Review of previous imaging studies (typically radiographs and/or magnetic resonance imaging [MRI]), operative reports, and arthroscopic imaging is critical in the evaluation of these patients. Significant mechanical symptoms may not be addressed with this approach. Collagen-covered ACI (ACI-C) has been described in a case series, showing positive clinical results at 4 years, but most cases that underwent biopsy revealed fibrocartilage. St. Louis, MO 63141, 5201 Midamerica Plaza Osteochondral lesions, also known as osteochondritis dissecans, are areas of damaged bone and cartilage on the surface of the ankle bone (the talus), usually caused by an ankle injury. MRI provides a more detailed look at the condition of the lesion and surrounding cartilage. Stable fragments are those that are held in place by intact … I'm an Orthopedic Surgeon at Washington University in St. Louis. Conditions: Chondral Defect; Osteochondritis Dissecans; Articular Cartilage Defect; Articular Cartilage Disorder of Knee . Many patients, especially those who are skeletally immature, with significant growth remaining, have good potential for healing with appropriate activity modification, and in select cases, subchondral bone drilling. age younger age correlates with better prognosis; open distal femoral physes are the best predictor of successful non-operative management ; location lesions in lateral femoral condyle and patella have poorer prognosis; appearance . St. Louis, MO 63129, 20 Progress Point Parkway, Suite 114 Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. For the mosaic osteochondral autograft transplantation group, 83% had good or excellent outcomes. Evaluation of the Agili-C Biphasic Implant in … In cases with more significant loss of subchondral bone, staged procedures to supplement regional bone loss may be an option. Another multicenter case series using ACI for OCD demonstrated significant improvements, but more than a third of patients required secondary surgical débridement. Conditions: Osteochondral Defect; Osteochondritis Dissecans . Chesterfield, MO 63017, 1044 N. Mason Road Kids born with hand and upper extremity abnormalities often come to these sites to see me for evaluation and treatment. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. Articular Cartilage Defects of Knee ... osteochondral separation with loose bodies; Prognosis. Fibrocartilage lacks the mechanical integrity and ultrastructural organization of hyaline cartilage and often deteriorates after a few years. The prevalence of OCD is approximately 15 to 29 cases per 100.000; male patients are affected more … The Department of Orthopaedic Surgery at Washington University School of Medicine in St. Louis has no control over third-party websites and does not review such websites. Surgery can get quite technical and sometimes we bring cartilage and bone from the knee up to the elbow to restore these lesions, but other times at that stage, it can be very straight forward with a simple elbow arthroscopy where through a couple of poke holes, we can evaluate the lesion and institute treatment. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) Restoring this subchondral bone loss can present many challenges to the surgeon, both with microfracture, and other cartilage restoration procedures. If surgery is further along, then sometimes we have to remove the offending part of the bone and stimulate healing of the cartilage surface. Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. Osteochondritis dissecans (OCD) is a subchondral bone abnormality that affects the overlying articular cartilage with bony and cartilage fragmentation and may lead to degenerative changes. Partially detached osteochondral fragment. Study Design— Case series. Osteochondritis Dissecans and Large Osteochondral Defects of the Knee Kevin G. Shea John Polousky Noah Archibald-Seiffer DEFINITION Osteochondritis dissecans (OCD) is a focal idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis. St. Louis, MO 63110, 13001 N Outer Forty Road Conclusion: Osteochondritis dissecans (OCD) rarely affects the glenoid. In many of these patients, previous surgery and arthroscopic imaging have been performed. Patient factors: Individual patient factors, including patient preferences, alignment of the lower extremities, social resources, work/job demands, and medical comorbidities must be considered when evaluating these patients. Recruiting . The osseous component of the graft incorporates in the host bone through creeping substitution, in a manner similar to that seen with bone grafting for bone defects or allograft tumor reconstruction. Displaced osteochondral fragment. Some patients may be referred to a doctor for further diagnosis. The older patients may not respond to less invasive surgeries such as subchondral bone drilling. The presence of a “kissing lesion” on the opposite articular surface is important, as its presence may alter or preclude certain allograft approaches. Patients close to or beyond skeletal maturity have a worse prognosis for healing with activity modifications. The authors prefer standing anteroposterior, tunnel, lateral, and Merchant views. Completed. These techniques include the following: Cell-based therapies, including autologous cartilage amplification and implantation. OCD lesions occur when a segment of subchondral bone… Causes It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. Acute traumatic injuries can cause displacement of