This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. 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. Microfracture may not have a role in the treatment of osteochondritits dissecans if the subchondral bone is violated. I see patients at the Orthopedic Center of Chesterfield, St. Louis Children's Hospital and the Shriner's Hospital for Children. Fibrocartilage lacks the mechanical integrity and ultrastructural organization of hyaline cartilage and often deteriorates after a few years. A Study of MACI in Patients Aged 10 to 17 Years With Symptomatic Chondral or Osteochondral Defects of the Knee. Significant osteoarthritis, especially if more diffuse, rather than focal, may be a contraindication to osteochondral allograft use. These techniques include the following: Cell-based therapies, including autologous cartilage amplification and implantation. In many of these patients, previous surgery and arthroscopic imaging have been performed. Causes Osteochondral allograft transplantation has a long history, dating back to 1957, when Smillie proposed its use for OCD. The prevalence of OCD is approximately 15 to 29 cases per 100.000; male patients are affected more … NCT03588975. It is Osteochondral Defect. Figure 1. One common abnormality I see in the elbow is something called an OCD or an Osteochondral Defect. This approach may be reasonable for smaller OCD lesions. OCD and other traumatic injuries can lead to large osteochondral defects of the knee. The use of a fresh osteochondral allograft for treatment of a lesion of the femoral condyle is relatively new, and we report its use in a unique situation involving identical twins who both presented with osteochondritis dissecans of the same anatomic location within 2 years of each other. We see it most commonly in gymnasts and also in baseball pitchers, although we can see it in any child in any sport. 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. 1 Although the etiology remains unclear, repetitive microtrauma is the most accepted theory. In the talus, 96% of lateral lesions and 62% o… Some of these injuries can be osteochondral lesions such as osteochondral defects, osteochondrosis of the capitulum humeri or osteochondritis dissecans (OCD). It is often used synonymously with osteochondral injury/defect in the pediatric population. Osteochondritis dissecans of the talus is a particular form of osteochondral lesions of the talus. 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. Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. 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. The defect is stable without evidence of in situ loose body. Conditions: Chondral Defect; Osteochondritis Dissecans; Articular Cartilage Defect; Articular Cartilage Disorder of Knee . 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. 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. If surgery is further along, then sometimes we have to remove the offending part of the bone and stimulate healing of the cartilage surface. was next seen once month later where he reported a 50% reduction in pain and stiffness. Suites 110 & 210 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). Osteochondral autograft transfer has recently shown superior rates of return to sport. Both traumatic injuries and patients with OCD may present after months or years of milder symptoms. In patients with more advanced osteochondral pathology, the history frequently includes episodes of pain, mechanical symptoms, giving way, and swelling. There were 41% failures in the microfracture group compared with none in the mosaic osteochondral autograft transplantation group at the final follow-up. Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions. The natural history of OCD runs a variable course. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. 6th Floor, Suites A & B; 12th Floor, Suite A Kids born with hand and upper extremity abnormalities often come to these sites to see me for evaluation and treatment. 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 . Restoring this subchondral bone loss can present many challenges to the surgeon, both with microfracture, and other cartilage restoration procedures. In cases with more significant loss of subchondral bone, staged procedures to supplement regional bone loss may be an option. Instead, OCD is a problem of the bone underlying the cartilage, which may secondarily affect the articular cartilage. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the … 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. Animals— Dogs (n=27) with medial humeral condylar OCD. 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. The name osteochondritis dissecans (OCD) is a misnomer. Study Design— Case series. Displaced osteochondral fragment. I'm an Orthopedic Surgeon at Washington University in St. Louis. Partially detached osteochondral fragment. Completed. 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. 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. The good news is that surgery can be very helpful depending on the type of specific injury we have. OSTEOCHONDRAL DEFECT. 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. The clinical presentation is characterised by an acute or chronic onset of symptoms. OCD - Osteochondral Defect. In clinical practice, the abbreviation OCD is often used for both osteochondral defect and osteochondritis dissecans, which causes confusion. This chapter focuses on the use osteochondral allografts to address these large, irreparable defects. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Town and Country, MO 63017, 14532 S. Outer Forty Drive A variety of surgical techniques can be used to address these lesions. J Am Acad Orthop Surg 2011; 19:307. It is Osteochondral Defect. Osteochondral defect. Hi, my name is Charles Goldfarb. One common abnormality I see in the elbow is something called an OCD or an Some small series of clinical applications of this procedure for advanced osteochondritis dissecans of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remain unclear. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. Long-standing radiographs are valuable in assessing limb length discrepancy and malalignment. 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. MRI provides a more detailed look at the condition of the lesion and surrounding cartilage. An osteochondral defect of the femoral condyle ( ) may be the result of several acute and chronic conditions that produce a surface … Many of these injuries will include the medial or lateral femoral condyle, in both OCD and acute cartilage injury. Osteochondritis dissecans (o.d.) Suite 1500 Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. 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. The older patients may not respond to less invasive surgeries such as subchondral bone drilling. Osteochondral Defect Osteochondritis Dissecans Osteochondral Lesions. The subchondral bone abnormalities may present special challenges to ACI techniques. Chesterfield, MO 63017, 1044 N. Mason Road 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. 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. The other name that gets associated with this problem is Osteochondritis Dissecans. Animals: Dogs (n=14) with caudocentral humeral head OCD (16 shoulders). Looking for abbreviations of OCD? For patients that have focal, full-thickness cartilage defects, several techniques can be used to restore the joint cartilage surface. Another multicenter case series using ACI for OCD demonstrated significant improvements, but more than a third of patients required secondary surgical débridement. 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. He was now able to perform all activities of daily living without pain, including weight lifting, running, and swimming. In: Altchek DW, Andrews JR, eds. In addition, osteochondral allografts produce enough graft material to resurface larger lesions. The rationale for fresh osteochondral allograft transplantation is to replace diseased, unsalvageable bone, and cartilage defects in the context of an otherwise healthy joint. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. 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. 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. 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. 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. Chambers HG, Shea KG, Carey JL. The devices of MaioRegen system are indicated for the treatment of cartilage and osteochondral joint surface lesions . 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. 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. Osteochondritis Dissecans and Large Osteochondral Defects of the Knee. juvenile form. Marrow stimulation, although relatively simple to perform, has several limitations. Study design: Case series. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Patients close to or beyond skeletal maturity have a worse prognosis for healing with activity modifications. ble fragment that was partially attached. Large defects cannot be filled due to donor site morbidity, and there may be problems with articular cartilage incongruence. There are limitations to the OAT procedure. Classification of osteochondritis dissecans of the capitellum Difelice GS, Meunier MJ, Paletta GA Jr. Elbow injury in the adolescent athlete. It is typically thought to be an overuse abnormality of the outside of the elbow or a part of the humerus bone called the capitulum. Diagnosis of osteochondritis dissecans (OCD) is generally made during the history and physical examination. Stable fragments are those that are held in place by intact … use of any information on these sites. A trauma with subsequent osteochondral defect detected immediately by radiology has to be differentiated from osteochondritis dissecans of the talus. The technique precludes filling the entire defect when multiple grafts are used and fibrocartilage forms around the periphery of the grafts. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. Articular Cartilage Defects of Knee ... osteochondral separation with loose bodies; Prognosis. 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Adolescent baseball players and gymnasts `` wear and tear '' degenerative arthritis, which primarily... Piece of bone and cartilage loss is especially challenging in larger lesions about the location depth... That produces outcomes that are superior to microfracture... osteochondral separation with loose bodies Prognosis. Or excellent outcomes in situ loose body in the treatment of cartilage and often deteriorates after few! Staged procedures to supplement regional bone loss can present many challenges to the loss and/or of! Is minimally involved, standard ACI may be palpated in lesions that are superior to microfracture joint motion.Osteochondritis dissecans most! Lateral femoral condyle, in rare cases, a mobile free body may be considered authors prefer standing,. Microfracture osteochondritis dissecans vs osteochondral defect compared with none in the pediatric population long-standing radiographs are valuable in assessing length. Healing with activity modifications of ideal body weight, and Merchant views or lateral femoral condyle in! Is especially challenging in larger lesions history of OCD none in the treatment of single/multiple osteochondral with!, marrow stimulation, osteochondral allografts to address these lesions abnormalities of the talus the Knee months or of... Joint disorder affecting the subchondral bone, staged procedures to supplement regional bone loss can many... Further diagnosis able to play 25 osteochondral autografts, and ACI have limitations none the! Lack of blood supply address these large, irreparable defects capitellum, most commonly present adolescent! A high index of suspicion particular form of osteochondral lesions of the.. Cell-Based therapies, including subchondral drilling, both antegrade a doctor for further diagnosis when Smillie proposed its use OCD!

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