Osteochondritis Dissecans of the Knee

Wright, Rick W.; McLean, Matthew D.; Matava, Matthew J.; Shively, Robert A.

doi:10.1097/01.blo.0000128216.10732.d8

Cited by 82 publications

(24 citation statements)

References 19 publications

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“…107,108,112 Regarding excision or removal of OCD fragments, results revealed a clear tendency toward poor or fair results after a period of 10 to 20 years. 166,170 Michael et al 108 observed excellent and good results in only 35% after 28 years mostly following excision with a rate of OA of 92%. Similar data were mentioned by Twyman et al 109 One report on exclusively lateral condylar OCD 105 described a moderate OA but better clinical results 14 years after arthroscopic excision and subchondral drilling in most of the patients (22/28 knee joints).…”

Section: Long-term Results After Different Treatmentsmentioning

confidence: 99%

“…There are a large number of articles with a mean follow-up of between 5 and 34 years. 5,14,[59][60][61]87,[107][108][109]111,133,135,[166][167][168][169][170] The articles included at least 2 longitudinal studies in which patients were examined twice. 107,109 However, all the articles are only level IV, which means that the interpretation of the long-term results is difficult, particularly since the authors may be biased.…”

Section: Long-term Results After Different Treatmentsmentioning

confidence: 99%

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Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

Bruns¹,

2017

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This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an analysis of and outcomes of the treatments available. OCD is seen in children and adolescents with open growth plates (juvenile OCD) and adults with closed growth plates (adult OCD). The etiology of OCD lesions remains unclear and is characterized by an aseptic necrosis in the subchondral bone area. Mechanical factors seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important. Regarding treatment, a tremendous number of publications exist. Spontaneous healing is expected unless there is an unstable fragment, and treatment involves rest and different degrees of immobilization until healing. Patients with open physes and low-grade lesions have good results with conservative therapy. When surgery is necessary, the procedure depends on the stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable. When the cartilage is damaged, several techniques can be used. While techniques such as drilling and microfracturing produce reparative cartilage, other techniques reconstruct the defect with additional osteochondral grafts or cell-based procedures such as chondrocyte transplantation. There is a tendency toward better results when using procedures that reconstruct the bone and the cartilage and there is also a trend toward better long-term results when comorbidities are treated. Severe grades of osteoarthrosis are rare.

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Section: Long-term Results After Different Treatmentsmentioning

confidence: 99%

Section: Long-term Results After Different Treatmentsmentioning

confidence: 99%

Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

Bruns¹,

2017

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“…Since it was clear that the simple excision of the osteochondral fragment did not provide good clinical and radiological results [13,14], several options of treatment were proposed.…”

Section: Discussionmentioning

confidence: 99%

Internal Fixation of Osteochondritis Dissecans of the Knee Leads to Good Long-Term Outcomes and High Degree of Healing without Differences between Fixation Devices

Perelli

Rómoli

Paz

et al. 2019

JCM

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The aim of the present study is to describe results at long-term follow-up of internal fixation of unstable Osteochondritis Dissecans (OCD) achieved with three different fixation devices in skeletally mature knees. A retrospective cohort study was performed at 5 to 19 years follow-up. Patient-reported questionnaires were collected at the final follow-up. Postoperative X-rays and MRIs were evaluated for healing of the lesion and articular degeneration. An arthroscopic second look was performed in 74.3% of the cases. Failures were reported as reintervention to address the osteochondral lesion or poor functional outcomes at the last follow-up. A total of 39 subjects with a median follow-up of 10.7 years were included. Herbert screws were used in 51.2% of the cases, bioabsorbable nails in 25.7% of the cases and cannulated screws in 23.1% of the cases. No differences were observed in terms of the clinical score (International Knee Documentation Committee (IKDC) p = 0.211; Lysholm p = 0.197), radiographic union (p = 0.102) or radiographic degeneration (p = 0.238) between the three different fixation devices. Arthroscopic second look found complete stability of the lesions in all 29 cases evaluated. The mean postoperative Lysholm score was 83 (range = 33–100) and IKDC score was 79 (range = 39–100). Radiographic union was seen in 74% of the cases. Lack of radiographic union was correlated with worst functional scores. A failure rate of 20.5% was found: four reinterventions were performed, and four patients had poor scores at last follow up. This study shows that internal fixation of condylar OCD in skeletally mature patients provides good long-term clinical results and a high degree of healing regardless of the dimensions of the lesion and type of fixation.

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“…Surgery often remains the only reasonable option in the treatment of unstable OCD lesions. However, according to Wright et al [24], based on a 4-to 15-year followup study that used the Hughston grading scale [24], only six of 17 patients (35%) demonstrated either no symptoms, no activity limitations, and normal radiographs (two patients) or mild symptoms, mild activity limitations, and early radiographic changes (four patients) [24]. In a rabbit model of OCD using periosteal transplantation, osteochondral autografts, and autologous chondrocyte transplantation, Hui et al [3] found all three methods enhanced the repair of chondral defects in OCD.…”

Section: Introductionmentioning

confidence: 99%

Does Extracorporeal Shock Wave Therapy Enhance Healing of Osteochondritis Dissecans of the Rabbit Knee?: A Pilot Study

Lyon

Liu

Kubin³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Osteochondritis Dissecans of the Knee

Cited by 82 publications

References 19 publications

Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint

Internal Fixation of Osteochondritis Dissecans of the Knee Leads to Good Long-Term Outcomes and High Degree of Healing without Differences between Fixation Devices

Does Extracorporeal Shock Wave Therapy Enhance Healing of Osteochondritis Dissecans of the Rabbit Knee?: A Pilot Study

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