Despite many years of interest regarding the diagnosis and treatment of OCD, the literature is sparse regarding the actual need for surgical intervention. Diseases & Conditions, 2002
Although mosaicplasty was effective for medial and lateral femoral condyle lesions, it was inferior to autologous chondrocyte implantation. Patients may also be offered autologous chondrocyte transplantation or mosaicplasty. Failure to establish a familial background. For more information view the SAGE Journals Article Sharing page. Treatment of severe lesions is typically surgical; however, the results of surgery are often suboptimal, and patients are advised to expect some limitation of range of motion and possibly function after surgery. 7 (2):157-62. i just had surgery on my knee for ocd mine is 2.9cm by 1.8cm the doctor made the same cuts to my knee 2 small ones and one big one half way down my knee its like 2inches long. Only Jurgensen et al24 has noted a greater rate of surgery in adult OCD (determined to be OCD with closed physis) as compared with juvenile OCD. TABLE 1 Demographics of Subjects Included in the OCD Surgery Modela, TABLE 2 OCD Surgery by Joint and Age Categorya. 2001. Future research will also need to differentiate responses between juvenile and adult OCD because the two patient populations affected by these conditions seem to respond differently to various treatments. ǁUniversity of Utah School of Medicine, Salt Lake City, Utah, USA. [Medline]. However, the study by Hefti et al20 included both adults and children and did not specifically assess surgical progression by age group. The study concluded that the allografts restored short-term function in patients in whom standard treatment was unsuccessful. [Medline]. Although this was not a natural history or epidemiologic study in a closed population, it did assess progression to surgery, among other things, in a large multicenter study. 2016 Apr. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. Outcomes with the following procedures are described below 42(10):886. Some authors advocate the use of arthroscopy as a diagnostic tool in addition to MRI prior to more invasive procedures. In fact, Lefort et al31 state that “complete cure is frequent before the age of 12 years.” However, none of the aforementioned studies actually assessed or documented a greater progression to surgery in younger OCD patients or those with open physes, and none specifically looked at surgical progression by age group in pediatric patients. 2012. [Medline]. The types of surgeries performed in this study are summarized in Table 5. 2009 Feb. 25(2):145-52. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Conservative treatment in these patients includes immobilization of the limb in a cast or brace and no weight bearing for 6-12 weeks. Various modalities and techniques exist, such as fixation, debridement, microfracture, and cartilage grafting/transplantation. Koulalis D, Schultz W, Heyden M. Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. The knee is the location most often requiring surgery, with 58% of procedures for OCD lesions being performed on the knee. [Medline]. Bojanic, I, Smoljanovic, T, Dokuzovic, S. Harada, M, Ogino, T, Takahara, M, Ishigaki, D, Kashiwa, H, Kanauchi, Y. Hayan, R, Phillipe, G, Ludovic, S, Claude, K, Jean-Michel, C. Higuera, J, Laguna, R, Peral, M, Aranda, E, Soleto, J. Iwasaki, N, Kato, H, Ishikawa, J, Masuko, T, Funakoshi, T, Minami, A. Jones, KJ, Wiesel, BB, Sankar, WN, Ganley, TJ. But, when a young horse has a bone chip in these joints, it has usually been caused by OCD. 166. Shimada, K, Yoshida, T, Nakata, K, Hamada, M, Akita, S. Takahara, M, Mura, N, Sasaki, J, Harada, M, Ogino, T. Zwingmann, J, Sudkamp, NP, Schmal, H, Niemeyer, P. View or download all content the institution has subscribed to. Nonetheless, data suggest certain definite trends. The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. J Pediatr Orthop. Patients with a medial lesion and radiographic findings of a completely detached fragment that remains in the underlying crater bed may also be treated with 6 months of conservative care. Magnetic Resonance Imaging After Arthroscopic Microfracture of Capitellar Osteochondritis Dissecans. Open removal of … Sports Health. The average age is about 70. It is a condition that is more common in males than females approximately 2:1 respectively. Barrett et al reported that headless metal compression screws, which can be left in place, provide a satisfactory union rate for treatment of unstable osteochondritis dissecans of the femoral condyles in patients who