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Kevin G Shea - One of the best experts on this subject based on the ideXlab platform.
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Osteochondritis Dissecans in the Skeletally Immature Knee.
Journal of Bone and Joint Surgery American Volume, 2018Co-Authors: Kevin G Shea, Connor G. Richmond, Theodore J GanleyAbstract:: Osteochondritis Dissecans of the knee, which results in knee symptoms and activity-related pain, is a condition that commonly affects young individuals. The etiology of Osteochondritis Dissecans remains unclear; however, genetic and endocrine factors, ischemia, inflammation, repetitive microtrauma, and spontaneous osteonecrosis have been suggested as causes of Osteochondritis Dissecans. Skeletally immature patients with a stable Osteochondritis Dissecans lesion typically have minimal clinical symptoms and, if treated nonsurgically, experience a high rate of healing. Surgical treatment should be considered for pediatric patients with a stable lesion that does not heal and pediatric patients who have an unstable lesion with articular cartilage defects. Surgical treatment also should be considered for patients who have nearly closed or closed physes, regardless of age. Skeletally immature patients with a stable lesion can be treated via subchondral bone drilling. Advanced lesions that are salvageable may require management via more complex procedures, including fixation with or without bone grafting and cartilage reconstruction procedures, to restore the osteochondral defect.
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Fluoroquinolone use in a child associated with development of Osteochondritis Dissecans.
Case Reports, 2014Co-Authors: John C. Jacobs, Kevin G Shea, Julia Thom Oxford, James L CareyAbstract:Several aetiological theories have been proposed for the development of Osteochondritis Dissecans. Cartilage toxicity after fluoroquinolone use has been well documented in vitro. We present a case report of a 10-year-old child who underwent a prolonged 18-month course of ciprofloxacin therapy for chronic urinary tract infections. This patient later developed an Osteochondritis Dissecans lesion of the medial femoral condyle. We hypothesise that the fluoroquinolone therapy disrupted normal endochondral ossification, resulting in development of Osteochondritis Dissecans. The aetiology of Osteochondritis Dissecans is still unclear, and this case describes an association between fluoroquinolone use and Osteochondritis Dissecans development.
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Osteochondritis Dissecans in an adult.
Orthopedics, 2012Co-Authors: James L Carey, Allen F Anderson, Kevin G SheaAbstract:Osteochondritis Dissecans in an Adult A 27-year-old student underwent surgical arthroscopy of the left knee with debridement and drilling of an Osteochondritis Dissecans lesion as a teenager. Approximately 1 year later, some symptoms returned. The intensity of pain was an 8 of 10 at worst and was associated with definite, unpredictable catching sensations. On physical examination, left knee range of motion was 0° to 135°. Point tenderness was localized to the distal aspect of the medial femoral condyle with the knee flexed to 90°. Moderate effusion was observed. Two magnetic resonance imaging (MRI) scans (Figure A, B) and 3 arthroscopy photographs (Figure C-E) are shown (arrow [E], cartilaginous loose fragment). What would you do?
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diagnosis and treatment of Osteochondritis Dissecans
Journal of The American Academy of Orthopaedic Surgeons, 2011Co-Authors: Henry G Chambers, Jennifer M Weiss, Tommy J Brunelle, Mark V. Paterno, Kevin G Shea, Allen E. Anderson, James L Carey, Theodore J Ganley, James O SandersAbstract:: This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of Osteochondritis Dissecans of the knee. None of the 16 recommendations made by the work group is graded as strong; most are graded inconclusive; two are graded weak; and four are consensus statements. Both of the weak recommendations are related to imaging evaluation. For patients with knee symptoms, radiographs of the joint may be obtained to identify the lesion. For patients with radiographically apparent lesions, MRI may be used to further characterize the Osteochondritis Dissecans lesion or identify other knee pathology.
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Juvenile Osteochondritis Dissecans of the knee.
Journal of Orthopaedic & Sports Physical Therapy, 2010Co-Authors: James H. Swain, Nathan L Grimm, Kevin G SheaAbstract:The patient was a 13-year-old male soccer player who was referred to a physical therapist with complaints of persistent worsening left medial knee pain with weight-bearing activity. Physical examination revealed no signs of joint effusion, lower extremity range-of-motion or strength discrepancies, ligamentous compromise, or tenderness to palpation. However, the patient reported discomfort with weight bearing, and a slightly antalgic gait was observed. Knee radiographs revealed a concave lucency involving the medial femoral condyle, consistent with an Osteochondritis Dissecans lesion. Magnetic resonance imaging confirmed an Osteochondritis Dissecans lesion of the medial femoral condyle, and the patient was diagnosed with stage I juvenile Osteochondritis Dissecans of the knee. Conservative management by a physical therapist was the recommended treatment, and after 6 months, the patient no longer complained of left knee pain, and repeat knee radiographs demonstrated evidence of a healing Osteochondritis diss...
Lyle J. Micheli - One of the best experts on this subject based on the ideXlab platform.
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internal fixation of juvenile Osteochondritis Dissecans lesions of the knee
American Journal of Sports Medicine, 2007Co-Authors: Mininder S Kocher, Joseph J Czarnecki, Jason S Andersen, Lyle J. MicheliAbstract:BackgroundOperative techniques for the management of juvenile Osteochondritis Dissecans lesions of the knee include drilling, internal fixation, fragment removal, and chondral resurfacing.PurposeTo evaluate the functional and radiographic outcome of internal fixation of juvenile Osteochondritis Dissecans lesions of the knee.Study DesignCase series; Level of evidence, 4.MethodsThe study design was a retrospective case series. Twenty-six knees in 24 skeletally immature patients underwent internal fixation of Osteochondritis Dissecans lesions. Mean follow-up was 4.25 years (range, 2-14.75 years). Mean patient age was 14.7 years (range, 11-16 years). There were 13 boys and 11 girls. Lesions were graded per the Ewing and Voto classification, with 9 stage II lesions (fissured), 11 stage III lesions (partially attached), and 6 stage IV lesions (detached). Methods of internal fixation included variable pitch screws (n = 11), bioabsorbable tacks (n = 10), partially threaded cannulated screws (n = 3), and bioabsorb...