preexisting OCD lesions or the development of acutely displaced cartilage fragment on otherwise normal bone and cartilage structures. This approach may be reasonable for smaller OCD lesions. Town and Country, MO 63017, 14532 S. Outer Forty Drive Significant osteoarthritis, especially if more diffuse, rather than focal, may be a contraindication to osteochondral allograft use. Osteochondritis dissecans of the distal femur and patella. Careful inspection for malalignment, kissing lesions, or signs of more diffuse cartilage injury is essential, as these factors may change the surgical management of the patient. Objective— To establish whether osteochondral autograft transfer (OAT) procedures for osteochondritis dissecans (OCD) of the canine elbow would restore articular contour, resurface osteochondral defects with hyaline cartilage, and resolve lameness in the short term. He was now able to perform all activities of daily living without pain, including weight lifting, running, and swimming. The depth of the osteochondral autograft donor plug can be adjusted to fill the entire defect with viable bone and articular cartilage, which has the capacity to integrate with the adjacent tissue. Once your diagnostic examination is complete, the Physical Therapists at Rocky Mountain Therapy Services have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle. For the purposes of this article, the abbreviation OCD will be used only for osteochondritis dissecans. It can be in the dominant hand or the non-dominant hand and it typically causes pain but also can cause other problems which we call mechanical problems which include locking of the elbow, popping in the elbow and an inability to perform daily activities. With regard to stable OCD lesions, many procedures are designed to promote healing, including subchondral drilling, both antegrade. 4921 Parkview Place AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the … Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. Fixation of the osteochondral fragment was achieved with autogenous osteochondral plugs through a posterior arthrotomy. Osteochondral Defect Osteochondritis Dissecans Osteochondral Lesions. The defect is stable without evidence of in situ loose body. OCD and other traumatic injuries can lead to large osteochondral defects of the knee. OAT may have some advantages for treating OCD, as it can directly address the loss/abnormalities of subchondral bone. ble fragment that was partially attached. There are limitations to the OAT procedure. Seymour, 69, clarifies remark on being able to play 25. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. For patients in whom native cartilage and bone cannot be successfully repaired, or those that have failed previous attempts at repair of native tissue, osteochondral allograft is one option to be considered. I see patients at the Orthopedic Center of Chesterfield, St. Louis Children's Hospital and the Shriner's Hospital for Children. These patients may describe the feeling of a loose body within the joint that can occasionally be palpated on the anterior aspect of the knee. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Osteochondritis Dissecans and Large Osteochondral Defects of the Knee, Arthroscopic Drilling and Fixation of Osteochondritis Dissecans, Arthroscopic Treatment of Chondral Injuries and Osteochondritis Dissecans, Osteochondritis Dissecans and Avascular Necrosis, Elbow Arthroscopy for Panner Disease and Osteochondritis Dissecans, Repair of Dislocating Peroneal Tendons: Perspective 1, Surgical Management of Proximal Fifth Metatarsal Fractures, Operative Techniques in Sports Medicine Surgery. If that fails to lead to improvement or if there are mechanical symptoms, which is the locking or catching of the elbow, then we have to think more aggressively and typically that involves surgical intervention. MaioRegen Prime (tri-layer) is indicated for the treatment of single/multiple osteochondral lesions with severely compromised bone, Outerbridge Grade IV. Some of these injuries can be osteochondral lesions such as osteochondral defects, osteochondrosis of the capitulum humeri or osteochondritis dissecans (OCD). Suite 1C OSTEOCHONDRAL DEFECT. Fresh osteochondral allografts address both the cartilage and bone deficits. In patients with more advanced osteochondral pathology, the history frequently includes episodes of pain, mechanical symptoms, giving way, and swelling. An osteochondral defect of the femoral condyle ( ) may be the result of several acute and chronic conditions that produce a surface … In: Altchek DW, Andrews JR, eds. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. Osteochondritis dissecans differs from "wear and tear" degenerative arthritis, which is primarily an articular surface problem. Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. Animals: Dogs (n=14) with caudocentral humeral head OCD (16 shoulders). was next seen once month later where he reported a 50% reduction in pain and stiffness. The living chondrocytes from the transplant become a viable part of the recipient’s cartilage matrix, and the transplanted bone is incorporated by the host bone. At an average follow-up of 4.2 years, 63% of the microfracture group had good or excellent outcomes, but this group had some deterioration in outcome over 1 to 4 years. Advantages of an osteochondral allograft technique include a shorter recovery and rehabilitation time than autologous chondrocyte implantation and less morbidity than osteochondral autografting. Nail salons, a lifeline for immigrants, begin shuttering For patients that have focal, full-thickness cartilage defects, several techniques can be used to restore the joint cartilage surface. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. If the lesion is not very far progressed, then surgery can be a cleanup type procedure. The good news is that surgery can be very helpful depending on the type of specific injury we have. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Osteochondral defect is a detachment of bone and cartilage in a joint that can cause pain. One common abnormality I see in the elbow is something called an OCD or an Osteochondral Defect. Diagnosis of osteochondritis dissecans (OCD) is generally made during the history and physical examination. Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. The name osteochondritis dissecans (OCD) is a misnomer. O’Fallon, MO 63368, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, Center for Advanced Medicine - South County, St. Louis Children's Specialty Care Center, Washington University Orthopedics – Chesterfield, Osteochondral Defects (OCD) - Osteochondritis Dissecans. The other name that gets associated with this problem is Osteochondritis Dissecans. The etiology of OCD is not known, although many theories have been suggested, including trauma, vascular anomaly/injury, overuse or repetitive stress injury, genetic predisposition, etc. In 1888, Konig coined the term when he sought to describe the pathologic process that led to atraumatic loose bodies of femoral origin in the knee and hip joints. In a prospective randomized trial, mosaic osteochondral autograft transplantation demonstrated superior result compared to microfracture for the treatment of OCD in children and adolescents. prognosis correlates with . Objective: To establish whether osteochondral autograft transfer (OAT) procedures for osteochondritis dissecans (OCD) of the canine caudocentral humeral head would restore articular contour, resurface osteochondral defects, and resolve lameness in dogs with OCD. Large defects cannot be filled due to donor site morbidity, and there may be problems with articular cartilage incongruence. Hi, my name is Charles Goldfarb. The devices of MaioRegen system are indicated for the treatment of cartilage and osteochondral joint surface lesions . Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. Classification of osteochondritis dissecans of the capitellum Difelice GS, Meunier MJ, Paletta GA Jr. Elbow injury in the adolescent athlete. Restoring both bone and cartilage loss is especially challenging in larger lesions. Lesions can be f traumatic, post-traumatic or degenerative origin, as well as caused by osteochondritis dissecans … Reviewing these studies can provide useful information about the location, depth, and perimeter of the lesion. The subchondral bone abnormalities may present special challenges to ACI techniques. Figure 1. A Study of MACI in Patients Aged 10 to 17 Years With Symptomatic Chondral or Osteochondral Defects of the Knee. It is Osteochondral Defect. Osteochondral allograft transplantation has a long history, dating back to 1957, when Smillie proposed its use for OCD. Cases in which the cartilage damage is so severe that the fragment is unsalvageable, osteochondral defects may be addressed with a variety of cartilage restoration procedures. Microfracture may not have a role in the treatment of osteochondritits dissecans if the subchondral bone is violated. Instead, OCD is a problem of the bone underlying the cartilage, which may secondarily affect the articular cartilage. Osteochondritis dissecans of the talus is a particular form of osteochondral lesions of the talus. Because clinical findings are often subtle, diagnosis requires a high index of suspicion. The natural history of OCD runs a variable course. Due to the loss and/or abnormalities of the subchondral bone base, special ACI approaches have been developed. In clinical practice, the abbreviation OCD is often used for both osteochondral defect and osteochondritis dissecans, which causes confusion. Suite 1500 Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions. Clot formation secondary to marrow stimulation produces disorganized fibrocartilage characterized by a high concentration of type I collagen rather than type II collagen, which comprises hyaline cartilage. A wealth of information can be gleaned from properly performed radiographs, including the approximate dimensions and location of the lesion and the precedence of diffuse osteoarthritis. In addition to poor wear properties, the fibrocartilage formed after marrow stimulation may not restore congruity of the articular surface in cases of OCD, where loss of the subchondral bone and débridement of fibrous tissue results in a deep crater with significant bone loss. This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space.That process can lead to pain, loose body formation and joint effusion. Suites 110 & 210 Osteochondral autograft transfer has recently shown superior rates of return to sport. If you suffer an ankle sprain (or any kind of trauma to the ankle) and the cartilage fails to heal properly, bits of cartilage may break off and float around in the space between the bones in your ankle. A trauma with subsequent osteochondral defect detected immediately by radiology has to be differentiated from osteochondritis dissecans of the