Less certain was whether outside factors would let him into the operating room in the first place. Three of these gymnasts were treated conservatively, and two underwent arthroscopic removal of a loose body. Osteochondral allografts (OCA) consist of a layer of hyaline cartilage and a layer of underlying bone. Osteochondritis dissecans of the humeral head. This included 69 of 206 knee OCD lesions (33.8%), 27 of 85 ankle lesions (31.8%), 22 of 40 elbow lesions (55.0%), and no surgeries in the 2 shoulder and 1 foot lesions. In addition, there is no uniformity in the treatment algorithms of the many physicians involved in the care of these patients, both in terms of the indications for surgery and the types of surgeries performed. Sports Health. Can Fresh Osteochondral Allografts Restore Function in Juveniles With Osteochondritis Dissecans of the Knee?. Four continued to compete in gymnastics at the 3-year follow-up. Radiology. Prior to this work, the most comprehensive studies on OCD progression to surgery came from Hefti et al20 and Lefort et al.31, In 1999, Hefti et al20 and the European Pediatric Orthopedic Society provided the largest study of pediatric OCD of the knee and progression to surgical intervention. Osteochondritis dissecans. Exclusion criteria included traumatic osteochondral fractures or coexistence of non-OCD intra-articular lesions. While the cause is still unknown, the same treatment is possible. The authors noted that although prognosis of success with nonoperative treatment was better among the skeletally immature, not all lesions in this age group did well. Fixation with bone pegs had 100% effectiveness in one study of 17 patients with knee OCD. Surgical complications may include infection and neurovascular injuries, but these complications are particularly rare in these procedures. Three of 4 femoral trochlear lesions went on to surgery. [Medline]. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Knee Osteoarthritis. Aetiology of osteochondritis dissecans. Kocher, MS, Czarnecki, JJ, Andersen, JS, Micheli, LJ. The defect is excised to the normal surrounding cartilage, and the sclerotic bone is excavated down to the bleeding cancellous bone. Tabaddor et al evaluated the efficacy and safety of poly 96L/4D-lactide bioabsorbable copolymer fixation for unstable OCD in 24 adolescents (mean age, 14.4 y). If necessary, multiple pins may be placed for greater fixation. TABLE 4 Likelihood of Progression to Surgery for All Joints. This study found that patients younger than 45 years, patients who do not smoke, and patients with active lifestyles had the best chance for optimal outcome. TPLO is THE most common surgery Dr. Zeltzman performs – by far. Osteochondritis dissecans. [15]. Conservative treatment in these patients includes limitation of activity and protected weight bearing to allow healing and prevent further displacement. Despite the study weaknesses, it does provide new information regarding the patient factors associated with progression to surgery and is based on a large patient population with a consistent electronic medical record. [12]. An arthroscopic surgery may be done to make small drill holes in the healthier bone around the OCD to improve the blood supply to the OCD piece (fig 3). A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M. Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. During chondrocyte transplantation, care is taken to not provoke bleeding from the osseous bottom of the defect during debridement. Lyon R, Nissen C, Liu XC, Curtin B. In the ankle, medial and lateral talar lesions required surgery in 20 of 61 (32.8%) and 6 of 19 (31.6%) lesions, respectively, while central talar lesions and tibial plafond lesions failed conservative treatment in 1 of 3 and 0 of 2 lesions (Table 3). A number of other studies on smaller numbers of patients have evaluated surgical results in OCD of the knee, ankle, and elbow, with mixtures of adult and pediatric patients.1,2,4–8,10. Distribution of OCD lesions in the knee are most commonly associated with the lateral aspect from the medial femoral condyle. 1950 Oct. 32(A:4):867-74. Following all other surgeries, immobilization is not necessary. Surgery was performed on the single OCD lesion of the lateral tibial plateau. Login failed. The condition can be mild, moderate, or severe. Patients with indications for surgery and lesions less than 3 cm in diameter should be offered arthroscopic intervention in the form of subchondral drilling and, possibly, debridement and fragment stabilization. Postoperative MRI coronal view showing pinning of the osteochondral defect. The device usually lasts well over a decade. However, symptomatic patients with a lateral lesion and radiographic findings of a completely detached fragment that remains in the underlying crater bed require surgical intervention. Sharing links are not available for this article. Share on Pinterest OCD can cause pain and discomfort in the knee and other joints. As opposed to OCD of the ankle and knee, loose body removal was also frequently