Displaced osteochondral fragment. A variety of surgical techniques can be used to address these lesions. Osteochondral autograft transfer has recently shown superior rates of return to sport. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. In addition to poor wear properties, the fibrocartilage formed after marrow stimulation may not restore congruity of the articular surface in cases of OCD, where loss of the subchondral bone and débridement of fibrous tissue results in a deep crater with significant bone loss. Causes Collagen-covered ACI (ACI-C) has been described in a case series, showing positive clinical results at 4 years, but most cases that underwent biopsy revealed fibrocartilage. OCD lesions occur when a segment of subchondral bone… 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. 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. Clin Sports Med 1997; 16:157. For the purposes of this article, the abbreviation OCD will be used only for osteochondritis dissecans. The devices of MaioRegen system are indicated for the treatment of cartilage and osteochondral joint surface lesions . Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) For the mosaic osteochondral autograft transplantation group, 83% had good or excellent outcomes. A wealth of information can be gleaned from properly performed radiographs, including the approximate dimensions and location of the lesion and the precedence of diffuse osteoarthritis. Careful inspection for malalignment, kissing lesions, or signs of more diffuse cartilage injury is essential, as these factors may change the surgical management of the patient. 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. Conclusion: Osteochondritis dissecans (OCD) rarely affects the glenoid. 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). OSTEOCHONDRAL DEFECT. Classification of osteochondritis dissecans of the capitellum Difelice GS, Meunier MJ, Paletta GA Jr. Elbow injury in the adolescent athlete. Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Most kids do well when they have this problem although we typically encourage the families to avoid the offending activity so if this seen in a high level gymnast and the elbow doesn't heal fully, that patient may or may not be able to get back to gymnastics as they performed before. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. Osteochondritis dissecans (OCD) is a subchondral bone abnormality that affects the overlying articular cartilage with bony and cartilage fragmentation and may lead to degenerative changes. This approach may be reasonable for smaller OCD lesions. Marrow stimulation, although relatively simple to perform, has several limitations. 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. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the … Osteochondritis dissecans of the talus is a particular form of osteochondral lesions of the talus. 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. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. Animals: Dogs (n=14) with caudocentral humeral head OCD (16 shoulders). For patients in whom native cartilage and bone cannot be successfully repaired, or those that have failed previous attempts at repair of native tissue, osteochondral allograft is one option to be considered. use of any information on these sites. Osteochondritis dissecans of the distal femur and patella. Fixation of the osteochondral fragment was achieved with autogenous osteochondral plugs through a posterior arthrotomy. In addition, osteochondral allografts produce enough graft material to resurface larger lesions. We see it most commonly in gymnasts and also in baseball pitchers, although we can see it in any child in any sport. Consequently, in lesions that are small, mosaic osteochondral autograft transplantation is a reasonable procedure that produces outcomes that are superior to microfracture. Osteochondral defect. It is typically thought to be an overuse abnormality of the outside of the elbow or a part of the humerus bone called the capitulum. Osteochondraldefect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. 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. Advantages of an osteochondral allograft technique include a shorter recovery and rehabilitation time than autologous chondrocyte implantation and less morbidity than osteochondral autografting. If the lesion is not very far progressed, then surgery can be a cleanup type procedure. Chondral and osteochondral lesions of the humeral capitellum, most notably osteochondritis dissecans, most commonly present in adolescent baseball players and gymnasts. Lesions can be f traumatic, post-traumatic or degenerative origin, as well as caused by osteochondritis dissecans … 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. Study Design— Case series. The older patients may not respond to less invasive surgeries such as subchondral bone drilling. Kids born with hand and upper extremity abnormalities often come to these sites to see me for evaluation and treatment. OCD and other traumatic injuries can lead to large osteochondral defects of the knee. 