are skeletally mature. Weight bearing is gradually introduced into the patient's rehabilitation schedule, and the patient is progressed to full weight bearing by 6-8 weeks. Surgical technique. This product could help you, Accessing resources off campus can be a challenge. The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents. J Bone Joint Surg Am. The treatment for OCD usually entails surgery, during which any bone fragments are removed and the abnormal bone is cleaned up. Similar to the recommendations of multiple authors,12,14,23,30,35,36,41,42 a large number of surgeries performed in our series to treat OCD of the elbow were marrow stimulation techniques, including chondroplasty/debridement (81.8%), drillings (45.5%), and microfracture (27.3%). 32(2):217-21. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years at the time of diagnosis. Success Rate For Ankle Microfracture Surgery? [Medline]. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. To assess the frequency of pediatric OCD lesions that progress to surgery based on sex, joint involvement, and age. If adult patients are appropriately selected (stage I and II lesions and stage III medial lesions) and conservative care is appropriately provided, the successful response rate is likely to be significantly higher. Am J Sports Med. If necessary, multiple pins may be placed for greater fixation. It also demonstrates that approximately one-third of pediatric patients with OCD as a whole and of the ankle and knee specifically progress to surgery, with a higher progression in elbow OCD patients. , Pascual-Garrido et al examined the outcomes of surgical procedures for osteochondritis dissecans in 46 adult patients (48 knees), with patients ranging in age from 20 to 49 years. Last of all, the present study does not specifically address the success of surgery, although 95% of patients did not require any further surgery after follow-up of at least 2 years. Diseases & Conditions, 2002
Recovery and surgery for an OCD lesion of the knee. A review of 14 clinical studies evaluating 201 patients without distinction between juvenile and adult ankle OCD found that only 45% of patients responded successfully to conservative management. My 16 yr old level 10 son is currently recovering from ocd but in his right elbow. However, a prospective, randomized study that directly compared autologous chondrocyte implantation with mosaicplasty for OCD lesions in the knee found that autologous chondrocyte implantation had significantly better results for lesions in the medial femoral condyle, lateral femoral condyle, and patella. This technique is required for extensive defects in which other treatments have failed. Surgical progression in the knee, elbow, and ankle were also significantly higher in each individual group among the older patients than the younger patients, all with P < .0001. Surgery was performed on the single OCD lesion of the lateral tibial plateau. 2009 Nov. 37 Suppl 1:125S-30S. [Medline]. OCD occurs not just in the knee, but in the ankle and elbow as well. The vast majority of studies on surgery for OCD of the elbow simply assess results of surgery in all patients# rather than assessing all results, both surgical and nonsurgical, in patients with elbow OCD. Once the piece has broken off, surgery is almost always necessary. Osteochondritis dissecans. The defect is excised to the normal surrounding cartilage, and the sclerotic bone is excavated down to the bleeding cancellous bone. Patients aged 12 to 19 years were 8.2 times more likely to progress to surgery for all OCD lesions than patients aged 6 to 11 years. The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described. 1950 Oct. 32(A:4):867-74. A second periosteal flap is then used for the autologous chondrocyte transplantation, which is performed as previously described. As described in prior studies on OCD of the ankle and knee,25,26 age at diagnosis, sex, race and ethnicity, joint involvement, side involved, and specific location within the joint were included as variables. Sharing links are not available for this article. Conservative treatment in these patients includes limitation of activity and protected weight bearing to allow healing and prevent further displacement. ‡St Luke’s Health System, Boise, Idaho, USA. The overall progression to surgery for this younger age group was 9.2%, which was significantly lower than the progression to surgery among the older patients (P < .0001). . Exclusion criteria included traumatic osteochondral fractures or coexistence of non-OCD intra-articular lesions. Surgical complications may include infection and neurovascular injuries, but these complications are particularly rare in these procedures. Signs and Symptoms. . Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). The leading thought as to why knee OCD happens relates to the thin layer of growth cartilage that caps the end of long bones, such as the femur or thigh bone. One surgery was performed out of the 3 patellar OCD lesions. [Medline]. Sagittal view of an osteochondral lesion in the medial femoral condyle. Multiple perforations of the lesion are made using Kirschner wires. †University of Minnesota Medical Center, Minneapolis, Minnesota, USA. About 60 percentof the recipients a… There is still incomplete understanding, however, as to what patient factors may correlate with success or failure of conservative management and the frequency of particular procedures. J Trauma. Open removal of loose bodies, reconstruction of the crater base, and replacement with fixation yield a success rate of approximately 70%. The decision for a given surgical procedure is based on findings from the preoperative evaluation. The Atlanta Equine Clinic (AEC) Client Education Library: Post-Op Arthroscopy Notes - We are happy that your horse is going home and getting back to a familiar environment! J Hand Surg [Am]. , Autologous chondrocyte transplantation for the treatment of OCD lesions of the femoral condyle was found to yield good results at 2-year follow-up in 52 of 53 patients. The OCD can however, affect any part of the joint, although it is very rare that it affects the tibial surface. ... tend to have a success rate of 30% to 100% depending on the technique utilized. Diseases & Conditions, encoded search term (Osteochondritis Dissecans) and Osteochondritis Dissecans, Humeral Capitellum Osteochondritis Dissecans, Cartilage Injury in the Knee: Assessment and Treatment Options, Management of Articular Cartilage Defects in the Glenohumeral Joint, Proposed RA Guidelines: Maximize Methotrexate Before Switching, Gout Clinical Practice Guidelines (ACR, 2020), A Man With Stooped Posture and Mysterious Back and Neck Pain, Denosumab Favored Over Alendronate for BMD Protection in Glucocorticoid-Induced Osteoporosis, Treatment Sequence With Romosozumab Influences Osteoporosis Outcomes. . J Bone Joint Surg Am. In order to do that, the bone must be healthy and have enough blood supply. Patients can develop knee problems after this procedure. Tabaddor RR, Banffy MB, Andersen JS, McFeely E, Ogunwole O, Micheli LJ, et al. Lyon et al reviewed 11 cases of children with OCD of the knee who were treated with a fresh osteochondral allograft. Surgical options include the following Plain knee radiographs provide the initial basis for assessment of growth plate maturation, but also lesion location and stability. Patients with lesions 8 cm or greater in diameter may be offered radical removal of sclerotic bone with bone grafting of the defect and autologous chondrocyte transplantation (sandwich technique). For the group as a whole, most patients had only 1 surgery (109/115, 94.8%), while 3 patients each had 2 (2.6%) and 3 surgeries (2.6%). 2002 Feb. 186-92. The associations between progression to surgery and race/ethnicity, age, and sex were assessed using multivariable logistic regression models to estimate odds ratios (ORs) and 95% CIs. The majority of lesions (61.7%) were in the knee, with ankle, elbow, shoulder, and foot lesions representing 25.4%, 12.0%, 0.6%, and 0.3% of all lesions, respectively. Another study in a military population evaluated fixation with bone pegs with supplementary Kirschner-wire fixation and found that 47 of 54 patients were able to return to active military duty. Osteochondritis dissecans. One study evaluated five female gymnasts aged 11-13 years. [Medline]. However, in this study, drilling was actually the most common of these 2 procedures performed (67% of patients). Kocher, MS, Micheli, LJ, Yaniv, M, Zurakowski, D, Ames, A, Adrignolo, AA. It also does not elucidate any relationship between the types of surgeries performed and the intraoperative and radiographic findings. In terms of the breakdown by joint location, progression to surgery for knee OCD was as follows: In the MFC, 37 surgeries were performed out of 131 lesions (28.2%), while in the lateral femoral condyle, 27 surgeries were performed out of 67 lesions (40.3%) (Table 3). The majority of joints needing surgery were in the knee (58.5%), with ankle and elbow lesions representing 22.9% and 18.6% of surgeries performed, respectively. 