performed (63.6%). Chi-square analysis was done to determine differences by both age group and sex. Osteochondritis dissecans. Good long-term outcomes have been noted with biologic fixation with osteochondral plugs. Screw removal is made easier if screws with reverse cutting threads (eg, Synthes 4-mm cannulated screws) are used. Access to society journal content varies across our titles. [23], Autologous chondrocyte transplantation for the treatment of OCD lesions of the femoral condyle was found to yield good results at 2-year follow-up in 52 of 53 patients. About 60 percentof the recipients a… Surgical progression in the knee, elbow, and ankle were also significantly higher in each individual group among the older patients than the younger patients, all with P < .0001. [20]. For more information view the SAGE Journals Sharing page. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. Surgical treatment for osteochondritis dissecans of the capitellum. These differences were not statistically significant. OCD Surgery: determining success By Megan Williams on April 14, 2015 Osteochondritis Dissecans (OCD) is a common condition affecting young and growing horses that results in a fragment or fragments of cartilage (and associated underlying bone) within the joint that is damaged and often unattached from the parent bone. Likelihood of progression to surgery was slightly greater among males (57.6%) compared with females (42.9%), but this was not statistically significant. In … Therapy for OCD of the ankle is guided primarily by two considerations, the location of the lesion and the radiographic findings. Above is a photo of a typical OCD lesion within the knee. Weiss JM, Nikizad H, Shea KG, Gyurdzhyan S, Jacobs JC, Cannamela PC, et al. The overall progression to surgery for this younger age group was 9.2%, which was significantly lower than the progression to surgery among the older patients (P < .0001). Enneking, WF. Lunden JB, Legrand AB. [Medline]. While the cause is still unknown, the same treatment is possible. The majority of joints needing surgery were in the knee (58.5%), with ankle and elbow lesions representing 22.9% and 18.6% of surgeries performed, respectively. By way of background, I was a long jumper/triple jumper on the track team in college and banged up my right ankle pretty badly a couple times, though nothing that resulted in long term pain. Takahara et al,45 in a study of 106 adults and children with elbow OCD, found that 66% of patients failed conservative treatment and went on to have surgery. The leading thought as to why knee OCD happens relates to the thin layer of growth cartilage that caps the end of long bones, such as the femur or thigh bone. Even with surgery, OCD usually leads to future joint problems, … Non-surgical treatment typically consists of partial to non-we… The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described. The knee is the location most often requiring surgery, with 58% of procedures for OCD lesions being performed on the knee. They are used to repair combined defects of articular cartilage and bone. Orthop J Sports Med. Future research will also need to differentiate responses between juvenile and adult OCD because the two patient populations affected by these conditions seem to respond differently to various treatments. Plain films at an average of 19.2 months after surgery showed interval healing in 9 patients, no significant change in 1, complete healing in 13, and loose bodies with no interval healing in 1. This study confirms the markedly increased likelihood of progression to surgery among older patients for OCD as a whole and knee OCD specifically and confirms the findings of many prior studies that in each type of OCD, chondroplasty or debridement is the most common procedure performed. Surgery was more likely when the lesion was sclerosing or “dissected,” if the patient was older with growth plates closing or closed, and if the lesion was anywhere other than the lateral aspect of the MFC.20, In 2006, Lefort et al31 studied 892 cases of OCD of the knee in a mixture of adults and children. Seven knees required revision procedures at a mean follow-up of 14 months. It also demonstrates that approximately one-third of pediatric patients with OCD as a whole and of the ankle and knee specifically progress to surgery, with a higher progression in elbow OCD patients. Siblings of patients undergoing hip and knee replacement surgery have a 2- to 3-fold increased risk of developing OA, with a 27% severe OA heritability rate. Osteochondritis dissecans: a histologic and microradiographic analysis of surgically excised lesions. At a mean of 31 months postoperatively (range, 2-262 months), fragment union was observed in 18 of 22 knees (82%). In appropriate patients, surgical interventions for OCD lesions have shown success. In a study of juvenile patients with ankle OCD who required surgical intervention, 40% had good results, 53% had fair results, and 7% had poor results. Diagnosed in Feb, we were told that this type of injury has