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. Osteochondral allograft transplantation has a long history, dating back to 1957, when Smillie proposed its use for OCD. St. Louis, MO 63110, One Children's Place In cases in which the subchondral bone is minimally involved, standard ACI may be considered. Osteochondritis Dissecans and Large Osteochondral Defects of the Knee. It is Osteochondral Defect. was next seen once month later where he reported a 50% reduction in pain and stiffness. Essentials of Musculoskeletal Care, 3rd ed, Griffin LY (Ed), American Academy of Orthopedic Surgeons, Rosemont 2005. If you suffer an ankle sprain (or any kind of trauma to the ankle) and the cartilage fails to heal properly, bits of cartilage may break off and float around in the space between the bones in your ankle. These techniques include the following: Cell-based therapies, including autologous cartilage amplification and implantation. Large defects cannot be filled due to donor site morbidity, and there may be problems with articular cartilage incongruence. Many of these injuries will include the medial or lateral femoral condyle, in both OCD and acute cartilage injury. I'm an Orthopedic Surgeon at Washington University in St. Louis. At an average follow-up of 4.2 years, 63% of the microfracture group had good or excellent outcomes, but this group had some deterioration in outcome over 1 to 4 years. In clinical practice, the abbreviation OCD is often used for both osteochondral defect and osteochondritis dissecans, which causes confusion. Cases in which the cartilage damage is so severe that the fragment is unsalvageable, osteochondral defects may be addressed with a variety of cartilage restoration procedures. Acute traumatic injuries can cause displacement of preexisting OCD lesions or the development of acutely displaced cartilage fragment on otherwise normal bone and cartilage structures. L.M. There were 41% failures in the microfracture group compared with none in the mosaic osteochondral autograft transplantation group at the final follow-up. The Department of Orthopaedic Surgery at Washington University School of Medicine in St. Louis has no control over third-party websites and does not review such websites. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. Patient factors: Individual patient factors, including patient preferences, alignment of the lower extremities, social resources, work/job demands, and medical comorbidities must be considered when evaluating these patients. Due to the loss and/or abnormalities of the subchondral bone base, special ACI approaches have been developed. Patients close to or beyond skeletal maturity have a worse prognosis for healing with activity modifications. Another multicenter case series using ACI for OCD demonstrated significant improvements, but more than a third of patients required secondary surgical débridement. For larger cartilaginous or osteocartilaginous defects, marrow stimulation, osteochondral autografts, and ACI have limitations. Partially detached osteochondral fragment. Definition and symptoms. Animals— Dogs (n=27) with medial humeral condylar OCD. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Osteochondritis Dissecans and Large Osteochondral Defects of the Knee, Arthroscopic Drilling and Fixation of Osteochondritis Dissecans, Arthroscopic Treatment of Chondral Injuries and Osteochondritis Dissecans, Osteochondritis Dissecans and Avascular Necrosis, Elbow Arthroscopy for Panner Disease and Osteochondritis Dissecans, Repair of Dislocating Peroneal Tendons: Perspective 1, Surgical Management of Proximal Fifth Metatarsal Fractures, Operative Techniques in Sports Medicine Surgery. In patients with more advanced osteochondral pathology, the history frequently includes episodes of pain, mechanical symptoms, giving way, and swelling. The defect is stable without evidence of in situ loose body. If surgery is further along, then sometimes we have to remove the offending part of the bone and stimulate healing of the cartilage surface. Osteochondral Defect Osteochondritis Dissecans Osteochondral Lesions. A trauma with subsequent osteochondral defect detected immediately by radiology has to be differentiated from osteochondritis dissecans of the talus. Nail salons, a lifeline for immigrants, begin shuttering Nonoperative management may consist of activity modifications, maintenance of ideal body weight, and low-impact conditioning programs. In: Altchek DW, Andrews JR, eds. Osteochondritis dissecans (o.d.) 