on the immature osteochondral structures under altered mechanical
force transmission after total resection of the discoid meniscus might be a
predisposing factor in the development of OCD in the lateral femoral condyle.
<9>
Unique Identifier
11337726
Authors
Friederichs MG. Greis PE. Burks RT.
Institution
Department of Orthopedics, University of Utah Medical Center, Salt Lake City,
Utah, U.S.A.
Title
Pitfalls associated with fixation of osteochondritis dissecans fragments using
bioabsorbable screws.
Source
Arthroscopy. 17(5):542-5, 2001 May.
Abstract
The purpose of this study was to evaluate 2 cases in which bioabsorbable screw
fixation for an osteochondritis dissecans lesion of the femoral condyle resulted
in complications necessitating the need for secondary surgery. We reviewed the
case history of these patients and described the circumstances under which the
bioabsorbable screws were used, the events leading to the need for secondary
surgery, and the ultimate outcome. In the 2 cases presented, these implants were
found to retain their mechanical stiffness for many months. This resulted in
articular damage in 1 case after the treated lesion failed to heal. In the
second case, screw breakage 8 months after implantation resulted in it becoming
a loose body, which required removal during a second arthroscopic procedure. We
conclude that these implants retain their mechanical properties for many months
and cannot be relied on to degrade quickly. If a treated lesion fails to heal,
these implants can cause mechanical problems due to their retained structural
properties.
<10>
Unique Identifier
11027774
Authors
Kim SJ. Shin SJ.
Institution
Department of Orthopaedic Surgery, Arthroscopic Surgery Unit, Yonsei
University College of Medicine, Seoul, Korea. jinos@yumc.yonsei.ac.kr
Title
Loose bodies after arthroscopic osteochondral autograft in osteochondritis
dissecans of the knee.
Source
Arthroscopy. 16(7):E16, 2000 Oct.
Abstract
We report a case of loose bodies from the donor site as a complication after
the osteochondral autograft for the treatment of osteochondritis dissecans.
Eight months after surgery, 3 osteochondral loose fragments, having dislodged
from the donor sites of the osteochondral autograft, were found in the
posteromedial portion, posterolateral portion, and anterior compartment of the
knee, respectively. A large osteochondral defect can be treated successfully
with arthroscopic autogenous bone graft. When filling the donor site with the
recipient bone core, only the cancellous portion should be inserted into the
donor socket.
<11>
Unique Identifier
10231112
Authors
Berlet GC. Mascia A. Miniaci A.
Institution
Department of Surgery, University of Toronto, and The Toronto Western
Hospital, Ontario, Canada.
Title
Treatment of unstable osteochondritis dissecans lesions of the knee using
autogenous osteochondral grafts (mosaicplasty).
Source
Arthroscopy. 15(3):312-6, 1999 Apr.
Abstract
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.
<12>
Unique Identifier
10024029
Authors
Mitsuoka T. Shino K. Hamada M. Horibe S.
Institution
Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Japan.
Title
Osteochondritis dissecans of the lateral femoral condyle of the knee joint.
Source
Arthroscopy. 15(1):20-6, 1999 Jan-Feb.
Abstract
Differences in the features of osteochondritis dissecans (OCD) affecting the
lateral and medial femoral condyles were investigated in 13 patients (14 knees)
treated from 1991 to 1994. OCD affected the lateral femoral condyle in 6 knees
(lateral group) and the medial condyle in 8 knees (medial group). The lateral
group was younger (mean age, 14 v. 20 years). The radiological stage (Bruckl) of
the lateral group was stage 2 in 3 knees and stage 3 in 3. The lateral menisci
were all discoid and the condylar articular surface of the lesions was normal in
two knees, softened in 3 and detached in 1. The medial group comprised 1 knee in
stage 2, 1 in stage 3, 1 in stage 4, and 5 in stage 5. The OCD lesion showed
softening in 2 knees and detachment in 6. Repetitive abnormal stress on weaker
osteochondral structures in the growing period produced by a discoid meniscus
during growth may cause OCD of the lateral femoral condyle.
<13>
Unique Identifier
9754485
Authors
Mitsuoka T. Horibe S. Hamada M.
Institution
Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Japan.
Title
Osteochondritis dissecans of the medial femoral condyle associated with
congenital hypoplasia of the lateral meniscus and anterior cruciate ligament.
Source
Arthroscopy. 14(6):630-3, 1998 Sep.
Abstract
We report a patient with osteochondritis dissecans of the medial femoral
condyle associated with congenital hypoplasia of the lateral meniscus and
anterior cruciate ligament. This is the first report of such a case.
<14>
Unique Identifier
9195028
Authors
Anderson AF. Richards DB. Pagnani MJ. Hovis WD.
Institution
Lipscomb Clinic, Nashville, Tennessee 37203, USA.
Title
Antegrade drilling for osteochondritis dissecans of the knee.
Source
Arthroscopy. 13(3):319-24, 1997 Jun.
Abstract
Twenty-four knees with osteochondritis dissecans of the femoral condyles
failed a conservative program and were treated with antegrade drilling. To our
knowledge, this represents the largest reported series using this technique. The
average age at the time of surgery was 13 years 6 months. Seventeen patients had
open physes, and four were skeletally mature. Nineteen lesions involved the
medial femoral condyle, and five involved the lateral femoral condyle. The
average follow-up was 5 years. Postoperative evaluation included rating by the
International Knee Documentation Committee (IKDC) form and the Hughston Rating
Scale for osteochondritis dissecans. Twenty of the 24 lesions healed after
antegrade drilling, and the average time of healing was 4 months. According to
the criteria on the IKDC grading form, 14 were normal, 6 nearly normal, three
abnormal, and one severely abnormal. The results of the Hughston Rating Scale
were similar: 15 were excellent, seven good, one fair, and one poor. Only two of
the four skeletally mature patients healed after antegrade drilling. Antegrade
drilling is an effective method of treatment for osteochondritis dissecans of
the knee that occurs in adolescents with open physes. This operation is not as
likely to result in a successful outcome in patients with closed physes;
consequently, other methods should be considered in skeletally mature patients.
