Case Report: Osteochondritis Dissecans in Twins

Abstract

Osteochondritis dissecans is a lesion of subchondral bone with subsequent involvement of the overlying cartilage. Although the etiology of the disease is unknown, mechanical, traumatic, and ischemic etiologies have been suggested, in addition to developmental and genetic factors. There are several treatment options depending on the stage of the disease and surgeon preference. 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. Since these were identical lesions in identical twins, this commonality supports the suggestion that some genetic component may be present in the etiology, especially in this situation where a genetic connection existed. We recommend genetic studies to determine the extent of genetic influence on the disease.

Osteochondritis Dissecans Lesions in Family Members: Does a Positive Family History Impact Phenotypic Potency?

“…Conversely, Bradley and Dandy [3] reported an incidence of 1.2% based on an analysis of OCD lesions seen on the femoral condyles during 5000 knee arthroscopies, and Marsden and Wiernik found an incidence of 4% in all knee radiographs reviewed from 18,405 radiographs of male patients in a military hospital. To our knowledge, no previous studies have formally assessed the incidence of OCD in relatives of patients who had previously been treated for OCD of the knee, although some reports have described case series of lesions among twins [5,9,15,17,19,21] and families with genetic syndromes [1,24]. In each of these reports, including ours, the incidence among family members was higher than expected based on the incidence of OCD in the general population, suggesting an underlying genetic component to disease development.…”

“…Specifically, many of these recent case reports have described OCD lesions in sets of monozygotic twins, including some in which the appearance of the lesions themselves is identical [5,9,15,17,19,21]. In further support of a genetic etiology, OCD lesions have been cited as a component of several syndromic conditions.…”

Osteochondritis dissecans of the humeral capitellum in identical twins

“…Genetic factors have been thought to play a secondary role in the pathogenesis of the disorder. However, OCD patients in the same family (6, 7) and bilateral OCD (8, 9) have been reported, as well as identical knee lesions in identical twins (11). …”

Candidate Loci are Revealed by an Initial Genome-wide Association Study of Juvenile Osteochondritis Dissecans

“…11 In fact, a genetic basis for OCD continues to garner increased support. [15][16][17][18][19][20][21][22][23][24][25][26][27] Case studies dating as early as 1925 to 1967 called into question the genetic aspects of OCD. 15 More recently, with increased awareness of the disease process, the literature has reflected an increase in reports of familial forms of OCD.…”

“…Several cases of monozygotic twins, both with OCD, have been reported over the past few years. [16][17][18][19][20][21] Of particular interest, a report by Mei-Dan et al 18 on 11-year-old monozygotic twin brothers presenting with OCD describes near-identical symptom onset that was simultaneous. These twin brothers also had a parallel clinical course, suggesting a genetic component to OCD.…”