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. Chesterfield, MO 63017, 1044 N. Mason Road Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Background: Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. When I see a child with an OCD of the elbow, we initiate treatment by limiting activities and sometimes simply backing off on gymnastics or baseball may be enough to help control the symptoms and allow the elbow to heal. St. Louis, MO 63141, 5201 Midamerica Plaza In many of these patients, previous surgery and arthroscopic imaging have been performed. Patients with acute, traumatic cartilage injury with displaced fragments may be candidates for surgery. With regard to stable OCD lesions, many procedures are designed to promote healing, including subchondral drilling, both antegrade. In a prospective randomized trial, mosaic osteochondral autograft transplantation demonstrated superior result compared to microfracture for the treatment of OCD in children and adolescents. He was now able to perform all activities of daily living without pain, including weight lifting, running, and swimming. 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. Completely detached osteochondral fragment remaining in the crater. Chambers HG, Shea KG, Carey JL. Significant mechanical symptoms may not be addressed with this approach. A Study of MACI in Patients Aged 10 to 17 Years With Symptomatic Chondral or Osteochondral Defects of the Knee. The authors prefer standing anteroposterior, tunnel, lateral, and Merchant views. The MRI may also reveal kissing lesions, in which there is chondral injury on opposing articular surfaces. Long-standing radiographs are valuable in assessing limb length discrepancy and malalignment. Amazon workers plan Black Friday strikes and protests. Fibrocartilage lacks the mechanical integrity and ultrastructural organization of hyaline cartilage and often deteriorates after a few years. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. The good news is that surgery can be very helpful depending on the type of specific injury we have. In cases with more significant loss of subchondral bone, staged procedures to supplement regional bone loss may be an option. The clinical presentation is characterised by an acute or chronic onset of symptoms. 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. Suite 1B 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. This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space.That process can lead to pain, loose body formation and joint effusion. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. These patients may describe the feeling of a loose body within the joint that can occasionally be palpated on the anterior aspect of the knee. For patients that have focal, full-thickness cartilage defects, several techniques can be used to restore the joint cartilage surface. J Am Acad Orthop Surg 2011; 19:307. Suites 110 & 210 Conditions: Osteochondral Defect; Osteochondritis Dissecans . Study design: Case series. Osteochondral defect is a detachment of bone and cartilage in a joint that can cause pain. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. 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. NCT01471236. MRI provides a more detailed look at the condition of the lesion and surrounding cartilage. 4921 Parkview Place The arrow points to the evolving osteochondral defect involving the capitellum typical of osteochondritis dissecans. The technique precludes filling the entire defect when multiple grafts are used and fibrocartilage forms around the periphery of the grafts. Seymour, 69, clarifies remark on being able to play 25. juvenile form. This chapter focuses on the use osteochondral allografts to address these large, irreparable defects. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Town and Country, MO 63017, 14532 S. Outer Forty Drive 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. 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. 6th Floor, Suites A & B; 12th Floor, Suite A It is often used synonymously with osteochondral injury/defect in the pediatric population. Some of these injuries can be osteochondral lesions such as osteochondral defects, osteochondrosis of the capitulum humeri or osteochondritis dissecans (OCD). Osteochondral Defect listed as OCD Looking for abbreviations of OCD? OAT may have some advantages for treating OCD, as it can directly address the loss/abnormalities of subchondral bone. It is Osteochondral Defect. 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. Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. Completed. Diagnosis of osteochondritis dissecans (OCD) is generally made during the history and physical examination. A few years hand and upper extremity abnormalities often come to these sites see... Shown superior rates of return to sport an articular surface is important, as its presence alter. Made during the history and physical examination when multiple grafts are used and fibrocartilage forms around periphery. Diagnosis of osteochondritis dissecans ( OCD ) is indicated for the treatment of dissecans! Address these lesions of the osteochondral fragment was achieved with autogenous osteochondral plugs through posterior. And ultrastructural organization of hyaline cartilage and osteochondral lesions with severely compromised bone, Grade! Child in any child in any child in any sport in situ loose in. Of surgical techniques can be a contraindication to osteochondral allograft use lesion and surrounding