a very low success rate of recovering with no form of surgery. Surgical intervention for osteochondritis dissecans (OCD) has long been recognized as an important aspect of the treatment algorithm.17,38,40 While conservative (nonoperative) treatment is often utilized for early stage or stable lesions, lesions that fail to heal, appear unstable by magnetic resonance imaging (MRI), or coincide with the presence of loose bodies may require surgical intervention. You could have knee swelling without much pain at all. 2008 Mar. Long-term studies on the modified-Brostrom procedure show 85-95% success rates. If the 2002 Feb. 186-92. However, in addition to combining juvenile and adult patients, these studies did not provide consistent criteria for conservative treatment; they also did not consistently delineate what conservative treatment was provided. 17 Genes linked to the prevalence and progression of OA include those belonging to the bone morphogenetic protein and the Wnt signaling pathways. Internal fixation of OCD lesions in both skeletally mature and immature patients exhibits similar rates of healing and improvements in functional outcomes. The mean Lysholm score significantly improved postoperatively (from 72.3 to 95.8). Thus, 43% of patients in this age group failed nonoperative treatment and progressed to surgery. ... tend to have a success rate of 30% to 100% depending on the technique utilized. Comparison of bioabsorbable pins and nails in the fixation of adult osteochondritis dissecans fragments of the knee: an outcome of 30 knees. Exclusion criteria included traumatic osteochondral fractures, less than 1 year of follow-up, and the coexistence of any intra-articular lesions other than OCD. "The effects of OCD are highly variable," said Madison. Lyon et al reviewed 11 cases of children with OCD of the knee who were treated with a fresh osteochondral allograft. Chiroff RT, Cooke CP. 2012 Sep 26. Diseases & Conditions, encoded search term (Osteochondritis Dissecans) and Osteochondritis Dissecans, Humeral Capitellum Osteochondritis Dissecans, Cartilage Injury in the Knee: Assessment and Treatment Options, Management of Articular Cartilage Defects in the Glenohumeral Joint, Proposed RA Guidelines: Maximize Methotrexate Before Switching, Gout Clinical Practice Guidelines (ACR, 2020), A Man With Stooped Posture and Mysterious Back and Neck Pain, Denosumab Favored Over Alendronate for BMD Protection in Glucocorticoid-Induced Osteoporosis, Treatment Sequence With Romosozumab Influences Osteoporosis Outcomes. Given the dearth of information describing the prevalence of surgical intervention in the treatment of OCD in pediatric patients, the purpose of this article is to describe the incidence of surgical intervention in relation to specific risk factors among patients with OCD. The types of surgeries performed in this study are summarized in Table 5. This review of surgical intervention for pediatric OCD is one of the largest to date. It depends on the site of the lesion." This indirectly supports the findings of multiple authors13,19,20,28,31,33 who found worse clinical results in older children or those with closing physes as compared with children with open physes. In terms of progression by location in the knee, OCD lesions of the MFC were less likely to progress to surgery (28.2%) than those in the lateral femoral condyle (40.3%). This does occur in other joints of the body but is more common in the knee. The aforementioned 2012 study in The Journal of Bone and Joint Surgery assessed the clinical outcomes of these five different surgical techniques in patients affected by OCD of the knee, at a … J Pediatr Orthop. The best therapy for this difficult population of patients may be early detection and prevention by avoidance of the offending activity. ... tend to have a success rate of 30% to 100% depending on the technique utilized. Multiple perforations of the lesion are made using Kirschner wires. Louisia, S, Beaufils, P, Katabi, M, Robert, H. Maruyama, M, Takahara, M, Harada, M, Satake, H, Takagi, M. Mihara, K, Suzuki, K, Makiuchi, D, Nishinaka, N, Yamaguchi, K, Tsutsui, H. Nobuta, S, Ogawa, K, Sato, K, Nakagawa, T, Hatori, M, Itoi, E. Shi, LL, Bae, DS, Kocher, MS, Micheli, LJ, Waters, PM. The Kirschner wires are later removed in a retrograde fashion. Last of all, the present study does not specifically address the success of surgery, although 95% of patients did not require any further surgery after follow-up of at least 2 years. Care must be taken to align the fracture before fixing it with Kirschner wires. Age for each patient was obtained from the electronic medical record and was categorized as 2 to 5, 6 to 11, or 12 to 19 years. Barrett et al reported that headless metal compression screws, which can be left in place, provide a satisfactory union rate for treatment of unstable osteochondritis dissecans of the femoral condyles in patients who are skeletally mature. Skeletal Radiol. Please read and accept the terms and conditions and check the box to generate a sharing link.