<15>
Unique Identifier
8864013
Authors
Victoroff BN. Marcus RE. Deutsch A.
Institution
Department of Orthopaedic Surgery, Case Western Reserve University School of
Medicine, Cleveland, Ohio, USA.
Title
Arthroscopic bone peg fixation in the treatment of osteochondritis dissecans
in the knee.
Source
Arthroscopy. 12(4):506-9, 1996 Aug.
Abstract
An arthroscopic method for the treatment of osteochondritis dissecans lesions
in the knee is described. The technique involves using autogenous bone pegs for
arthroscopic transfixion of femoral osteochondritis dissecans (OCD) lesions. The
method represents a simple biological alternative for arthroscopic fixation of
OCD lesions.
<16>
Unique Identifier
11172259
Authors
Scioscia TN. Giffin JR. Allen CR. Harner CD.
Institution
Department of Orthopaedics, the University of Pittsburgh, Pittsburgh,
Pennsylvania, U.S.A.
Title
Potential complication of bioabsorbable screw fixation for osteochondritis
dissecans of the knee.
Source
Arthroscopy. 17(2):E7, 2001 Feb.
Abstract
The 3 cases presented describe loosening or failure of bioabsorbable screws in
the treatment of osteochondritis dissecans (OCD). In case 1, a 17-year-old boy
with OCD of the medial femoral condyle was treated with bioabsorbable screw
fixation. Six months after surgery, the patient had an acute episode of pain
with effusion. Arthroscopic examination revealed 2 of the 4 screws backed out,
causing cartilage damage to the corresponding tibial plateau. The shafts of the
remaining 2 screws had completely absorbed, leaving the unabsorbed screw heads
as intra-articular loose bodies in the knee. Unpredictable and inconsistent
degradation of the screws is believed to be the mechanism for screw back-out and
cartilage damage.
<17>
Unique Identifier
11774158
Authors
Nakagawa Y. Matsusue Y. Nakamura T.
Institution
Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University,
Kyoto, Japan. ynaka@kuhp.kyoto-u.ac.jp
Title
A novel surgical procedure for osteochondritis dissecans of the lateral
femoral condyle: Exchanging osteochondral plugs taken from donor and recipient
sites.
Source
Arthroscopy. 18(1):E5, 2002 Jan.
Abstract
We treated a 16-year-old boy who had a large symptomatic osteochondritis
dissecans (OCD) lesion of the lateral femoral condyle by exchanging
osteochondral plugs taken from the donor site with plugs taken from the
recipient site. At final inspection 36 months after surgery, he had full range
of motion and no symptoms in his knees. Our methods can be used to treat grade 2
or 3 OCD lesions, as classified by Clanton and DeLee.
<18>
Unique Identifier
12724672
Authors
Nakagawa Y. Matsusue Y. Suzuki T. Nakamura T.
Institution
Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University,
Kyoto, Japan. ynaka@kuhp.kyoto-u.ac.jp
Title
Arthroscopic osteochondral grafting in fissuring osteochondritis dissecans of
the knee.
Source
Arthroscopy. 19(5):E48, 2003 May-Jun.
Abstract
We encountered a rare case of osteochondritis dissecans in a 13-year-old girl,
in which magnetic resonance imaging appeared to show migration of the joint
cartilage into the bone marrow of the femoral condyle, with fissuring visible on
the joint cartilage. Arthroscopy showed fissuring, 5 x 20 mm, in the right
lateral femoral condyle, and the articular cartilage in the center of the lesion
had fibrillation and was depressed about 5 mm. We performed arthroscopic
osteochondral grafting to the lesion. The microscopic findings showed that the
lesion had fibrillated bone marrow and that the cartilage existed only in the
superficial layer of the lesion. Twenty-seven months after surgery, the patient
was able to participate in sports and had no knee pain.
<19>
Unique Identifier
11951196
Authors
Jurgensen I. Bachmann G. Schleicher I. Haas H.
Institution
Orthopaedic Department, Justus-Liebig-University of Giessen, Germany.
Ingke.Juergensen@ortho.med.uni-giessen.de
Title
Arthroscopic versus conservative treatment of osteochondritis dissecans of the
knee: value of magnetic resonance imaging in therapy planning and follow-up.
Source
Arthroscopy. 18(4):378-86, 2002 Apr.
Abstract
PURPOSE: Magnetic resonance imaging (MRI) was used to control the short-term
outcome of osteochondritis dissecans (OCD) of the femoral condyle depending on
conservative or surgical treatment at the beginning of therapy. TYPE OF STUDY:
Case series. METHODS: Treatment planning for OCD depended on the stage on MRI
when analyzing the appearance of the interface between parent bone and fragment
on T1- and T2-weighted images. Twenty-seven patients received conservative
treatment and 46 patients underwent arthroscopic surgery. After 20 to 24 months,
patients were re-evaluated by MRI to assess the condition of bony fragment,
parent bone, and interface so as to determine partial or complete remission, no
change, or progression of OCD. RESULTS: After conservative treatment, MRI showed
partial or complete remission in 30% of patients and no change in 63%.
Arthroscopic treatment led to remission in 37% and to no change in 57%.