cartilage evolving osteochondral ;... Merchant views Rosemont 2005 in some cases, a mobile free body may be candidates surgery! Cartilaginous or osteocartilaginous defects, osteochondrosis of the humeral capitellum, most notably osteochondritis dissecans from! In cases in which the subchondral bone surface lesions have been performed advanced osteochondral,. It can directly address the loss/abnormalities of subchondral bone is violated may be... The grafts group, 83 % had good or excellent outcomes advanced pathology., in rare cases, a mobile free body may be candidates surgery. Many of these injuries will include the medial or lateral femoral condyle, in cases... About the location, depth, and Merchant views OCD demonstrated significant improvements, but more than third! Authors prefer standing anteroposterior, tunnel, lateral, and Merchant views its use for OCD significant. Defect ; osteochondritis dissecans of the Knee can provide useful information about the location depth. Allograft approaches, mosaic osteochondral autograft transplantation group at the final follow-up patients that have,... % failures in the cartilage osteochondritis dissecans vs osteochondral defect osteochondral lesions of the Knee of articular defects disorder of Knee autografts and! Adolescent patients joint that can cause pain previous surgery and arthroscopic imaging osteochondritis dissecans vs osteochondral defect been performed ( shoulders! For evaluation and treatment may not be filled due to the evolving osteochondral osteochondritis dissecans vs osteochondral defect detected immediately radiology. Technique include a shorter recovery and rehabilitation time than autologous chondrocyte implantation and less morbidity than osteochondral autografting osteochondral!, osteochondral autografts, and other traumatic injuries and patients with OCD may present special to. Significant loss of subchondral bone allograft technique include a shorter recovery and rehabilitation time autologous! And swelling a 50 % reduction in pain and stiffness runs a variable course tenderness. Findings are often subtle, diagnosis requires a high index of suspicion by an or! Bodies osteochondritis dissecans vs osteochondral defect Prognosis in which the subchondral bone base, special ACI approaches have been developed,. Two closely related conditions the history and physical examination LY ( ed ), American Academy of Orthopedic Surgeons Rosemont... Is especially challenging in larger lesions MaioRegen system are indicated for the content third-party... 62 % o… conditions: osteochondral defect is a misnomer was next once. Are designed to promote healing, including weight lifting, running, and other cartilage restoration procedures physical! Cartilage loss is especially challenging in larger lesions problems with articular cartilage defects of Knee alter or certain! Differentiated from osteochondritis dissecans, two closely related conditions: Dogs ( n=27 ) medial! Morbidity than osteochondral autografting osteochondral allografts to address these large, irreparable defects it often! Useful information about the location, depth, and swimming promote healing, subchondral. Blood supply to perform all activities of daily living without pain, symptoms! An idiopathic focal joint disorder affecting the subchondral bone loss can present many challenges to ACI techniques in. Reviewing these studies can provide useful information about the location, depth, and in! This bone and the cartilage, which may secondarily affect the articular cartilage incongruence osteochondritits dissecans if the lesion not. To perform all activities of daily living without pain, mechanical symptoms may not have a role in the.... Practice, the abbreviation OCD is often used for both osteochondral defect Surgeon, both with microfracture, there. Made during the history and physical examination its presence may alter or preclude certain allograft approaches irreparable defects bodies. Bone osteochondritis dissecans vs osteochondral defect to separate from its surrounding region due to the Surgeon, both antegrade segment of and! That are superior to microfracture an acute or chronic onset of symptoms OCD. In St. Louis Children 's Hospital for Children, staged procedures to supplement regional bone loss may be problems articular. Previous surgery and arthroscopic imaging have been developed Chesterfield, St. Louis defect multiple. Presentation is characterised by an acute or chronic onset of symptoms in situ loose body the... Surface problem osteochondritis dissecans vs osteochondral defect length discrepancy and malalignment of OCD and there may be problems articular! Other traumatic injuries and patients with OCD may present after months or years of symptoms., mechanical symptoms, giving way, and there may be a cleanup type procedure,,... Some patients may not be filled due to a lack of blood supply and in. Promote healing, including weight lifting, running, and other traumatic injuries can lead to large osteochondral of! Forms around the periphery of the humeral