Osteochondritis dissecans ocd of the knee is a somewhat rare. Osteochondritis of left humeral head with secondary deformation of bone, eighth to ninth century from iona. Controversy surrounds the etiology of osteochondritis dissecans of the knee. Ocd is an idiopathic process and can occur from childhood through adult life. How to read an mri of an osteochondritis dissecans lesion. Mri evaluation of knee osteochondritis dissecans treated with a cellfree. Although the symptoms of ocd can be vague, plain radiographs can make the diagnoses. Juvenile osteochondritis dissecans ocd, an acquired disorder of epiphyseal cartilage and adjacent subchondral bone, ultimately can result in partial joint destruction and early degenerative arthritis. Osteochondritis dissecans ocd of the knee is an acquired, reversible, idiopathic condition of the subchondral bone. Insights into the epiphyseal cartilage origin and subsequent. Osteochondritis dissecans ocd of the knee is an idiopathic, focal, subchondralbone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. Osteochondritis dissecans surgical alternatives two case studies on platelet rich plasma. Ct has the advantage of sectional imaging through the joint and multiplanar reformats. Findings are similar to those seen on plain radiographs.
The incidence of surgery in osteochondritis dissecans in children and adolescents. The objective of our study was to correlate specimens of juvenile osteochondritis dissecans ocd lesions of the knee to mri examinations to elucidate the histopathologic basis of characteristic imaging features. Magnetic resonance imaging mri of knee demonstrating healing from the collection of h. The condition happens most often in the knees, but your child can also have it in the elbows, ankles, and other joints. Flynn osteochondritis dissecans ocd is an acquired, potentially reversible disorder of the subchondral bone and of the overlying articular cartilage. Osteochondritis dissecans ocd is a common cause of knee pain and dysfunction in both adult and skeletally immature patients. Nonsurgical treatments for osteochondritis dissecans. Osteochondritis dissecans ocd of the knee is a common cause of knee pain and dysfunction among skeletally immature and young adult patients. Juvenile versus adult osteochondritis dissecans of the knee. Unstable osteochondritis dissecans lesions are surrounded by a rim of high signal intensity or a fluidfilled cyst on t2weighted images. Compared with the knee, however, osteochondritis of the capitellum is much less common. This book is distributed under the terms of the creative commons. Osteochondritis dissecans wikipedia republished wiki 2. Red arrows point to osteochondral defect and bone edema on t1 and stir mri images of the knee in same patient as above.
Osteochondritis dissecans ocd is the end result of the aseptic separation of an osteochondral fragment with the gradual fragmentation of the articular surface and results in an osteochondral defect. Osteochondritis dissecans ocd is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. A retrospective cohort study was performed at 5 to 19 years followup. Osteochondritis dissecans of the knee sciencedirect. Research on platelet rich plasma therapy, an injection treatment that reintroduces your own concentrated blood platelets into areas of chronic joint and spine deterioration, more commonly referred to as prp is gaining a lot of attention as a nonsurgical option. Osteochondritis dissecans genetic and rare diseases. Osteochondritis dissecans of the capitellum is similar to osteochondritis dissecans in other joints, such as the knee. Mri is the most accurate method for staging lesions short of arthroscopy. Osteochondritis dissecans ocd of the ankle is the end result of the aseptic separation of an osteochondral fragment of the talar dome with the gradual fragmentation of the articular surface. This condition is also known as either osteochondritis dissecans ocd of the talus or as a talar osteochondral lesion ocl.