2012 Sep. 4(5):425-32. A case report, Osteochondritis dissecans of the femoral condyles. For OCD of the ankle, progression to surgery was 38.5% among females and 21.2% among males, which, despite the difference, was not statistically significant (P = .25). #References 12, 14, 18, 22, 23, 29, 30, 34-37, 41-44. 2007 Oct. 36(10):929-35. Long-term results after operative treatment of osteochondritis dissecans of the knee joint-30 year results. The model was adjusted for race (non-Hispanic white, Hispanic, black, Asian or Pacific Islander, other/unknown), age, and sex. Osteochondritis Dissecansor OCD lesion is a condition that can occur and develop in children, adolescents and young adults from a decreased blood supply to a specific area of bone affecting the cartilage site. In terms of ankle OCD, progression to surgery in these 85 children was similar to that of the knee at 31.8%. Thomas M DeBerardino, MD Orthopedic Surgeon, The San Antonio Orthopaedic Group; Professor of Orthopedic Surgery, Baylor College of Medicine as Co-Director, Combined Baylor College of Medicine-The San Antonio Orthopaedic Group, Texas Sports Medicine Fellowship; Medical Director, Burkhart Research Institute for Orthopaedics (BRIO) of the San Antonio Orthopaedic Group; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder Progression to surgery for OCD of the knee, elbow, and ankle strongly correlated with patient age at the time of diagnosis. The lack of blood supply causes the cartilage to become damaged and crack and loosen. Your doctor will also check other structures around the joint, such as the ligaments.Your doctor will also ask you to move your joint in different directions to see whether the joint can move smoothly through its normal range of motion. Arthroscopic drilling with fixation in patients with knee OCD yields good or excellent results in approximately 94% of patients. If the patient has open physes, care must be taken to avoid penetrating too deeply into the physis. For OCD of the ankle, this older group had an increased risk of surgery, but this risk was just shy of statistical significance (OR, 7.08; 95% CI, 0.85-58.95; P = .07) (Table 4). They based surgical recommendations on stability of the lesion, and suggested that transchondral perforation should be considered early. In the breakdown by both age and joint, in patients aged 12 to 19 years, surgeries were performed for 147 OCD lesions of the knee (42.9%), 26 surgeries were performed on 72 OCD lesions of the ankle (36.1%), and 22 surgeries for 37 OCD lesions of the elbow (59.5%) (Table 2). In addition, this work provides a benchmark with which to compare treatment and intervention, with the goal of decreasing the need for surgical intervention in the future for this pathology. [Medline]. The Kirschner wires are later removed in a retrograde fashion. 4 (3):2325967116635515. For the knee as a whole, right-sided lesions failed conservative treatment 29.4% of the time and left-sided lesions 38.9% of the time. Patients with lesions 3 cm or greater in diameter or patients with multiple loose bodies may have their lesions fixed and replaced through an open procedure. The breakdown of the 317 patients was as follows: 192 patients (60.6%) had knee lesions, 85 patients (26.8%) had ankle lesions, 37 patients (11.7%) had elbow lesions, 2 patients (0.6%) had shoulder lesions, and 1 patient (0.3%) had a lesion of the foot. 2:131-8. Internal Fixation of Unstable Osteochondritis Dissecans in the Skeletally Mature Knee with Metal Screws. In terms of progression by location in the knee, OCD lesions of the MFC were less likely to progress to surgery (28.2%) than those in the lateral femoral condyle (40.3%). Specific locations in the knee included the medial femoral condyle (MFC), lateral femoral condyle, patella, trochlea, and the lateral or medial tibial plateau; in the ankle, we included medial talus, lateral talus, central talus, and distal tibia; last, the sites in the elbow included the trochlea and capitellum. Their initial results are promising; however, further data are needed before firm recommendations can be made. Rogers WM, Gladstone H. Vascular foramina and arterial supply of the distal end of the femur. Midterm results of surgical treatment for adult osteochondritis dissecans of the knee. The number of procedures done per surgery varied from 1 (28 patients, 23.7%), 2 (45 patients, 38.1%), 3 (38 patients, 32.2%), and 4 (7 patients, 5.9%). Distribution of OCD lesions in the knee are most commonly associated with the lateral aspect from the medial femoral condyle. Patients should undergo preoperative MRI to better define the lesion. It depends on the site of the lesion." Barrett I, King AH, Riester S, van Wijnen A, Levy BA, Stuart MJ, et al. Gainesville, Florida: University of Florida Press; 1990. 