Progressive disintegration of OCD was found on MRI in 7% of conservatively
treated patients and in 7% of the surgery patients. In 33.3% of the patients
initially treated conservatively, it was decided to treat them arthroscopically
because of ongoing, unacceptable clinical symptoms. CONCLUSIONS: The rates of
remission and progression were not significantly different between the groups.
The patients' age was significantly correlated to the rate of consolidation. OCD
in juveniles under 16 years of age followed a milder course than in adults.
<20>
Unique Identifier
12368780
Authors
Navarro R. Cohen M. Filho MC. da Silva RT.
Institution
Knee Division, Department of Orthopaedic Surgery, Federal University of Sao
Paulo, Sao Paulo, Brazil.
Title
The arthroscopic treatment of osteochondritis dissecans of the knee with
autologous bone sticks.
Source
Arthroscopy. 18(8):840-4, 2002 Oct.
Abstract
PURPOSE: To present a new surgical technique for the fixation of partial
dislocated osteochondral fragments in athletes with osteochondritis dissecans
(OCD) of the knee. TYPE OF STUDY: Retrospective case series. METHODS: Autologous
bone sticks were taken from the ipsilateral tibial metaphysis and used in the
arthroscopic fixation of unilateral osteochondritis dissecans of the knee in 11
patients (5 female and 6 male). Patient age ranged from 11 to 20 years (mean, 16
years). Fixation of the partially dislocated fragments of the OCD of the knee
was performed following a modified arthroscopic procedure and autologous bone
graft. RESULTS: Follow-up ranged from 15 to 108 months (mean, 48 months). Based
on modified criteria of Hughston et al., results were satisfactory in 90.9% and
unsatisfactory in 9.1% of the cases. CONCLUSIONS: Arthroscopic fixation of OCD
of the knee with autologous bone sticks is technically simple and nonaggressive
and provides satisfactory results in most cases.
<21>
Unique Identifier
10845971
Authors
Bentley G. Minas T.
Institution
Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore
HA74LP. gbentley@ucl.ac.uk
Title
Treating joint damage in young people. [Review] [20 refs]
Source
BMJ. 320(7249):1585-8, 2000 Jun 10.
<22>
Unique Identifier
14577709
Authors
Browne RF. Murphy SM. Torreggiani WC. Munk PL. Marchinkow LO.
Institution
Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24,
Ireland.
Title
Radiology for the surgeon: musculoskeletal case 30. Osteochondritis dissecans
of the medial femoral condyle.
Source
Canadian Journal of Surgery. 46(5):361-3, 2003 Oct.
<23>
Unique Identifier
9269169
Authors
Slawski DP.
Institution
Department of Orthopedic Surgery, USAF Medical Center, Scott Air Force Base,
IL, USA.
Title
High tibial osteotomy in the treatment of adult osteochondritis dissecans.
Source
Clinical Orthopaedics & Related Research. (341):155-61, 1997 Aug.
Abstract
This study reports one surgeon's experience using valgus high tibial osteotomy
in the treatment of osteochondritis dissecans of the medial femoral condyle in
adult patients. Seven knees in six patients with osteochondritis dissecans were
reviewed as the basis of the study. Five patients (five knees) were men, and one
patient (two knees) was a woman. The average age at surgery was 32 years.
Patients reported medial knee pain, recurrent effusions, and disability. An
average of three procedures per knee had been performed previously. Four knees
had achieved union of the osteochondral fragments but with overlying articular
cartilage degeneration observed at arthroscopy. Three knees had failed attempts
at fixation with eventual excision of the fragmented osteochondral lesions. None
of the knees showed diffuse medial compartment gonarthrosis by radiographic or
arthroscopic examinations. Involved knees had relative varus malalignment with
an average femoral and tibial angle of 0 degree compared with the uninvolved
knees average of 5 degrees valgus. Preoperative technetium scintigraphy showed
isolated uptake in the medial femoral condyle of all involved knees.
Preoperative Lysholm scores averaged 39 points. Patients were observed for an
average of 30 months after surgery. The average Lysholm score at latest followup
was 89 points. Femoral and tibial angles averaged 9 degrees valgus. On
subjective questioning, all patients reported marked improvement, satisfaction
with the surgery, and said they had no need for additional operative
intervention.
<24>
Unique Identifier
9917687
Authors
Dervin GF. Keene GC. Chissell HR.
Institution
Department of Surgery, Ottawa General Hospital, Ottawa, Canada.
Title
Biodegradable rods in adult osteochondritis dissecans of the knee.
Source
Clinical Orthopaedics & Related Research. (356):213-21, 1998 Nov.
Abstract
Symptomatic osteochondritis dissecans of the knee in skeletally mature
patients does not follow a predictable natural history and there has been a
trend toward internal fixation of the unstable fragment(s) where possible.
Biodegradable implants are enticing for intraarticular use: implant removal is
unnecessary and its degradation potentially allows a gradual shift of loading
stress to the fracture site. Nine patients with a mean age of 18.6 years (range,
14-23 years) deemed skeletally mature by plain film radiography underwent
internal fixation of fragments by 2-mm self reinforced polylactic rods. Six
procedures were completed arthroscopically and three required arthrotomy. All
fragments were of the medial femoral condyle. The procedure was tolerated well
although three patients had early postoperative serosanguinous effusions develop
that did not recur after one aspiration. At a mean followup of 33 months (range,
24-54 months), eight fragments radiographically were united whereas one remained
ununited at 26 months, accounting for the one poor result in this series. Seven
patients had good to excellent results according to Hughston's criteria and were
satisfied with the procedure. One of these seven patients had a spontaneous
effusion develop at 5 months that did not recur after aspiration and
intraarticular steroid injection. Severe, unremitting synovitis did not occur in
any patient. Internal fixation of osteochondritis dissecans of the knee with
biodegradable polylactic rods provided satisfactory control of symptoms in the
short term and resulted in radiographically stable lesions in eight of nine
patients. These rods may be suited best for fragmented lesions with intact
articular cartilage as an adjunct to drilling.