Mininder S Kocher - One of the best experts on this subject based on the ideXlab platform.
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Osteochondritis Dissecans of the Knee.
Jbjs reviews, 2015Co-Authors: Benton E. Heyworth, Mininder S KocherAbstract:First described as a named entity by Konig in a classic German text in 1887[1][1], Osteochondritis Dissecans has more recently been defined by a research study group of high-volume Osteochondritis Dissecans surgeons, musculoskeletal radiologists, physical therapists, and researchers[2][2] as “a
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internal fixation of juvenile Osteochondritis Dissecans lesions of the knee
American Journal of Sports Medicine, 2007Co-Authors: Mininder S Kocher, Joseph J Czarnecki, Jason S Andersen, Lyle J. MicheliAbstract:BackgroundOperative techniques for the management of juvenile Osteochondritis Dissecans lesions of the knee include drilling, internal fixation, fragment removal, and chondral resurfacing.PurposeTo evaluate the functional and radiographic outcome of internal fixation of juvenile Osteochondritis Dissecans lesions of the knee.Study DesignCase series; Level of evidence, 4.MethodsThe study design was a retrospective case series. Twenty-six knees in 24 skeletally immature patients underwent internal fixation of Osteochondritis Dissecans lesions. Mean follow-up was 4.25 years (range, 2-14.75 years). Mean patient age was 14.7 years (range, 11-16 years). There were 13 boys and 11 girls. Lesions were graded per the Ewing and Voto classification, with 9 stage II lesions (fissured), 11 stage III lesions (partially attached), and 6 stage IV lesions (detached). Methods of internal fixation included variable pitch screws (n = 11), bioabsorbable tacks (n = 10), partially threaded cannulated screws (n = 3), and bioabsorb...
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management of Osteochondritis Dissecans of the knee current concepts review
American Journal of Sports Medicine, 2006Co-Authors: Mininder S Kocher, Rachael Tucker, Theodore J Ganley, John M FlynnAbstract:Osteochondritis Dissecans of the knee is being seen with increased frequency in pediatric and young adult athletes and is thought to be, in part, owing to earlier and increasingly competitive sports participation. Despite much speculation, the cause of both juvenile and adult Osteochondritis Dissecans remains unclear. Early recognition is essential. Whereas adult Osteochondritis Dissecans lesions have a greater propensity to instability, juvenile Osteochondritis Dissecans lesions are typically stable, and those with an intact articular surface have a potential to heal with nonoperative treatment through cessation of repetitive impact loading. The value of adjunctive immobilization, protected weightbearing, and unloader bracing has not been established. Skeletally immature patients with stable lesions that have not healed with nonoperative treatment should have consideration given to arthroscopic drilling to promote healing before the lesion progresses and requires more involved treatment with a less optimistic prognosis. Magnetic resonance imaging may allow early prediction of lesion healing potential. The majority of adult Osteochondritis Dissecans cases as well as those skeletally immature patients with unstable lesions and secondary loose bodies require fixation and possible bone grafting. Many unstable lesions will heal after stabilization, but long-term prognosis is not clear. Chronic loose fragments can be difficult to fix and have poor healing potential. Results of excision of large lesions from weightbearing zones are poor. Chondral resurfacing techniques have limited long-term data for cases of Osteochondritis Dissecans in skeletally immature patients.
Daniel W Green - One of the best experts on this subject based on the ideXlab platform.
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Classification and assessment of juvenile Osteochondritis Dissecans knee lesions.
Current Opinion in Pediatrics, 2016Co-Authors: Tyler J. Uppstrom, Elizabeth B. Gausden, Daniel W GreenAbstract:Purpose of reviewJuvenile Osteochondritis Dissecans (JOCD) knee lesions are common abnormalities in adolescents and children, and have higher rates of spontaneous healing with nonoperative management compared to adult Osteochondritis Dissecans (OCD) lesions. Multiple classification and assessment sy
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Osteochondritis Dissecans of the knee in children
Current Opinion in Pediatrics, 2003Co-Authors: William J Robertson, Bryan T. Kelly, Daniel W GreenAbstract: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
Arthur A De Smet - One of the best experts on this subject based on the ideXlab platform.
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mri findings of Osteochondritis Dissecans of the capitellum with surgical correlation
American Journal of Roentgenology, 2005Co-Authors: Richard Kijowski, Arthur A De SmetAbstract:OBJECTIVE. Few studies have described the MRI findings of Osteochondritis Dissecans of the capitellum. Our objective was to describe the MRI findings of 10 patients with Osteochondritis Dissecans of the capitellum and to correlate the imaging findings with surgical findings of stability and instability.CONCLUSION. The MRI findings of unstable and stable Osteochondritis Dissecans of the capitellum are similar to the findings described for Osteochondritis Dissecans of the femoral condyles and talar dome. Unstable Osteochondritis Dissecans lesions are surrounded by a rim of high signal intensity or a fluid-filled cyst on T2-weighted images. Stable Osteochondritis Dissecans lesions show no surrounding signal abnormality on T2-weighted images.