90 Suppl 2:47-62. 2007 Jun. Brunton LM, Anderson MW, Pannunzio ME, Khanna AJ, Chhabra AB. This is somewhat similar to the largest study done on OCD of the knee by Hefti et al,20 who found drilling and chondroplasty (“operative resurfacing”) were also the most common procedures in 355 patients treated surgically. Enneking, WF. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. These differences were not statistically significant. Jurgensen, I, Bachmann, G, Schleicher, I, Haas, H. Kessler, JI, Nikizad, H, Shea, KG, Jacobs, JC, Bebchuk, JD, Weiss, JM. 2003. Logistic regression analysis found no statistically significant different risk of progressing to surgery for OCD of the knee, elbow, and ankle between sexes. Pascual-Garrido C, Friel NA, Kirk SS, McNickle AG, Bach BR Jr, Bush-Joseph CA, et al. However, these generally must be removed after healing, which can be difficult. What is the ACL or CCL? [Medline]. However, the pins should be placed at an angle and not parallel to one another. Non-surgical treatment typically consists of partial to non-we… Adachi et al evaluated the functional and radiographic outcome of retroarticular drilling without bone grafting in 12 patients with juvenile osteochondritis dissecans after 6 months of unsuccessful nonoperative treatment. 1 Distal femoral varus osteotomy (DFVO) can effectively correct valgus knee malalignment and unload the lateral compartment. Manuscript content on this site is licensed under Creative Commons Licenses, The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents, http://www.creativecommons.org/licenses/by-nc-nd/3.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage. When the right criteria are met, however, "the success rate is really pretty high, 75 to 85 percent. However, in addition to combining juvenile and adult patients, these studies did not provide consistent criteria for conservative treatment; they also did not consistently delineate what conservative treatment was provided. The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. Ed. Peterson L, Minas T, Brittberg M, Lindahl A. Takahara et al,45 in a study of 106 adults and children with elbow OCD, found that 66% of patients failed conservative treatment and went on to have surgery. ... tend to have a success rate of 30% to 100% depending on the technique utilized. The highest incident rates appear among patients between the ages of 10-15. Therapy for OCD of the ankle is guided primarily by two considerations, the location of the lesion and the radiographic findings. [Medline]. The aforementioned 2012 study in The Journal of Bone and Joint Surgery assessed the clinical outcomes of these five different surgical techniques in patients affected by OCD of the knee, at a … The cancellous bone graft is packed as needed into the lesion to restore articular congruity. Demographics and Epidemiology of Osteochondritis Dissecans of the Elbow Among Children and Adol... Osteochondritis Dissecans of the Tibial Plateau in Children and Adolescents: A Case Series. Please confirm that you would like to log out of Medscape. View or download all the content the society has access to. [Medline]. [16, 17]. Patients with medial or lateral lesions and normal radiographic findings or radiographic findings that reveal only a partially detached osteochondral fragment may be treated conservatively. [Full Text]. Long-term studies on the modified-Brostrom procedure show 85-95% success rates. Many will complain of deep knee pain or pain in the back of the joint. The aforementioned 2012 study in The Journal of Bone and Joint Surgery assessed the clinical outcomes of these five different surgical techniques in patients affected by OCD of the knee, at a … Seven knees required revision procedures at a mean follow-up of 14 months. 2008 Mar. Patient sex was not found to correlate with likelihood of progression to surgery for OCD in any location. Osteochondritis dissecans: a histologic and microradiographic analysis of surgically excised lesions. This underscores the need for further well-designed study of surgical intervention for OCD of the knee, as recommended by the AAOS (American Academy of Orthopaedic Surgeons) study group guidelines published in 2011.15,16 In terms of the need for revision or second surgeries, our study demonstrated that only 5% of patients with any type of OCD required 2 or more surgeries. [Medline]. Wiesler E, Poehling GG. 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