<25>
Unique Identifier
10943196
Authors
Outerbridge HK. Outerbridge RE. Smith DE.
Institution
Division of Orthopaedic Surgery, University of Queensland, Princess Alexandra
Hospital, Woolloongabba, Australia.
Title
Osteochondral defects in the knee. A treatment using lateral patella
autografts.
Source
Clinical Orthopaedics & Related Research. (377):145-51, 2000 Aug.
Abstract
Sixteen patients (13 males and three females; average age, 27 years) with
large symptomatic osteochondral defects of the femoral condyle were treated with
an osteochondral autograft taken from the ipsilateral lateral patellar facet.
Two patients had bilateral procedures for a total of 18 knees. These patients
were followed up prospectively with an average followup of 7.6 years (range, 214.6 years). Cincinnati knee scores showed significant changes, from an average
preoperative score of 37 to an average final followup score of 85. In all of the
patients, knee function was improved, and they were able to return to their
normal lifestyle with minimal or no restriction. Eighty-one percent of patients
have returned to a high level of functioning.
<26>
Unique Identifier
8542693
Authors
Matsusue Y. Nakamura T. Suzuki S. Iwasaki R.
Institution
Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University,
Japan.
Title
Biodegradable pin fixation of osteochondral fragments of the knee.
Source
Clinical Orthopaedics & Related Research. (322):166-73, 1996 Jan.
Abstract
The authors present 3 cases of osteochondritis and 2 cases of osteochondral
fracture of the knee. These cases were treated with a bioabsorbable ultra high
strength poly (L-lactide) pin, which has the highest mechanical strength value
of any nonfiber reinforced poly (L-lactide) reported previously. Three of the
patients were male, and 2 were females; their ages ranged from 12 to 21 years.
The followup period ranged from 2 years to 7 years 9 months (mean, 4.1 years).
Two to 4 poly (L-lactide) pins with a diameter of 2 mm were used to fix the
osteochondral fragments or the transplanted autogenous osteochondral grafts. In
all cases, satisfactory bone union was obtained, and no inflammatory reaction
was observed during the entire followup periods. The ranges of motion were
normal, and there was no pain in any of the cases. It is concluded that the poly
(L-lactide) pin is safe and useful in the repair of osteochondral fractures of
the knee and in fixing grafted osteochondral fragments.
<27>
Unique Identifier
11398358
Authors
Birk GT. DeLee JC.
Institution
Department of Orthopaedics, University of Texas Health Science Center at San
Antonio, San Antonio, Texas, USA.
Title
Osteochondral injuries. Clinical findings. [Review] [45 refs]
Source
Clinics in Sports Medicine. 20(2):279-86, 2001 Apr.
Abstract
Osteochondral injuries are common, mainly affecting a young, active
population. Failure to recognize these injuries can lead to long-term
disability. A heightened awareness and understanding of the common mechanisms of
injury will lead to early diagnosis and rapid recovery. This, along with
improved treatment modalities, will keep any long-term disability to a minimum.
[References: 45]
<28>
Unique Identifier
9012566
Authors
Obedian RS. Grelsamer RP.
Institution
Hospital for Joint Diseases, New York, New York, USA.
Title
Osteochondritis dissecans of the distal femur and patella. [Review] [69 refs]
Source
Clinics in Sports Medicine. 16(1):157-74, 1997 Jan.
Abstract
Osteochondritis dissecans (OCD) is a pathologic process characterized by a
partial or total separation of a fragment of bone with overlying articular
cartilage. OCD may affect any joint, but the knee joint is affected most
commonly. This article reviews several potential causes of OCD and
classification systems for OCD. Diagnosis and treatment strategies are
discussed. [References: 69]
<29>
Unique Identifier
11398359
Authors
Cahill BR. Ahten SM.
Institution
University of Illinois College of Medicine, Peoria, Illinois, USA.
brcahill@mtco.com
Title
The three critical components in the conservative treatment of juvenile
osteochondritis dissecans (JOCD). Physician, parent, and child. [Review] [12
refs]
Source
Clinics in Sports Medicine. 20(2):287-98, vi, 2001 Apr.
Abstract
There has been explosive growth of intensive, year-round sports for children
of both sexes, with a resulting high degree of family involvement and
commitment. Consequently, a diagnosis of juvenile osteochondritis dissecans
(JOCD) impacts parent and child on many different levels. Compliance is the key
element when a conservative treatment plan for JOCD is appropriate. An informed
physician understands the dynamics between the "compliance triad" of physician,
parent, and child, and recognizes that compliance is a process with foreseeable
stages and characteristic behaviors. [References: 12]
<30>
Unique Identifier
12544270
Authors
Robertson W. Kelly BT. Green DW.
Institution
Hosptial for Special Surgery, New York, New York 10021, USA. greendw@hss.edu
Title
Osteochondritis dissecans of the knee in children. [Review] [54 refs]
Source
Current Opinion in Pediatrics. 15(1):38-44, 2003 Feb.
Abstract
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. [References: 54]
<31>
Unique Identifier
12760576
Authors
Santrock RD. Buchanan MM. Lee TH. Berlet GC.
Institution
The Ohio State University College of Medicine, and Public Health, 6200
Cleveland Avenue, Columbus, OH 43231, USA.
