The Reaction to Mechanical Trauma in Growing Articular Cartilage: An Experimental Study on Rabbits and a Comparison of the Results with the Pathological Anatomy of Osteochondritis Dissecans

Tallqvist, Gustav

doi:10.3109/ort.1962.33.suppl-53.01

Cited by 9 publications

(7 citation statements)

References 43 publications

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“…Experimental results showed that OCD can arise as a sequel of cartilage fracture in the immature epiphysis. 19,39 On the basis of clinical correlations, our study clinically demonstrated that the pathological progression of OCD begins with separation beneath the immature epiphyseal cartilage. Figure 7.…”

Section: Discussionmentioning

confidence: 72%

“…The intermediate unstable layer showed various degrees of separation, and fibrocartilage covered the surface of the proximal epiphyseal bone, as commonly seen in previous studies. 9,16,17,41,42 It is generally accepted that separation is a crucial pathological condition for the appearance of an articular fragment, 2,3,17,19,39,41,42 and that fibrocartilage formation is a common reaction to exposure of the proximal epiphyseal bone.…”

Section: Discussionmentioning

confidence: 99%

“…k On the other hand, several reports suggested a link between OCD and hereditary familial factors. 28,31,33 A variety of pathologic conditions associated with OCD have been reported, such as chondral injury, 2,3,17,19,39 cartilage degeneration, 12,15,42 ossification defects, 1,2,3 osteochondral fractures, 9,41 nonunion, 42 and avascular necrosis. 16,21,24,27,40,41 However, the natural pathological progression of OCD has remained unclear; for example, it remains controversial whether osteonecrosis is an early 5,16,20,41 or late 4,17 event.…”

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confidence: 99%

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Progression of Epiphyseal Cartilage and Bone Pathology in Surgically Treated Cases of Osteochondritis Dissecans of the Elbow

et al. 2020

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Background: Although a variety of pathologic conditions associated with osteochondritis dissecans (OCD) have been reported, the pathological progression has remained unclear. Hypothesis: Separation of the immature epiphyseal cartilage is an early event in OCD, and osteonecrosis in the articular fragment is a late event. Study Design: Case Series; Level of evidence, 4. Methods: The participants were 26 boys (mean age, 13.8 years; mean skeletal age score for the elbow, 24.6 points) with capitellar OCD who underwent osteochondral autograft transplantation. A total of 28 cylindrical osteochondral plugs, including the articular fragment, an intermediate layer, and proximal epiphyseal bone, were harvested from the central area of the capitellum and were examined histologically. The articular fragments of OCD were independently assessed by 5 observers and divided into 4 pathological variations: IA, nearly normal-cartilaginous; IB, deteriorated-cartilaginous; IIA, cartilage-ossifying; and IIB, cartilage-osteonecrotic. The reliability of assessment and the correlation of the pathological variations with the clinical data were examined. Results: The reliability of the assessment among 5 observers was almost perfect (Cohen kappa value = 0.91). OCD variations of IA, IB, IIA, and IIB were evident in 5, 10, 5, and 6 patients, respectively. OCD-I (cartilaginous) and OCD-II (osteochondral) corresponded significantly to radiographic stage I (radiolucency or slight calcification with open physis) and stage II (delayed ossification or bony fragment), respectively (Cohen kappa value = 0.79; percentage agreement = 81%). The pathological OCD variations were significantly correlated with the clinical data, including the period from symptom onset to surgery, patient age, and the skeletal age score ( P < .01, in each). Conclusion: The present study has revealed that the pathological variations correspond to the progression of OCD, thus proving our hypothesis. OCD-IA was shown to be an early lesion caused by separation of the immature epiphyseal cartilage. OCD-IB appeared to result from ossification arrest over a prolonged period from the onset of OCD-IA, whereas OCD-IIA showed delayed ossification in the epiphyseal cartilage where vascularization from the surrounding bone had been established. Osteonecrosis in OCD-IIB was shown to be a late pathological event caused by disruption of the vascular supply to OCD-IIA.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Progression of Epiphyseal Cartilage and Bone Pathology in Surgically Treated Cases of Osteochondritis Dissecans of the Elbow

