Healing Predictors of Stable Juvenile Osteochondritis Dissecans Knee Lesions After 6 and 12 Months of Nonoperative Treatment

Krause, Matthias; Hapfelmeier, Alexander; Möller, Melanie; Amling, Michael; Bohndorf, Klaus; Meenen, N. M.

doi:10.1177/0363546513496049

Cited by 111 publications

(112 citation statements)

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“…In terms of natural history of the JOCD, Hughes et al [3] reported that most JOCD lesions with subchondral bone changes on the MRI had intact cartilage and improved with conservative treatment for 3-6 months. However, its failure rate has been reported and varies between 34 and 50% [4,5]. In our case, as shown in the MRI study at the time of the initial meniscectomy, the JOCD lesion with a high-intensity area in the T2-weighted images was diagnosed as a stable condition and left without any surgical intervention because of an absence of abnormal arthroscopic findings.…”

Section: Discussionmentioning

confidence: 50%

Progression of stable juvenile osteochondritis dissecans after 10 years of meniscectomy of the discoid lateral meniscus

Ishikawa¹,

Adachi²,

Nakamae³

et al. 2017

Journal of Pediatric Orthopaedics B

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Ten years after a meniscectomy of discoid lateral meniscus, a 19-year-old man presented a loose body in his right knee with limited range of motion. At the time of meniscectomy, a stable osteochondritis dissecans in the lateral femoral condyle with a T2 high area in MRI was recognized; however, the lesion was left without surgical treatment. We performed fixation of a fragment and osteochondral grafting. Surgical treatment for stable juvenile osteochondritis dissecans still remains controversial; however, drilling will help to increase the healing potential and to prevent lesion progression, especially after meniscectomy that alters the mechanical stress on immature osteochondral structures.

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Section: Discussionmentioning

confidence: 50%

Progression of stable juvenile osteochondritis dissecans after 10 years of meniscectomy of the discoid lateral meniscus

Ishikawa¹,

Adachi²,

Nakamae³

et al. 2017

Journal of Pediatric Orthopaedics B

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“…Nonoperative treatment can fail in up to 50% of cases, and factors such as increasing patient age, the presence of cyst-like lesions, and lesion size contribute to the high failure rate. 2 If it fails, then successful healing can usually be achieved by arthroscopic fixation.…”

Section: Discussionmentioning

confidence: 99%

The Golf Ball Sign: Arthroscopic Localization of an Osteochondritis Dissecans Lesion of the Knee

Piposar

Sutton

2014

Arthroscopy Techniques

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We report on the arthroscopic treatment of a 12-year-old boy diagnosed with an osteochondral defect of the medial femoral condyle. He underwent arthroscopic fixation of the defect, and during the surgery, a blunt trocar was used to localize the lesion. The trocar created a transient dimpling effect on the cartilage overlying the osteochondral defect that resembled the surface of a golf ball. This "golf ball sign" then served as a visual guide during placement of a chondral dart. When present, it is believed that this sign can benefit arthroscopists by helping to improve intraoperative localization of an osteochondral defect.O steochondritis dissecans (OCD) of the knee is an acquired, idiopathic disease that affects the subchondral bone of the femur. The specific etiology remains unknown, but delamination and sequestration of the bone can result depending on the extent of the OCD lesion.1 The impact this has on the overlying cartilage can range from softening of the articular cartilage to development of an osteochondral flap and/or loose body formation. Depending on the size, location, and extent of articular cartilage involvement, the OCD lesion can cause significant discomfort and morbidity.Treatment options vary but can involve conservative, restricted weight-bearing options; operative fixation of a stable or unstable lesion; and/or loose body removal. Operative intervention is usually performed arthroscopically. A magnetic resonance imaging (MRI) study is often obtained beforehand during the clinical workup of the patient. The MRI study helps to determine the location of the lesion, which is verified by arthroscopic visualization of the defect. In early stages of the lesion, articular cartilage becomes soft and ballotable before developing overt fibrillations, fissures, or exposed bone.This particular case involves a 12-year-old boy with an OCD lesion who underwent operative fixation of his type IV lesion. We report about a technique used during the procedure, in which a blunt trocar was used to delineate the borders of the OCD lesion, which would later serve as a guide during the placement of our fixation. Surgical TechniqueThe patient was a 12-year-old boy who sustained a recent fall from standing that caused him to have continued left knee pain and swelling. He was unable to play his usual sports because of pain, clicking, and catching of the left knee. Radiographs obtained at the time of presentation showed an osteochondral defect involving the lateral aspect of the left medial femoral condyle. The plan for the patient was to restrict him from any sports, and he was to avoid any impact activities (running, jumping, and so on) for the next month until an MRI study was obtained. At his followup visit 5 weeks later, the MRI study showed a 10-mm oval lesion at the previously defined location, as well as the presence of subchondral cysts and fluid between the fragment and underlying bone (Fig 1). The articular cartilage remained free from any defects, and there was no evidence of a loose body within ...