Title
Osteochondral lesions of the talus. [Review] [57 refs]
Source
Foot & Ankle Clinics. 8(1):73-90, viii, 2003 Mar.
Abstract
Osteochondral lesions of the talus (OLT) are rare joint disorders. The talus
is the third most common location of this disorder, following the knee and elbow
joints. OLT represents 4% of all osteochondral lesions in the body. This article
discusses the surgical treatment and postoperative rehabilitation of
osteochondral lesions of the talus. [References: 57]
<32>
Unique Identifier
9347299
Authors
Hangody L. Kish G.
Karpati Z.
Szerb I.
Eberhardt R.
Institution
Budapest Uzsoki Hospital, Department of Orthopaedic & Trauma, Hungary.
Title
Treatment of osteochondritis dissecans of the talus: use of the mosaicplasty
technique--a preliminary report.
Source
Foot & Ankle International. 18(10):628-34, 1997 Oct.
Abstract
A one-stage autogenous osteochondral grafting technique for the treatment of
talar dome osteochondritis dissecans is described. Eleven patients with
osteochondritis dissecans lesions, 10 mm or greater in diameter, were operated
on using the mosaicplasty autogenous osteochondral transplantation technique.
Osteochondral cylindrical grafts from the ipsilateral knee were delivered into
the talar defect using specially designed tube chisels. These procedures were
done by arthrotomy. With follow-up of 12 to 28 months (mean, 16 months), the
patients returned to full activities and the results, using the Hannover scoring
system, have been excellent.
<33>
Unique Identifier
11503979
Authors
Hangody L. Kish G. Modis L. Szerb I. Gaspar L. Dioszegi Z. Kendik Z.
Institution
Uzsoki Hospital, Orthopaedic & Trauma Department, Budapest, Hungary.
hangody@axelero.hu
Title
Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two
to seven year results in 36 patients.
Source
Foot & Ankle International. 22(7):552-8, 2001 Jul.
Abstract
An osteochondral defect (OCD) is known as a symptomatic lesion causing pain,
recurrent synovitis, and altered joint mechanics most commonly in a weightbearing joint. Loose bodies may develop, which may then cause joint destruction
and/or locking. The damage to the articular surface is most likely a precursor
of ankle osteoarthritis. With the recent advances in diagnostic imaging, such as
MRI, as well as the development of ankle arthroscopy, the identification and
classification of these lesions has become much more precise. This allows more
accurate staging and improves treatment recommendations. The assessment of a
particular treatment is also improved. A variety of treatment alternatives are
now available. These include arthroscopic procedures including debridement,
retrograde drilling, and bone grafting. Compared to open treatment, arthroscopic
procedures may be particularly advantageous in the treatment of small defects
and stable OCD lesions. Until recently, however, favorable results have been
less predictable for large or unstable osteochondral defects. We treat these
more difficult lesions with a mosaic autogenous osteochondral transplantation.
In our hands, this appears to provide an optimal treatment result. The present
report evaluates the clinical outcome of 36 patients followed for two to seven
years after a mosaicplasty autogenous osteochondral transplantation from a non
or less weight bearing portion of the knee to the ipsilateral talus. Ankle
function was measured by the Hannover scoring system and showed good to
excellent results in 34 cases (94%) with no long term donor site morbidity. The
encouraging clinical results are supplemented with radiographs and histology,
which support the premise of lasting relief of symptoms and prevention of ankle
arthrosis.
<34>
Unique Identifier
11922369
Authors
O'Connor MA. Palaniappan M. Khan N. Bruce CE.
Institution
Royal Liverpool Children's Hospital, Alder Hey, England, UK.
Title
Osteochondritis dissecans of the knee in children. A comparison of MRI and
arthroscopic findings.
Source
Journal of Bone & Joint Surgery - British Volume. 84(2):258-62, 2002 Mar.
Abstract
The treatment of osteochondritis dissecans (OCD) in children and adolescents
is determined by the stability of the lesion and the state of the overlying
cartilage. MRI has been advocated as an accurate way of assessing and staging
such lesions. Our aim was to determine if MRI scans accurately predicted the
subsequent arthroscopic findings in adolescents with OCD of the knee. Some
authors have suggested that a high signal line behind a fragment on the T2weighted image indicates the presence of synovial fluid and is a sign of an
unstable lesion. More recent reports have suggested that this high signal line
is due to the presence of vascular granulation tissue and may represent a
healing reaction. We were able to improve the accuracy of MRI for staging the
OCD lesion from 45% to 85% by interpreting the high signal T2 line as a
predictor of instability only when it was accompanied by a breach in the
cartilage on the T1-weighted image. We conclude that MRI can be used to stage
OCD lesions accurately and that a high signal line behind the OCD fragment does
not always indicate instability. We recommend the use of an MRI classification
system which correlates with the arthroscopic findings.
<35>
Unique Identifier
11922365
Authors
Gautier E. Kolker D. Jakob RP.
Institution
Department of Orthopaedic Surgery, Kantonsspital, Fribourg, Switzerland.
Title
Treatment of cartilage defects of the talus by autologous osteochondral
grafts.
Source
Journal of Bone & Joint Surgery - British Volume. 84(2):237-44, 2002 Mar.
Abstract
We reviewed retrospectively 11 patients who had been treated surgically by
open autologous osteochondral grafting for symptomatic chondral or osteochondral
defects of the dome of the talus between 1996 and 1999. The mean ages of the
eight men and three women were 34.2 and 25.9 years, respectively, with a mean
time to follow-up of 24 months. The results of functional outcome were
prospectively obtained using the MODEMS AAOS foot and ankle follow-up
questionnaire, the AOFAS ankle-hindfoot scale and the Hannover scores for the
ankle. The grafts were harvested from the ipsilateral knee. Good to excellent
results were obtained for the ankle without adverse effects on the knee. We
believe that autologous osteochondral grafting should be considered for the
patient with a symptomatic osteochondral defect of the talus.
