Osteochondritis

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Mininder S Kocher - One of the best experts on this subject based on the ideXlab platform.

  • Osteochondritis Dissecans of the Knee.
    Jbjs reviews, 2015
    Co-Authors: Benton E. Heyworth, Mininder S Kocher
    Abstract:

    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

  • internal fixation of juvenile Osteochondritis dissecans lesions of the knee
    American Journal of Sports Medicine, 2007
    Co-Authors: Mininder S Kocher, Joseph J Czarnecki, Jason S Andersen, Lyle J Micheli
    Abstract:

    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...

  • management of Osteochondritis dissecans of the knee current concepts review
    American Journal of Sports Medicine, 2006
    Co-Authors: Mininder S Kocher, Rachael Tucker, Theodore J Ganley, John M Flynn
    Abstract:

    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.

Richard Kijowski - One of the best experts on this subject based on the ideXlab platform.

Theodore J Ganley - One of the best experts on this subject based on the ideXlab platform.

  • Osteochondritis dissecans of the elbow in children mri findings of instability
    American Journal of Roentgenology, 2019
    Co-Authors: Jie C Nguyen, Theodore J Ganley, Andrew J Degnan, Christian A Barrera, Richard Kijowski
    Abstract:

    OBJECTIVE. The purpose of this study was to investigate the performance of MRI criteria for predicting instability of Osteochondritis dissecans (OCD) lesions of the elbow in children. MATERIALS AND...

  • Osteochondritis Dissecans in the Skeletally Immature Knee.
    Journal of Bone and Joint Surgery American Volume, 2018
    Co-Authors: Kevin G. Shea, Connor G. Richmond, Theodore J Ganley
    Abstract:

    : 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.

  • diagnosis and treatment of Osteochondritis dissecans
    Journal of The American Academy of Orthopaedic Surgeons, 2011
    Co-Authors: Henry G Chambers, Kevin G. Shea, James L. Carey, Mark V Paterno, Jennifer M Weiss, Theodore J Ganley, Allen E Anderson, Tommy J Brunelle, James O Sanders
    Abstract:

    : 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.

  • management of Osteochondritis dissecans of the knee current concepts review
    American Journal of Sports Medicine, 2006
    Co-Authors: Mininder S Kocher, Rachael Tucker, Theodore J Ganley, John M Flynn
    Abstract:

    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.

Kevin G. Shea - One of the best experts on this subject based on the ideXlab platform.

  • autologous chondrocyte implantation as treatment for unsalvageable Osteochondritis dissecans 10 to 25 year follow up
    American Journal of Sports Medicine, 2020
    Co-Authors: James L. Carey, Kevin G. Shea, Anders Lindahl, Haris S Vasiliadis, Carl Lindahl, Lars Peterson
    Abstract:

    Background:An unsalvageable Osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fra...

  • Osteochondritis Dissecans in the Skeletally Immature Knee.
    Journal of Bone and Joint Surgery American Volume, 2018
    Co-Authors: Kevin G. Shea, Connor G. Richmond, Theodore J Ganley
    Abstract:

    : 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.

  • Fluoroquinolone use in a child associated with development of Osteochondritis dissecans.
    Case Reports, 2014
    Co-Authors: John C. Jacobs, Kevin G. Shea, Julia Thom Oxford, James L. Carey
    Abstract:

    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.

  • a review of arthroscopic classification systems for Osteochondritis dissecans of the knee
    Clinics in Sports Medicine, 2014
    Co-Authors: John C. Jacobs, James L. Carey, Nathan L Grimm, Noah Archibaldseiffer, Kevin G. Shea
    Abstract:

    SUMMARY Multiple systems have been described over the past several decades for classifyingOCD of the knee during arthroscopic surgery. However, no single classification sys-tem has been universally accepted and routinely used. Although this lack of uniformitycould be caused by several factors, one central issue identified in this review was thatno study assessed the inter-rater and intra-rater reliability of their classification sys-tem. Reliability testing will need to be completed to determine the overall utility of aclassification system. Future research should be performed in this area to establisha standard classification system for OCD of the knee during arthroscopy that showshigh inter-rater and intra-rater reliability. A future system should include a descriptionof the lesion’s articular cartilage contour and stability/integrity, and a gross overalldescription of the lesion. REFERENCES 1. Edmonds EW, Shea KG. Osteochondritis dissecans: editorial comment. ClinOrthop Relat Res 2013;471(4):1105–6.2. Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adultforms. J Am Acad Orthop Surg 1995;3:237–47.3. Kessler JI, Nikizad H, Shea KG, et al. The demographics and epidemiology of os-teochondritis dissecans of the knee in children and adolescents. Am J SportsMed 2013; [Epub ahead of print].4. Linden B. The incidence of Osteochondritis dissecans in the condyles of thefemur. Acta Orthop Scand 1976;47:664–7.5. Mesgarzadeh M, Sapega AA, Bonakdarpour A, et al. Osteochondritis dissecans:analysis of mechanical stability with radiography, scintigraphy, and MR imaging.Radiology 1987;165:775–80.6. Nelson DW, DiPaola J, Colville M, et al. Osteochondritis dissecans of the talusand knee: prospective comparison of MR and arthroscopic classifications.J Comput Assist Tomogr 1990;14:804–8.7. Berndt AL, Harty M. Transchondral fractures (Osteochondritis dissecans) of thetalus. J Bone Joint Surg Am 1959;41:988–1020.8. Kocher MS, Micheli LJ, Yaniv M, et al. Functional and radiographic outcome ofjuvenile Osteochondritis dissecans of the knee treated with transarticular arthro-scopic drilling. Am J Sports Med 2001;29:562–6.

  • Osteochondritis dissecans in an adult.
    Orthopedics, 2012
    Co-Authors: James L. Carey, Allen F. Anderson, Kevin G. Shea
    Abstract:

    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?

Daniel W Green - One of the best experts on this subject based on the ideXlab platform.

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