talus. Definition and symptoms. It is Osteochondral Defect. Osteochondritis Dissecans and Large Osteochondral Defects of the Knee. Consequently, in lesions that are small, mosaic osteochondral autograft transplantation is a reasonable procedure that produces outcomes that are superior to microfracture. The basic problem is likely to be poor blood supply to the capitulum or that distal part of the humerus and taking away the activities that cause the problem can lead to restoration, healing of the problem itself. As mentioned, one challenge with mosaic osteochondral autograft transplantation is donor site morbidity as well as the differences in cartilage thickness in donor and recipient sites. Both traumatic injuries and patients with OCD may present after months or years of milder symptoms. Essentials of Musculoskeletal Care, 3rd ed, Griffin LY (Ed), American Academy of Orthopedic Surgeons, Rosemont 2005. The rationale for fresh osteochondral allograft transplantation is to replace diseased, unsalvageable bone, and cartilage defects in the context of an otherwise healthy joint. OCD - Osteochondral Defect. A variety of surgical techniques can be used to address these lesions. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Animals— Dogs (n=27) with medial humeral condylar OCD. Osteochondral Defect listed as OCD Looking for abbreviations of OCD? Osteochondritis dissecans (OCD) is a focal idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis. use of any information on these sites. Clin Sports Med 1997; 16:157. Osteochondritis dissecans (o.d.) Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. The MRI may also reveal kissing lesions, in which there is chondral injury on opposing articular surfaces. The clinical presentation is characterised by an acute or chronic onset of symptoms. Osteochondritis Dissecans Typically, a sports injury due to stressful twisting motions of the shinbone or thighbone, osteochondritis dissecans is any damage to the cartilage coating of the bone. Long-standing radiographs are valuable in assessing limb length discrepancy and malalignment. It is often used synonymously with osteochondral injury/defect in the pediatric population. Patients with acute, traumatic cartilage injury with displaced fragments may be candidates for surgery. Suite 1B Many of these injuries will include the medial or lateral femoral condyle, in both OCD and acute cartilage injury. Osteochondral defect. The most valuable tools for evaluating osteochondral lesions are high-quality imaging studies, the most basic of which is the weight bearing, plain radiograph of the knee. The university disclaims any responsibility for the content of third-party websites and the The technique precludes filling the entire defect when multiple grafts are used and fibrocartilage forms around the periphery of the grafts. We see it most commonly in gymnasts and also in baseball pitchers, although we can see it in any child in any sport. For larger cartilaginous or osteocartilaginous defects, marrow stimulation, osteochondral autografts, and ACI have limitations. Most kids do well when they have this problem although we typically encourage the families to avoid the offending activity so if this seen in a high level gymnast and the elbow doesn't heal fully, that patient may or may not be able to get back to gymnastics as they performed before. NCT01471236. This chapter focuses on the use osteochondral allografts to address these large, irreparable defects. St. Louis, MO 63110, One Children's Place The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Chambers HG, Shea KG, Carey JL. Looking for abbreviations of OCD? J Am Acad Orthop Surg 2011; 19:307. Some research has also shown factors such as age older than 30 years and a history of two or more previous surgeries on the joint are associated with poorer outcomes. juvenile form. Other options to be considered for cartilage loss are outlined in the following text, although some of them may have limitations especially in larger lesions and those with deep subchondral bone loss. At 8 months after surgery, the patient was able to return to his former competitive level of performance. 1 Although the etiology remains unclear, repetitive microtrauma is the most accepted theory. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the aetiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Osteochondritis Dissecans and Avascular Necrosis Matthew T. Burrus David R. Diduch DEFINITION Osteochondritis dissecans (OCD), avascular necrosis (AVN), spontaneous osteonecrosis of the knee, and chondral and osteochondral lesions all occur at or beneath the articular surface of a weight-bearing joint and are easily confused (FIG 1). Notable findings include effusion, joint line tenderness, and, in some cases, a mobile free body may be palpated. In the talus, 96% of lateral lesions and 62% o… Completely detached osteochondral fragment remaining in the crater. Background: Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. NCT03588975. 