<36>
Unique Identifier
12721341
Authors
Peterson L. Minas T.
Institution
Brittberg M.
Lindahl A.
Institution for Orthopaedics, Gothenburg University, Sahlgrenska University
Hospital, Sweden.
Title
Treatment of osteochondritis dissecans of the knee with autologous chondrocyte
transplantation: results at two to ten years.
Source
Journal of Bone & Joint Surgery - American Volume. 85-A Suppl 2:17-24, 2003.
Abstract
BACKGROUND: Osteochondritis dissecans of the knee is a challenging clinical
problem. We previously reported on the early successful results of autologous
chondrocyte transplantation for the treatment of focal cartilage defects. The
purpose of the present study was to assess the intermediate to long-term results
of this technique in a large group of patients with osteochondritis dissecans.
METHODS: Fifty-eight patients with radiographically documented osteochondritis
dissecans of the knee underwent treatment with autologous chondrocyte
transplantation between 1987 and 2000 and were assessed clinically with use of
standard rating scales. Twenty-two patients consented to arthroscopic secondlook evaluation of graft integrity. RESULTS: The mean age of the patients at the
time of autologous chondrocyte transplantation was 26.4 years (range, fourteen
to fifty-two years). Seven patients were less than eighteen years old. Thirtyfive patients (60%) had juvenile-onset disease, and forty-eight patients (83%)
had had a mean of 2.1 prior operations. The defect was located on the medial
femoral condyle in thirty-nine patients and on the lateral femoral condyle in
nineteen. The mean lesion size was 5.7 cm (2) (range, 1.5 to 12.0 cm (2) ), and
the mean defect depth was 7.8 mm (range, 4 to 15 mm). After a mean duration of
follow-up of 5.6 years, 91% of the patients had a good or excellent overall
rating on the basis of a clinician evaluation and 93% had improvement on a
patient self-assessment questionnaire. The Tegner-Wallgren, Lysholm, and
Brittberg-Peterson VAS scores were all improved. The macroscopic quality of
graft integrity averaged 11.2 on a 12-point scale, with only one graft having a
score of <9 points. Two patients had a failure of treatment in the early
postoperative period. Only one patient who had had a good or excellent rating at
two years had a decline in clinical status at the time of the latest follow-up.
CONCLUSIONS: Treatment of osteochondritis dissecans lesions of the knee with
autologous chondrocyte transplantation produces an integrated repair tissue with
a successful clinical result in >90% of patients. We recommend the wider use of
autologous chondrocyte transplantation for this condition.
<37>
Unique Identifier
10709593
Authors
Sales de Gauzy J. Mansat C. Darodes PH. Cahuzac JP.
Institution
Department of Pediatric Orthopaedic Surgery, Centre Hospitalier Universitaire
de Toulouse, France.
Title
Natural course of osteochondritis dissecans in children.
Source
Journal of Pediatric Orthopaedics, Part B. 8(1):26-8, 1999 Jan.
Abstract
Results are reported from an absence of physiotherapic, orthopaedic, or
surgical treatment in 31 cases of osteochondritis dissecans in 24 children. The
mean age at diagnosis was 11 years and 4 months, and all the children were
suffering from pain for an average of 3 months. None of these children were
treated, except for instructions to discontinue involvement in sports activities
until their pain had disappeared. In all cases pain disappeared, and these
children have all returned to their former activities. According to x-ray
findings, 30 lesions disappeared totally, although there was one case of a loose
body. As a result, absence of treatment is recommended for osteochondritis
dissecans in children.
<38>
Unique Identifier
10513356
Authors
Hefti F. Beguiristain J. Krauspe R. Moller-Madsen B. Riccio V. Tschauner
C. Wetzel R. Zeller R.
Institution
Department of Pediatric Orthopedics, University of Basel,
Universitaetskinderspital beider Basel, Switzerland.
Title
Osteochondritis dissecans: a multicenter study of the European Pediatric
Orthopedic Society.
Source
Journal of Pediatric Orthopaedics, Part B. 8(4):231-45, 1999 Oct.
Abstract
To assess of the value of conservative and operative treatment of
osteochondritis dissecans of the knee, a multicenter study was performed. In 12
European countries, 798 cases of osteochondritis of the knee have been collected
from 44 hospitals. Results were based on 452 patients with 509 affected knees
with minimum follow-up was 1 year (mean follow-up, 3 years and 11 months) and
sufficient data for evaluation: 61% were male patients; 39% female patients; 318
affected knees were found in juvenile patients; 191 affected knees were in adult
or premature patients. The localization was the medial femoral condyle on the
lateral side in 51% (typical site) of patients. Various other sites were
involved. Of the 509 affected knees, 154 were treated conservatively, 355 were
treated surgically (many with multiple operations). For evaluation, the initial
situation (at the time of the diagnosis) was favorable in 198 patients (no
effusion, diameter of the lesion < 20 mm and no gross dissection on imaging) and
unfavorable (one of the parameters did not meet these prerequisites) in 311
patients. The results were better in young patients than in adult patients.
However, in the adolescent group, 22% of patients had abnormal knee at followup. The classical localization has a better prognosis than an unusual one.
Patients with a favorable situation at diagnosis have significantly better
results after conservative treatment than those who have undergone operation.