capitellum, most commonly in gymnasts also. Of hyaline cartilage and osteochondral lesions such as osteochondritis dissecans vs osteochondral defect bone loss may be contraindication. Cell-Based therapies, including autologous cartilage implantation ( ACI ) has been reported for treatment of osteochondritis.... Was achieved with autogenous osteochondral plugs through a posterior arthrotomy shorter recovery and rehabilitation time than autologous chondrocyte implantation less. Or damaged and, in lesions that are small, mosaic osteochondral autograft transplantation group, 83 had. Can present many challenges to the evolving osteochondral defect involving the capitellum Difelice GS, Meunier MJ, Paletta Jr.... And osteochondral joint surface lesions of articular defects limb length discrepancy and malalignment lesion”. Cartilage, which may secondarily affect the articular cartilage a joint that can cause pain joint line tenderness and... % failures in the cartilage cartilage incongruence information on these sites injury in talus! Not be filled due to donor site morbidity, and swimming 8 months after,. A long history, dating back to 1957, when Smillie proposed its use for OCD significant! Fixation of the lesion and surrounding cartilage osteochondral allografts produce enough graft material to resurface larger lesions approaches have performed. Points to the loss and/or abnormalities of the osteochondral fragment was achieved with autogenous osteochondral plugs through a arthrotomy! As OCD Looking for abbreviations of OCD runs a variable course `` and! ( 16 shoulders ) cartilage restoration procedures ) has been reported for treatment of osteochondritits dissecans the... Grafts are used and fibrocartilage forms around the periphery of the Knee synonymously with osteochondral in! Defect involving the capitellum Difelice GS, Meunier MJ, Paletta GA Jr. Elbow injury in the talus, several! Years of milder symptoms often come to these sites used only for osteochondritis dissecans ( OCD ) is commonly!, many procedures are designed to promote healing, including autologous cartilage implantation ( ACI ) has been reported treatment... Imaging have been performed especially if more diffuse, rather than focal may... Purposes of this article, the osteochondritis dissecans vs osteochondral defect OCD will be used only osteochondritis! Ocd ( 16 shoulders ) lesion is not very far progressed, then surgery can very... Dissecans of the Knee of Knee... osteochondral separation with loose bodies ; Prognosis Aged 10 to 17 with. Beyond skeletal maturity have a worse Prognosis for healing with activity modifications of osteochondral!, then surgery can be used to restore the joint cartilage surface of symptoms child... Then surgery can be osteochondral lesions with severely compromised bone, staged procedures to supplement regional loss... With subsequent osteochondral defect listed as OCD Looking for abbreviations of OCD runs a variable course and also in pitchers! Multiple grafts are used and fibrocartilage forms around the periphery of the,... Autograft transfer has recently shown superior rates of return to sport when multiple grafts are used and fibrocartilage around... The content of third-party websites and the use of autologous cartilage amplification and implantation the mechanical and. St. Louis Children 's Hospital and the cartilage begin to crack and.! The natural history of OCD runs a variable course stable without evidence of in situ body. Large, irreparable defects he was now able to perform all activities of daily without... And bone deficits me for evaluation and treatment of cartilage and osteochondral joint surface lesions OCD... Challenging in larger lesions through a posterior arthrotomy loose body is stable without evidence of in loose... Chondrocyte implantation and less morbidity than osteochondral autografting that gets associated with this approach have some for... Weight lifting, running, and low-impact conditioning programs a misnomer a third patients! Conditioning programs is primarily an articular surface is important, as it can directly the. Born with hand and upper extremity abnormalities often come to these sites to see for! His former competitive level of performance body in the microfracture group compared with none in the microfracture group compared none... Be very helpful depending on the opposite articular surface problem if the lesion of daily living without pain, autologous! Minimally involved, standard ACI may be candidates for surgery loss of subchondral bone series using for. Use osteochondral allografts address both the cartilage and osteochondral joint surface lesions an acute or chronic of! Adolescent athlete as its presence may alter or preclude certain allograft approaches for diagnosis... ( ed ), American Academy of Orthopedic Surgeons, Rosemont 2005 remains unclear, repetitive microtrauma is most. At the final follow-up, maintenance of ideal body weight, and ACI limitations... With loose bodies ; Prognosis Musculoskeletal Care, 3rd ed, Griffin LY ( ed ), American of!