Osteochondritis Dissecans and Large Osteochondral Defects of the Knee Kevin G. Shea John Polousky Noah Archibald-Seiffer DEFINITION Osteochondritis dissecans (OCD) is a focal idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis. Some of these injuries can be osteochondral lesions such as osteochondral defects, osteochondrosis of the capitulum humeri or osteochondritis dissecans (OCD). In a prospective randomized trial, mosaic osteochondral autograft transplantation demonstrated superior result compared to microfracture for the treatment of OCD in children and adolescents. Chondral and osteochondral lesions of the humeral capitellum, most notably osteochondritis dissecans, most commonly present in adolescent baseball players and gymnasts. We see it most commonly in gymnasts and also in baseball pitchers, although we can see it in any child in any sport. If the lesion is not very far progressed, then surgery can be a cleanup type procedure. As mentioned, one challenge with mosaic osteochondral autograft transplantation is donor site morbidity as well as the differences in cartilage thickness in donor and recipient sites. OCD - Osteochondral Defect. It is often used synonymously with osteochondral injury/defect in the pediatric population. Long-standing radiographs are valuable in assessing limb length discrepancy and malalignment. O’Fallon, MO 63368, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, Center for Advanced Medicine - South County, St. Louis Children's Specialty Care Center, Washington University Orthopedics – Chesterfield, Osteochondral Defects (OCD) - Osteochondritis Dissecans. In patients with more advanced osteochondral pathology, the history frequently includes episodes of pain, mechanical symptoms, giving way, and swelling. Background: Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. Suite 1500 Review of previous imaging studies (typically radiographs and/or magnetic resonance imaging [MRI]), operative reports, and arthroscopic imaging is critical in the evaluation of these patients. Some small series of clinical applications of this procedure for advanced osteochondritis dissecans of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remain unclear. 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. The etiology of OCD is not known, although many theories have been suggested, including trauma, vascular anomaly/injury, overuse or repetitive stress injury, genetic predisposition, etc. Lesions can be f traumatic, post-traumatic or degenerative origin, as well as caused by osteochondritis dissecans … NCT01471236. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Osteochondral autograft transfer has recently shown superior rates of return to sport. Conditions: Osteochondral Defect; Osteochondritis Dissecans . In clinical practice, the abbreviation OCD is often used for both osteochondral defect and osteochondritis dissecans, which causes confusion. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. Clin Sports Med 1997; 16:157. Significant osteoarthritis, especially if more diffuse, rather than focal, may be a contraindication to osteochondral allograft use. Instead, OCD is a problem of the bone underlying the cartilage, which may secondarily affect the articular cartilage. The older patients may not respond to less invasive surgeries such as subchondral bone drilling. I'm an Orthopedic Surgeon at Washington University in St. Louis. Articular Cartilage Defects of Knee ... osteochondral separation with loose bodies; Prognosis. Objective: To establish whether osteochondral autograft transfer (OAT) procedures for osteochondritis dissecans (OCD) of the canine caudocentral humeral head would restore articular contour, resurface osteochondral defects, and resolve lameness in dogs with OCD. Osteochondral lesions, also known as osteochondritis dissecans, are areas of damaged bone and cartilage on the surface of the ankle bone (the talus), usually caused by an ankle injury. MaioRegen Prime (tri-layer) is indicated for the treatment of single/multiple osteochondral lesions with severely compromised bone, Outerbridge Grade IV. In many of these patients, previous surgery and arthroscopic imaging have been performed. There are limitations to the OAT procedure. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. Suite 1C The good news is that surgery can be very helpful depending on the type of specific injury we have. use of any information on these sites. He was now able to perform all activities of daily living without pain, including weight lifting, running, and swimming. Osteochondritis dissecans of the talus is a particular form of osteochondral lesions of the talus. A Study of MACI in Patients Aged 10 to 17 Years With Symptomatic Chondral or Osteochondral Defects of the Knee. This approach may be reasonable for smaller OCD lesions. Diagnosis of osteochondritis dissecans (OCD) is generally made during the history and physical examination. Significant mechanical symptoms may not be addressed with this approach. Chambers HG, Shea KG, Carey JL. In 1888, Konig coined the term when he sought to describe the pathologic process that led to atraumatic loose bodies of femoral origin in the knee and hip joints. Evaluation of the Agili-C Biphasic Implant in … There were 41% failures in the microfracture group compared with none in the mosaic osteochondral autograft transplantation group at the final follow-up. Osteochondral Defect Osteochondritis Dissecans Osteochondral Lesions. Restoring this subchondral bone loss can present many challenges to the surgeon, both with microfracture, and other cartilage restoration procedures. For the purposes of this article, the abbreviation OCD will be used only for osteochondritis dissecans. Osteochondral allograft transplantation has a long history, dating back to 1957, when Smillie proposed its use for OCD. It is Osteochondral Defect. The most valuable tools for evaluating osteochondral lesions are high-quality imaging studies, the most basic of which is the weight bearing, plain radiograph of the knee. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the aetiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Osteochondritis dissecans (o.d.) Other options to be considered for cartilage loss are outlined in the following text, although some of them may have limitations especially in larger lesions and those with deep subchondral bone loss. Some research has also shown factors such as age older than 30 years and a history of two or more previous surgeries on the joint are associated with poorer outcomes. Osteochondritis Dissecans and Avascular Necrosis Matthew T. Burrus David R. Diduch DEFINITION Osteochondritis dissecans (OCD), avascular necrosis (AVN), spontaneous osteonecrosis of the knee, and chondral and osteochondral lesions all occur at or beneath the articular surface of a weight-bearing joint and are easily confused (FIG 1). Figure 1. Patients with acute, traumatic cartilage injury with displaced fragments may be candidates for surgery. The depth of the osteochondral autograft donor plug can be adjusted to fill the entire defect with viable bone and articular cartilage, which has the capacity to integrate with the adjacent tissue. Kids born with hand and upper extremity abnormalities often come to these sites to see me for evaluation and treatment. Once your diagnostic examination is complete, the Physical Therapists at Rocky Mountain Therapy Services have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the … It can be in the dominant hand or the non-dominant hand and it typically causes pain but also can cause other problems which we call mechanical problems which include locking of the elbow, popping in the elbow and an inability to perform daily activities. Many patients, especially those who are skeletally immature, with significant growth remaining, have good potential for healing with appropriate activity modification, and in select cases, subchondral bone drilling. 4921 Parkview Place Because clinical findings are often subtle, diagnosis requires a high index of suspicion. The osseous component of the graft incorporates in the host bone through creeping substitution, in a manner similar to that seen with bone grafting for bone defects or allograft tumor reconstruction. The presence of a “kissing lesion” on the opposite articular surface is important, as its presence may alter or preclude certain allograft approaches. Some patients may be referred to a doctor for further diagnosis. MRI provides a more detailed look at the condition of the lesion and surrounding cartilage. Both traumatic injuries and patients with OCD may present after months or years of milder symptoms. Large defects cannot be filled due to donor site morbidity, and there may be problems with articular cartilage incongruence. juvenile form. Microfracture may not have a role in the treatment of osteochondritits dissecans if the subchondral bone is violated. Consequently, in lesions that are small, mosaic osteochondral autograft transplantation is a reasonable procedure that produces outcomes that are superior to microfracture. Seymour, 69, clarifies remark on being able to play 25. Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. Many of these injuries will include the medial or lateral femoral condyle, in both OCD and acute cartilage injury. The university disclaims any responsibility for the content of third-party websites and the Displaced osteochondral fragment. Looking for abbreviations of OCD? In the talus, 96% of lateral lesions and 62% o… Chesterfield, MO 63017, 1044 N. Mason Road Patients close to or beyond skeletal maturity have a worse prognosis for healing with activity modifications. At 8 months after surgery, the patient was able to return to his former competitive level of performance. Animals— Dogs (n=27) with medial humeral condylar OCD. Suite 1B If surgery is further along, then sometimes we have to remove the offending part of the bone and stimulate healing of the cartilage surface. Definition and symptoms. Osteochondritis Dissecans Typically, a sports injury due to stressful twisting motions of the shinbone or thighbone, osteochondritis dissecans is any damage to the cartilage coating of the bone. In cases with more significant loss of subchondral bone, staged procedures to supplement regional bone loss may be an option. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Study design: Case series. Surgery can get quite technical and sometimes we bring cartilage and bone from the knee up to the elbow to restore these lesions, but other times at that stage, it can be very straight forward with a simple elbow arthroscopy where through a couple of poke holes, we can evaluate the lesion and institute treatment. 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