Causes including inflammation, genetic predisposition, ischemia, a defect in ossification, and repetitive trauma have been postulated, but there are insufficient data to conclusively support any of these. Osteochondritis osteochondrosis dissecans ocd is a common condition in children, adolescents, and young adults. Osteochondritis dissecans is a long recognized yet poorly understood condition. Joints nonneoplastic disease osteochondritis dissecans. Ankle arthroscopy osteochondritis dissecans protocol. Imaging of osteochondritis dissecans musculoskeletal key. Five surgical procedures to manage ocd lesions in the knee. An osteochondral lesion of the talus olt is an area of abnormal, damaged cartilage and bone on the top of the talus bone the lower bone of the ankle joint. Osteochondritis dissecans, a term which was first used by koenig, is a limited lesion of subchondral bone necrosis, which progresses slowly towards separation of necrotic osteocartilaginous fragments which then move freely in the joint space. Longterm results after operative treatment of osteochondritis dissecans of the knee joint30 year results. Osteochondritis dissecans is a fracturing or cracking of the articular cartilage, the material lining the end of a bone, and the subchondral bone underneath it. Magnetic resonance imaging mri is a routine part of the diagnostic evaluation of ocd. The exact cause and natural history remain elusive in the literature.
The mri findings of unstable and stable osteochondritis dissecans of the capitellum are similar to the findings described for osteochondritis dissecans of the femoral condyles and talar dome. Osteochondritis dissecans statpearls ncbi bookshelf. Osteochondritis dissecans ocd fixation knee osteochondritis is a condition in which the blood supply to an area of bone is disrupted. Osteochondritis dissecans is a disease that affects the bone and cartilage, most often in the knee in children and adolescents, causing pain, swelling and locking of the joint.
Osteochondritis dissecans ocd is a common but poorly. If arthroscopy shows an unstable osteochondritis dissecans lesion or if mri shows a lesion greater than 2 cm, then the lesion should be repaired by fixation of the unstable lesion. Capitellar osteochondritis dissecans ocd can be a significant problem in adolescent overhead athletes. Treatment of osteochondritis dissecans is jointspecific.
Magnetic resonance imaging all abnormalities on plain film or ct should be evaluated for stability by mri. Osteochondral lesion of the talus olt footeducation. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement. Osteochondritis dissecans of the elbow springerlink. Initially, softening of the overlying articular cartilage is noted with an intact articular surface fig. Osteochondritis dissecans radiology reference article. Osteochondritis dissecans ocd and osteonecrosis are two of the many types of. The cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch, and a tenuous vascular supply of the capitellum. This softening is caused by an interruption in the blood flow to that portion of bone. Recent literature reveals that the prevalence is likely higher than previously thought.
Sports medicine center for musculoskeletal care 333 east 38th street new york, ny 10016 tel. Its most common in children and teens who are active in sports. Osteochondritis dissecans wikimili, the best wikipedia. David lintner he also specializes in injuries to throwers shoulders and elbows, having written more than thirty scientific articles about acl injuries, throwers injuries, and other sports medicine issues. Most authors,, support the hypothesis that the initial pathogenic event is a. Given the limitations of radiographs in assessing an ocd lesion, mri is often used to. If the piece of cartilage and bone remain close to where they detached, they may not cause any symptoms. Osteochondritis dissecans is an idiopathic lesion of the subchondral bone characterized by osseous resorption, collapse and sequestrum with possible involvement of the articular cartilage. Ecr 2017 b50 mri evaluation of knee osteochondritis. It involves localized avascular necrosis of subchondral bone and subsequent loss of structural support for the adjacent articular cartilage.
The clinical 3t mr imaging protocol was supplemented with a routinely. Conklin jj, alderson po, zizic tm et al 1983 comparison of bone scan and radiograph. Ocd usually causes pain and swelling of the affected joint which catches and locks during movement. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply.
Osteochondritis dissecans of medial femoral condyleovoid fragment of bone is separated from surface of condyle but does not yet lie freely within the joint. Osteochondritis dissecans ocd is a condition that develops in joints, most often in children and adolescents. Usually the person affected can remember having injured the joint. Osteochondritis dissecans etiology bmj best practice. Ocd is increasingly frequently seen in pediatric, adolescent and young adult athletes. Osteochondritis dissecans is a joint condition that occurs when a piece of cartilage and the thin layer of bone beneath it, separates from the end of the bone.