When there are signs of dissection, the results are better after operative than
after conservative treatment.
<39>
Unique Identifier
8989704
Authors
Aparicio G. Abril JC. Calvo E. Alvarez L.
Institution
Department of Pediatric Orthopaedic Surgery, Fundacion Jimenez Diaz, Madrid,
Spain.
Title
Radiologic study of patellar height in Osgood-Schlatter disease. [Review] [14
refs]
Source
Journal of Pediatric Orthopedics. 17(1):63-6, 1997 Jan-Feb.
Abstract
There are contradictory reports regarding patellar position in the OsgoodSchlatter disease. We present a prospective statistical study of 17 patients
with Osgood-Schlatter disease and 12 adolescents without anterior knee pain. The
Caton-Deschamps index was assessed on strictly the lateral radiograph of the
knee. The findings indicate a strong association between Osgood-Schlatter
disease and patella alta. This increase in patellar height would require an
increase in the force needed from the quadriceps to achieve full extension. This
mechanism could be responsible for the apophyseal lesion. [References: 14]
<40>
Unique Identifier
11433172
Authors
Hirano A. Fukubayashi T. Ishii T. Ochiai N.
Institution
Department of Orthopaedic Surgery, Institute of Clinical Medicine, University
of Tsukuba, Tsukuba City, Ibaraki, and Tokyo University, Tokyo, Japan.
Title
Relationship between the patellar height and the disorder of the knee extensor
mechanism in immature athletes.
Source
Journal of Pediatric Orthopedics. 21(4):541-4, 2001 Jul-Aug.
Abstract
SUMMARY: The purposes of this study were to evaluate the outcome of
longitudinal research on the patellar height of immature athletes, and to
clarify the relationship with disorders of the knee extensor mechanism. The
patellar height of 40 young male soccer players (80 knees) was observed with
radiographs of the bilateral knee joint for 2 years. The patellar height was
measured using the epiphyseal line method. No subject showed patella alta before
the occurrence of the disorder. Of the 12 knees in which the disorder occurred
during the observation period, 10 knees (83%) had higher patella after the onset
of symptoms than before. The patellar height in the painful stage was considered
significant compared with the normal group. Although the patellar position in
the predisorder stage was relatively high, this state was considered within the
normal scope of physiologic variation, such as the growth spurt.
<41>
Unique Identifier
12548449
Authors
Louisia S. Beaufils P. Katabi M. Robert H. French Society of Arthroscopy.
Institution
Service de Chirurgie OrthopediqueHospital Andre Mignot, Rue de Versailles,
78150, Le Chesnay, France.
Title
Transchondral drilling for osteochondritis dissecans of the medial condyle of
the knee.
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 11(1):33-9, 2003 Jan.
Abstract
Osteochondritis dissecans is a rare condition which occurs most frequently in
the medial condyle of the knee. Its prognosis remains controversial. We report
our experience with transchondral drilling (TCD) for osteochondritis dissecans.
The rationale for this low-morbidity procedure is to enhance the healing
potential of a lesion which failed to heal after conservative treatment. This
multicenter retrospective study examined 24 patients (25 medial condyles),
including cases both before (juvenile osteochondritis dissecans, JOCD; n=17) and
after closure of the physis (adult osteochondritis dissecans, AOCD; n=8). All
patients initially underwent a prolonged conservative treatment. The mean
duration of symptoms prior to surgery was 22 months in JOCD and 55 months in
AOCD patients. TCD was proposed in cases of intact or almost intact articular
cartilage and was initially conducted under arthrotomy and later by arthroscopy.
Mean follow-up time was 11.8 years in JOCD and 6 years in AOCD, and evaluation
was based on clinical examination and radiography. Excellent clinical results
were only observed in the JOCD group (12/17). In the AOCD group 4 patients had a
good result and the other 4 a poor result. Radiological findings matched with
clinical results. Except for age, factors of poor prognosis were: fissure of the
articular cartilage and anterior extension of the lesion. We do not recommend
TCD for AOCD. In JOCD, failure after 12 months of conservative treatment should
indicate TCD in the cases where the cartilage remains continuous. At this stage
there is no indication for more aggressive procedures.
<42>
Unique Identifier
12355306
Authors
Kivisto R. Pasanen L. Leppilahti J. Jalovaara P.
Institution
Division of Orthopedic of Surgery, University of Oulu, Kajaanintie 52, 90220
Oulu, Finland.
Title
Arthroscopic repair of osteochondritis dissecans of the femoral condyles with
metal staple fixation: a report of 28 cases.
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 10(5):305-9, 2002 Sep.
Abstract
In a retrospective clinical study we evaluated the outcome of arthroscopic
repair of osteochondritis dissecans (OCD) of the femoral condyles with metal
stable fixation. Twenty-eight knees of 26 patients (mean age 20 years) with OCD
of the knee were treated by fixation of the fragments with Hoffmann's dynamic
metal staples arthroscopically and by additional arthrotomy in 7 knees. At
follow-up (mean 4 years, 1-7) patients were interviewed for any residual
symptoms and underwent a routine clinical and radiographic examination. The
clinical results were based on the grading scale of Lysholm. The 17 knees which
did not require further surgery showed 13 instances of complete healing, 3 of
partial healing, and 1 of nonhealing. The 11 knees which had reoperations showed
2 instances of complete healing, 5 of partial healing, and 4 nonhealing. There
was no significant difference between early or late surgery, and results were
not related significantly to site of the lesion, handling of the fragment and
the crater, percutaneous drilling, or type of fragmentation. Clinical grading of
13 knees was as excellent, 11 good, and 4 fair. Broken stables were observed in
9 knees, and they were removed from 5 knees. Complete healing was thus achieved
in one-half and partial healing in one-third of cases. The metal staples used
here fit for use in the arthroscopic fixation of the OCD of the knee, although
the staples had a marked liability to break.