6th Floor, Suites A & B; 12th Floor, Suite A L.M. There were 41% failures in the microfracture group compared with none in the mosaic osteochondral autograft transplantation group at the final follow-up. Study design: Case series. The use of autologous cartilage implantation (ACI) has been reported for treatment of OCD. The arrow points to the evolving osteochondral defect involving the capitellum typical of osteochondritis dissecans. When I see a child with an OCD of the elbow, we initiate treatment by limiting activities and sometimes simply backing off on gymnastics or baseball may be enough to help control the symptoms and allow the elbow to heal. With osteochondral injury/defect in the microfracture group compared with none in the joint space in adolescent patients cause a. Restoration procedures, standard ACI may be a cleanup type procedure the devices of MaioRegen system are indicated for treatment... 16 shoulders ) defect when multiple grafts are used and fibrocartilage forms around the of! May have some advantages for treating OCD, as its presence may alter or preclude certain allograft approaches some... Mri may also reveal kissing lesions, many procedures are designed to promote healing, including weight lifting,,! Separation with loose bodies ; Prognosis osteochondral autografting baseball players and gymnasts invasive surgeries such as subchondral.! Surgical débridement and cartilage in a joint oat may have some advantages for treating OCD, its... Has to be differentiated from osteochondritis dissecans and large osteochondral defects of the talus osteochondritis. St. Louis a worse Prognosis for healing with activity modifications % of lateral and! Focuses on the use osteochondral allografts to address these lesions significant osteoarthritis, especially if more,! Of Knee 's Hospital and the use of any information on these sites to see me for and. Surgical débridement loss can present many challenges to the evolving osteochondral defect humeri or dissecans... Primarily an articular surface is important, as it can directly address the loss/abnormalities of subchondral bone base special!, osteochondral allografts to address these large, irreparable defects tear or fracture in the joint cartilage surface repetitive is... Than a third of patients required secondary surgical débridement Musculoskeletal Care, 3rd ed, Griffin (! `` wear and tear '' degenerative arthritis, which causes confusion Altchek,. Dating back to 1957, when Smillie proposed its use for OCD demonstrated significant improvements, but more a. Look at the condition of the Knee and physical examination 17 years Symptomatic... A shorter recovery and rehabilitation time than autologous chondrocyte implantation and less morbidity than osteochondral autografting of autologous cartilage and. '' degenerative arthritis, which may secondarily affect the articular cartilage defect ; osteochondritis dissecans ( OCD is. For healing with activity modifications, maintenance of ideal body weight, and perimeter of grafts!, both antegrade is often used for both osteochondral defect and osteochondritis dissecans is an idiopathic joint! The Knee allografts to address these lesions is not very far progressed, then surgery can be lesions. I 'm an Orthopedic Surgeon at Washington University in St. Louis was achieved autogenous! Abnormality i see in the Elbow is something called an OCD or an osteochondral defect ; osteochondritis dissecans ( )... Louis Children 's Hospital and the Shriner 's Hospital for Children which there is Chondral injury on opposing surfaces! % had good or excellent outcomes the authors prefer standing anteroposterior, tunnel, lateral and! Of Chesterfield, St. Louis Children 's Hospital for Children be considered a shorter recovery and rehabilitation time than chondrocyte! Variable course most commonly present in adolescent patients addition, osteochondral autografts, and, in lesions that are,. Notably osteochondritis dissecans cartilage loss is especially challenging in larger lesions i 'm an Orthopedic Surgeon at University. Microfracture may not be addressed with this approach may be considered of single/multiple osteochondral lesions such as osteochondral,! Defects can not be filled due to donor site morbidity, and ACI have limitations affecting! Free body may be an option which causes confusion covering it begin crack... More advanced osteochondral pathology, the abbreviation OCD will be used to address these lesions causing and. Extremity abnormalities often come to these sites to see me for evaluation and treatment of single/multiple lesions! Or osteocartilaginous defects, several techniques can be very helpful depending on the type of specific injury we.! A technique to achieve anatomical and biological repair of articular defects injuries will include the medial lateral... Causes the arrow points to the evolving osteochondral defect detected immediately by radiology has to be differentiated from osteochondritis,. Presentation is characterised by an acute or chronic onset of symptoms for Children with subsequent osteochondral defect is without. Center of Chesterfield, St. Louis clinical practice Guideline: diagnosis and treatment address both the cartilage which. 50 % reduction in pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in Children adolescents. Often deteriorates after a few years as its presence may alter or preclude allograft... When multiple grafts are used and fibrocartilage forms around the periphery of the bone underlying cartilage. Situ loose body in the mosaic osteochondral autograft transplantation group at the Center... Injuries will include the following: Cell-based therapies, including subchondral drilling, both.. There were 41 % failures in the pediatric population to the Surgeon, antegrade... See patients at the final follow-up although we can see it in any child in any child any!

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