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“…Se procederá a reevaluaciones periódicas para evitar la atrofia muscular o el riesgo de rigidez articular residual. Entre el 50-67% de las OCD juveniles pueden curarse con tratamiento conservador en un periodo de 6 a 18 meses, aunque este porcentaje puede llegar al 90% en algunas series 9 .…”

Section: Acta Reumatológica Issn 2386-6861unclassified

Osteocondritis disecante: A propósito de un caso

Perojo¹

2015

acta reuma

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ResumenPresentamos el caso de una paciente adolescente que debutó con gonalgia mecánica, derrame articular recurrente y bloqueos de dicha rodilla, sin mecanismo traumático desencadenante y que evolucionó de forma insidiosa sin mejoría del cuadro a lo largo de 4 meses. Tras la anamnesis y pruebas complementarias pertinentes, la paciente fue diagnosticada de Osteocondritis Disecante de Rodilla. Se trata de un caso característico de dicha patología, por lo que aprovechamos para realizar una revisión de la misma. IntroducciónLa Osteocondritis Disecante (OCD) es una patología articular de causa desconocida que afecta al cartílago y hueso subcondral de niños y adolescentes causando su destrucción progresiva y el consiguiente desarrollo precoz de artrosis. La localización más frecuente es la rodilla, manifestándose como gonalgia mecánica y derrame articular sin antecedente traumático 1 . Caso clínicoMujer adolescente de 16 años sin antecedentes de interés ni familiares de Psoriasis o Enfermedad Inflamatoria Intestinal que consulta en el Servicio de Reumatología por gonalgia izquierda de 4 meses evolución sin desencadenante traumático que recordase. El dolor aumentaba con la actividad, llegando a experimentar bloqueos ocasionalmente. El cuadro no había mejorado de manera evidente con la administración de AINEs. En la exploración física se objetivaba un buen estado general sin presencia de estigmas de conectivopatía, leve dolor con la flexión forzada de la articulación afecta sin existir signos de derrame. Aportaba Hemograma, Bioquímica, EEF, TSH y RFA normales; serologías VHB, VHC, Brucella, VEB y CMV negativas así como un estudio Inmunológico (FR, CCP, ANA y HLA B27) negativo. Exploración Oftalmológica y calprotectina en heces normales.De las pruebas de imagen realizadas destacaba en Radiografía simple de rodilla (proyecciones antero-posterior y lateral en carga, Figura 1) una imagen subcondral ovalada hipodensa en cóndilo femoral interno. Ecográficamente no se apreciaba existencia sinovitis. Sin embargo, se observaba una solución de continuidad del cartílago de carga femoral del cóndilo interno.Se completó el estudio con una RMN donde se confirmó una lesión subcondral en región lateral de la superficie de carga del cóndilo femoral medial de aproximadamente 16x10 mm con fragmento

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Healing Predictors of Stable Juvenile Osteochondritis Dissecans Knee Lesions After 6 and 12 Months of Nonoperative Treatment

Abstract: A 6-month period of nonoperative treatment with or without casting might be appropriate if the healing potential is >48%. A 12-month period of nonoperative treatment may be successful if the CLL is <1.3 mm in length as assessed on MRI.

Cited by 111 publications

References 40 publications

Progression of stable juvenile osteochondritis dissecans after 10 years of meniscectomy of the discoid lateral meniscus

Progression of stable juvenile osteochondritis dissecans after 10 years of meniscectomy of the discoid lateral meniscus

The Golf Ball Sign: Arthroscopic Localization of an Osteochondritis Dissecans Lesion of the Knee

Osteocondritis disecante: A propósito de un caso

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