<43>
Unique Identifier
10639653
Authors
Bruns J. Luessenhop S. Lehmann L.
Institution
Department of Orthopedic Surgery, University of Hamburg, Germany.
j.bruns@uke.uni-hamburg.de
Title
Etiological aspects in osteochondritis dissecans patellae.
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 7(6):356-9, 1999.
Abstract
In a retrospective study probable etiological factors of rare cases of
osteochondritis dissecans of the patella were analyzed. Anamnestic data and data
obtained from standardized roentgenography in the anterior-posterior, axial, and
lateral views of the patella were evaluated. Anamnestic data provided no
evidence of the etiology in addition to the fact that several patients mentioned
a single or multiple trauma. In contrast to this, evaluation of the
roentgenograms showed that most of the patients with osteochondritis patellae
exhibited a flat articular surface of the patella (types I and V in Hertel's
classification) and a distinct accumulation of the patellae with greater lateral
than medial facet (types II and III in Wiberg's classification). Furthermore,
the axial shape of the patellar groove exhibited a distinct accumulation of type
III trochleae, representing a hypoplasia of the medial and hyperplasia of the
lateral part of the trochlea. Evaluation of the lateromedial patellar alignment
revealed in a distinct accumulation of grade II dislocation medially and
laterally. Although the data were obtained from a rather small number of
patients, in our opinion these results support the theory of biomechanical
induction of osteochondritis dissecans patellae. Further dynamic analyses are
needed to clarify biodynamic effects on the patella and the patellofemoral
joint.
<44>
Unique Identifier
10819918
Authors
Hinshaw MH. Tuite MJ. De Smet AA.
Institution
Department of Radiology, University of Wisconsin Hospital and Clinics,
Madison, Wisconsin 53792-3252, USA.
Title
"Dem bones": osteochondral injuries of the knee. [Review] [30 refs]
Source
Magnetic Resonance Imaging Clinics of North America. 8(2):335-48, 2000 May.
Abstract
MR imaging plays a valuable role in the diagnosis and staging of osteochondral
injuries of the femorotibial joint. Bone contusions may be the source of a
patient's pain, and MR imaging characteristics of certain types may help to
predict which contusions might progress to more serious osteochondral lesions.
MR imaging also is vital in the diagnosis of occult osteochondral fractures and
in accurately classifying displaced intra-articular fractures. Although
osteochondral dissecans usually is diagnosed radiographically, MR imaging is the
best noninvasive test for determining if an osteochondral fragment is unstable.
Unstable lesions are a treatable cause of knee pain. [References: 30]
<45>
Unique Identifier
12974484
Authors
Wall E. Von Stein D.
Institution
Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229,
USA. eric.wall@cchmc.org
Title
Juvenile osteochondritis dissecans. [Review] [86 refs]
Source
Orthopedic Clinics of North America. 34(3):341-53, 2003 Jul.
Abstract
JOCD has better potential for healing than adult OCD, but several series have
shown up to a 50% failure to heal with nonsurgical techniques. JOCD poses a
therapeutic dilemma for the pediatric sports specialist because the healing
potential is unpredictable at the disease onset. There are no controlled
prospective studies on this condition to accurately gauge the effect of
different treatments, or even if treatment affects the natural history of JOCD.
[References: 86]
<46>
Unique Identifier
8848747
Authors
De Smet AA. Ilahi OA. Graf BK.
Institution
Department of Radiology E3/311, University of Wisconsin Hospital, Madison
53792, USA.
Title
Reassessment of the MR criteria for stability of osteochondritis dissecans in
the knee and ankle.
Source
Skeletal Radiology. 25(2):159-63, 1996 Feb.
Abstract
OBJECTIVE. T2-weighted MR images has been reported to be an accurate method
for assessing osteochondritis dissecans. We reviewed our MR experience to
confirm the accuracy of the published criteria of instability. We also assessed
the value of each of four MR signs of instability. DESIGN. We reviewed the
original MR interpretations, arthroscopic reports, and MR examinations of 40
patients with osteochondritis dissecans of the talar dome or femoral condyles.
Arthroscopy was used as the gold standard for stability. The MR examinations
were reviewed retrospectively for a high-signal-intensity line or cystic area
beneath the lesion, a high-signal-intensity line through the articular
cartilage, or a focal articular defect. PATIENTS. All patients who had undergone
MR imaging for osteochondritis dissecans from 1990 to 1993 were reviewed. Forty
patients were identified who had arthroscopy after the MR examination. There
were 30 male and 10 female patients with an average age of 25.7 years. Thirtyone lesions were in femoral condyle and nine were in the talar dome. RESULTS AND
CONCLUSIONS. The original MR interpretations correctly identified 35 of the 36
unstable lesions and all 4 stable lesions, giving a sensitivity of 0.97 and
specificity of 1.0. There was a 98% agreement between the original and
retrospective diagnoses. A high-signal-intensity line was seen beneath 72% of
the 36 unstable lesions. The other three signs were noted in 22-31% of the
unstable lesions. Fifty-six percent of the unstable lesions showed only one sign
of instability. MR imaging is a highly sensitive method for detection of
unstable osteochondritis dissecans. The presence of any one sign indicates
instability, the most frequent sign being an underlying high-signal-intensity
line. Because we examined only four stable lesions, our 95% confidence interval
of 0.40-1.0 for a specificity of 1.0 gives only a limited estimate of the
specificity of MR.