BACKGROUND: One of the most debatable issues in osteochondritis dissecans (OCD) research is bone and cartilage healing assessment during OCD postoperative management. The x-ray scale developed by Wall and colleagues is a commonly used evaluation tool for OCD lesion assessment. This tool has excellent reliability but is associated with radiologic exposure. Also, it provides complete information about bone structure only, even though the articular cartilage is also involved in the pathological process. Lack of cartilage assessment combined with radiation exposure facilitated the development of the novel MRI-based OCD healing assessment tool. It could draw attention to bone and cartilage during healing assessment to improve decision-making in the postoperative period after OCD treatment. AIM: This study assesses the reliability of a developed novel MRI-based OCD healing assessment tool. MATERIALS AND METHODS: Ten patients with OCD of the femoral condyle were involved in the current study. A reliability test for the novel MRI-based assessment tool was performed with the expert group comprising six participants to assess 34 MRI studies of 10 patients. From all studies, one study was obligatory for each patient before the operative treatment, and a postoperative MRI study series was performed during the first postoperative year. Each MRI study was examined by each expert twice with a 4-week time lag. The novel MRI-based assessment tool consists of five criteria, of which the common criterion was general healing, incorporating all previously described ones. Each criterion was tested, and a two-way mixed-effects intraclass correlation coefficient (ICC) was used to assess intraobserver and interobserver reliability. RESULTS: The main parameter general healing calculations were made first. Two patients achieved full OCD lesion healing with 100 scale points and two patients with 97.5 and 98.5 points, respectively. Other patients reached the cut-off value of 75 points and were defined as healed with minimally detectable changes on MRI. Second, a two-way mixed-effects ICC calculation was performed. The bone marrow extension parameter reached the value of 0.972, the extent of the union 0.984, bone structure 0.977, and articular cartilage intensity and structure 0.977. The general healing parameter reached the value of 0.993. These values corresponded to the excellent marks according to the guidelines for ICC assessment. The novel MRI-based assessment tool showed excellent intraobserver and interobserver reliability. CONCLUSIONS: The novel MRI-based assessment tool permits assessing bony and cartilage structures while making decisions about OCD lesion healing in the postoperative period. The novel OCD healing assessment tool has excellent intraobserver and interobserver reliability. Also, it is recommended for use in clinical and research practice since a study revealed a correlation of the MRI healing score with that of the clinical assessment tool.
Introduction. The osteochondritis dissecans (OCD) is a pathologic condition of osteochondral tissue predominantly in the femoral condyles, which is met most often in adolescents and which can lead to the formation of early arthrosis in the knee joint in the remote time. By modern concepts, stable OCD foci are the foci with intact articular cartilage without the risk of migration into the joint cavity. To date, there are very few studies in the world literature on the treatment of early stages of osteochondrosis dissecans.Material and methods. Two independent researchers have carried out a systematic review of literature sources (2000-2020 ) using Pubmed, Medline and GoogleScholar. 9 publications were selected for data analysis out of 5184 publications after the qualitative assessment by the Yang scale and the obtained consensus in disputable situations.Results. Statistical analysis of the obtained data with the Statistica program revealed that the average rate of OCD foci healing was seen in 86.7% (from 70.6 to 100%). The most effective outcomes were in the group of antegrade drilling (95.3% of healed foci), then in the group with biodegradable implants fixation (88.5%), then the group of antegrade drilling with the introduction of bone marrow aspirate concentrate (BMAC) - 76.9%, and then the retrograde drilling - 76.8%.Conclusion. The analysis performed have shown a significant heterogeneity in data reporting, different methods for diagnosing osteochondritis dissecans, different approaches to healing assessment as well as a small number of children in samples what determined the lack of statistical significance between different options of surgical treatment (p = 0.27). Carefully planned trials with a proper design, standardized techniques for healing assessment and time of their application as well as the assessment of comparison groups and of all other necessary factors affecting lesion healing are needed.
Osteochondritis dissecans (OCD) of the knee is a pathological condition of subchondral bone resembling focal osteolysis with subsequent bone resorption, which may lead to osteochondral fragment separation. Several etiological concepts reported for OCD development. The multifactorial theory is commonly adopted for days. Different investigators report OCD lesion healing while using conservative treatment or even “waitful watching” with a healing rate of up to 67%. In spite of these results, there are not any commonly adopted guidelines for conservative treatment. The last stage of OCD is a separation of osteochondral fragment leaving a full-thickness osteochondral defect, which is usually filled with low-quality fibrocartilaginous tissue. This tissue provides a lesser extent of resistance to peak loading forces, which poses at risk subchondral bone for further destruction and early osteoarthritis development. Appropriate treatment method should be chosen for each OCD stage in order to prevent early osteoarthritis development, increase return-to-sport rate, and decrease healing time for OCD lesions. This chapter provides short but comprehensive to date knowledge about OCD on the knee of adolescents and young adults.
One of the most urgent and socially significant problems of modern medicine is the widespread occurrence of orthopedic pathology, among which the leading place is occupied by diseases of the spine, accompanied by a steady increase in pain vertebrogenic syndromes that affect the functioning of the child's body as a whole. The prevalence of this nosological form in children, according to various population studies, ranges from 0.42 to 37%. ScheuermannMau disease (Scheuermanns kyphosis) is the most common osteochondropathy in children and adolescents and ranges from 0.48.3% of the pediatric population. To date, the etiology of osteochondropathy of the spine is still unclear. Medical rehabilitation of children with osteochondropathy of the spine is aimed at preventing further progression of deformity, normalizing posture, the functions of the cardio-respiratory system and includes: rational motor mode and nutrition, conservative orthopedic measures (corsetting), kinesiotherapy, hydrocolonotherapy, massage, positional treatment, restorative and hardening procedures, physiotherapy (electrical muscle stimulation), sports (skiing, swimming). An important place in the review is given to the description of the stages of medical rehabilitation of children and adolescents with dorsalgia on the background of spinal osteochondropathy who underwent surgical treatment.
To days debates about most frequent complications after adolescent idiopathic surgery and its risk factors remains to persist. Taking into account rising possibilities of orthopaedic surgery departments worldwide to reduce AIS patients hospital length of stay, strong need in strict knowledge about types and frequency of abovementioned complications and its risk factors is emerging. This knowledge can help clinicians in prediction of complications development and can aid in better diagnostics and treatment. Two main groups of complications were described thoroughly in current review: non-neurologic and neurologic. Both frequently developing and rare complications were described including superior mesenteric artery syndrome and deep infections. There an obvious tendency of the rate of complications after AIS surgery to decline during last two decades from 5.7% in 20002003 to 4.95% in 2007 and to 0.98% in 2016. Despite that fact these complications still remain to be a big burden for clinicians. Major risk factors for its development include concomitant renal diseases, large intraoperative blood loss, substantial increase of anesthesia and surgery duration, stainless steel rods implementation combined or anterior only approach and refuse of intraoperative neuromonitoring.
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