et al. 2020

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“…11,22 Repetitive microtrauma to articular cartilage has been demonstrated ex vivo to cause the same subchondral fracture, ischemia, and fragment formation seen in OCD. 27 Management of the disease is guided by the stability of the lesion and status of the articular cartilage. Plain radiographs are often unremarkable early in the disease process.…”

mentioning

confidence: 99%

Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes

Lyons

Werner

Gluck

et al. 2015

Journal of Shoulder and Elbow Surgery

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“… 19 , 43 This condition most commonly affects juveniles and young adults, 23 and approximately 75% of cases involve the knee. 8 While the exact etiology of OCD is unknown, both clinical 3 , 6 and basic science 2 , 41 studies support trauma as a contributing factor. Other less substantiated etiologic theories include inflammation, 40 ossification abnormalities, 38 and ischemia.…”

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confidence: 99%

Operative Fixation of Chondral Loose Bodies in Osteochondritis Dissecans in the Knee

Anderson

Magnussen

Block

et al. 2013

Orthopaedic Journal of Sports Medicine

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Background:Osteochondritis dissecans (OCD) can progress to loose body formation, with or without subchondral bone attachment to the lesion. The efficacy of internal fixation of chondral loose bodies has not been determined.Hypothesis:Operative fixation of cartilaginous loose bodies would result in (1) healed OCD at second-look arthroscopy, (2) restored cartilage appearance on magnetic resonance imaging (MRI), and (3) nearly normal knee function, as determined by patient-reported outcome scores.Study Design:Retrospective case series; Level of evidence, 4.Methods:Five patients who underwent cartilaginous loose body fixation were identified. Lesions were located on the lateral trochlea (n = 2) and medial femoral condyle (n = 3) (mean size, 2.5 cm2). Loose bodies were reattached with compression screws through mini-arthrotomy or arthroscopy. Patients were nonweightbearing for 12 weeks postoperatively. After 12 weeks, screws were removed arthroscopically, and OCD stability was evaluated. Three patients underwent MRI to determine articular cartilage status. Images were evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score. Patients were interviewed and completed the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire.Results:Four patients had stable lesions at 12 weeks after surgery. One patient had slight motion to one-third of the lesion and stability to the remaining two-thirds. Three patients underwent an MRI. The mean time from surgery to MRI was 3.1 years. Mean MOCART score was 72.0 ± 10.4. One patient required repeat arthroscopy 1 year after initial fixation for debridement and arthroscopic drilling of an incompletely healed area of the lesion. Four patients completed the KOOS questionnaire. The mean time to KOOS completion was 4.6 years. Mean KOOS subscales for knee pain (91.0 ± 8.9), knee symptoms (83.0 ± 7.9), and function in activities of daily living (91.9 ± 10.6) were similar to published age-matched controls; however, scores for sports and recreation function (70.0 ± 17.8) and knee-related quality of life (67.2 ± 12.9) were lower.Conclusion:Operative fixation of chondral loose bodies, without macroscopically visible subchondral bone attachment, resulted in lesion stability at second-look arthroscopy. At final follow-up, patients had no substantial pain and normal function in activities of daily life compared with controls; however, knee-related quality of life and sport and recreation function were reduced, and 1 patient required reoperation for an unhealed portion of the lesion.

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The Reaction to Mechanical Trauma in Growing Articular Cartilage: An Experimental Study on Rabbits and a Comparison of the Results with the Pathological Anatomy of Osteochondritis Dissecans

Cited by 9 publications

References 43 publications

Progression of Epiphyseal Cartilage and Bone Pathology in Surgically Treated Cases of Osteochondritis Dissecans of the Elbow

Progression of Epiphyseal Cartilage and Bone Pathology in Surgically Treated Cases of Osteochondritis Dissecans of the Elbow

Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes

Operative Fixation of Chondral Loose Bodies in Osteochondritis Dissecans in the Knee

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