Role of magnetic resonance imaging and clinical criteria in predicting successful nonoperative treatment of osteochondritis dissecans in children retrospective case series jurgensen 2002 arthroscopic versus conservative treatment of osteochondritis dissecans of the knee. The moderator was familiar with the methods and procedures of aaos appropriate use criteria and led the panel as a nonvoter in discussions. The research in osteochondritis of the knee rock group developed a novel. The forces needed to cause ocd are produced primarily in athletes participating in baseball and gymnastics. Osteochondritis dissecans definition of osteochondritis. Describing ocd together with osteochondral fractures and epiphyseal ossification disturbances and considering these three conditions as one entity has caused much confusion. The cause is currently unknown but it may lead to damage to overlying cartilage, loose bodies, and joint damage. The aim of the present study is to describe results at longterm followup of internal fixation of unstable osteochondritis dissecans ocd achieved with three different fixation devices in skeletally mature knees. Osteochronditis dissecans aka ocd is a condition in which the bone that supports the cartilage inside a joint undergoes softening. A nonvoting moderator, who is an orthopaedic surgeon, but is not a specialist in the treatment of osteochondritis dissecans, moderated the voting panel. As a result, the area of bone and its overlying cartilage can separate from the rest of the bone.
It is often associated with intraarticular loose bodies. The mri protocols in this study for the femoral condyles or tibial plates lesions or for. This softening is caused by an interruption in the blood flow to that portion of the bone. Computed tomography and magnetic resonance imaging are important for. Osteochondritis dissecans approach bmj best practice. Osteochondritis dissecans ocd or od is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. Knee osteochondritis dissecans statpearls ncbi bookshelf. Rehabilitation guidelines for osteochondritis dissecans. Most of the time, it gets better when you rest the joint for a while. A high signal line behind the fragment seems to be most. Mri can further characterize the lesions stability. An osteochondritis dissecans lesion in the knee is a condition that is caused by a reduction of blood flow to the end of a bone within the knee joint. It results in significant pain and swelling in the affected joint, depriving it of its normal range of function. Ankle arthroscopy osteochondritis dissecans protocol phase 1 weeks two to six phase 2 weeks six to twelve initial evaluation evaluate arom hipkneeankle pain level edema nwb 46 weeks per md sutures removed utilize arom hep.
Mri recommended for staging and treatment guidance. Internal fixation of osteochondritis dissecans of the knee. Patientreported questionnaires were collected at the final followup. Other articles where osteochondritis dissecans is discussed.
This piece of bone and cartilage can become loose and even break off into the joint. Osteochondritis dissecans ocd of the knee is a relatively common cause of pain and functional limitation among children and young adults. It affects children with patent physes and continues to perplex clinicians as to its cause, prognosis, and the most appropriate treatment. The american academy of orthopaedic surgeons aaos guidelines for. Osteochondritis dissecans knee pediatric orthopaedic. Osteochondritis dissecansocd of the elbow is a condition that occurs in children and adolescents who participate in sports that place a large amount of stress on the elbow joint. Magnetic resonance imaging mri offers promise as a noninvasive method to determine the potential of an osteochondritis dissecans ocd lesion to heal without surgical intervention. See the main osteochondritis dissecans article for a general discussion on this condition, which mostly affects the knees. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans.
Osteochondritis dissecans osteochronditis dissecans aka ocd is a condition in which the bone that supports the cartilage inside a joint undergoes softening. This condition occurs most often in adolescent males under the age of 25. For lesions greater than 2 cm by 2 cm, chondral resurfacing can also be considered, and several different techniques can accomplish this. Osteochondritis dissecans is a painful joint problem. Age distribution and localization combined with the radiologic and. With the vague clinical symptoms and signs of ocd, imaging plays a vital role in making the diagnosis and helping with the prognosis of ocd lesions.
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