The knee is the location most often requiring surgery, with 58% of procedures for OCD lesions being performed on the knee. Pascual-Garrido C, Friel NA, Kirk SS, McNickle AG, Bach BR Jr, Bush-Joseph CA, et al. Another study reported an 82% successful rate for juvenile ankle OCD with conservative therapy. Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions, If you have access to journal content via a university, library or employer, sign in here, Research off-campus without worrying about access issues. J Bone Joint Surg Br. Weiss JM, Nikizad H, Shea KG, Gyurdzhyan S, Jacobs JC, Cannamela PC, et al. An alpha level of 0.05 was used to determine statistical significance, and SAS Enterprise Guide version 4.2 (SAS Institute) was used for all analyses. This is especially true with regard to their use in ankle and elbow OCD. Postoperative MRI coronal view showing pinning of the osteochondral defect. Am J Sports Med. 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. Wulf CA, Stone RM, Giveans MR, Lervick GN. This is a much lower rate of progression to surgery compared with the studies of Backes et al 9 and Hefti et al 20 assessing both conservative and surgical treatment of knee OCD, in which the authors found progression to surgery in the vast majority (74% and 70%, respectively) of patients. Therefore, in patients with mild-to-moderate and, possibly, severe disease, conservative therapy consisting of avoidance of the offending activity and immobilization of the elbow joint seems reasonable if the growth plates are open. This study confirms a worse prognosis in the nonoperative treatment of older patients with OCD. Adult OCD in the knee, by contrast, rarely responds to conservative measures. . The frustrating, painful years of missing years of high school sports -- while waiting for nature to heal what nature has damaged--are over. Kocher, MS, Micheli, LJ, Yaniv, M, Zurakowski, D, Ames, A, Adrignolo, AA. 90 Suppl 2:47-62. The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents. Anteroposterior radiograph showing lucency in the medial femoral condyle. 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. However, it is possible that with longer follow-up of the present patient cohort, a greater rate of revision surgery could be seen. Cartilage. 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. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. A similar rehabilitation protocol should be used after fixation with bone pegs. If the patient remains asymptomatic at skeletal maturity and the radiographic findings have not progressed, the patient may be reassured that no further treatment is indicated. Nonabsorbable screws (eg, Acutrak or Herbert screws) may be used in larger lesions with a firm crater. Success rates and quality of life improvements for knee replacement patients are reliably very high. Good long-term outcomes have been noted with biologic fixation with osteochondral plugs. Osteochondritis dissecans. You can be signed in via any or all of the methods shown below at the same time. Open Treatment for Unstable Osteochondritis Dissecans of the Knee: Aut... Regeneration of hyaline cartilage in osteochondral lesion model using ... Osteochondritis Dissecans of the Tibial Plateau in Children and Adoles... Aglietti, P, Ciardullo, A, Giron, F, Ponteggia, F. Anderson, AF, Richards, DB, Pagnani, MJ, Hovis, WD. Access to society journal content varies across our titles. Diseases & Conditions, 2002
[Medline]. For more information view the SAGE Journals Article Sharing page. Russell Warren, MD Professor of Surgery, Professor, Division of Orthopedic Surgery, Weill Medical College of Cornell University Except when comparing white and other (P = .0092), ethnicity did not show statistically significant correlation to progression to surgery. 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. 2002 Feb. 186-92. 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 … . Adult ankle OCD seems to respond better than juvenile ankle OCD when surgical intervention is required. If they involve the humeral head (the end of the humerus bone that articulates with the scapula), surgery is necessary; still, these operations only have a 50/50 … In the analysis by sex, no significant differences were seen for any joints (Table 4). . Chondrocytes are arthroscopically harvested and cultured in a cell culture laboratory for 2-3 weeks. The lack of blood supply causes the cartilage to become damaged and crack and loosen. 1950 Oct. 32(A:4):867-74. Share cases and questions with Physicians on Medscape consult. Radiology. Thus, 43% of patients in this age group failed nonoperative treatment and progressed to surgery. Likelihood of progression to surgery was slightly greater among males (57.6%) compared with females (42.9%), but this was not statistically significant. Failure to establish a familial background. Few long-term studies have evaluated elbow OCD. Recovery and surgery for an OCD lesion of the knee. 1975 Aug. 15(8):689-96. Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Medical Society of the State of New YorkDisclosure: Nothing to disclose. A case report, Osteochondritis dissecans of the femoral condyles. [Medline]. Surgical complications may include infection and neurovascular injuries, but these complications are particularly rare in these procedures. Introduction. In this large cohort study of pediatric OCD patients, 35% progressed to surgery. During the physical exam, your doctor will press on the affected joint, checking for areas of swelling or tenderness. 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. By way of background, I was a long jumper/triple jumper on the track team in college and banged up my right ankle pretty badly a couple times, though nothing that resulted in long term pain. Non-surgical treatment typically consists of partial to non-we… The Kirschner wires are later removed in a retrograde fashion. Bentley G, Biant LC, Carrington RW, et al. 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. Please check you selected the correct society from the list and entered the user name and password you use to log in to your society website. Diseases & Conditions, 2002
Diseases & Conditions, 2002
2008 Mar. Patients can develop knee problems after this procedure. Surgery was more likely when the lesion was sclerosing or “dissected,” if the patient was older with growth plates closing or closed, and if the lesion was anywhere other than the lateral aspect of the MFC.20, In 2006, Lefort et al31 studied 892 cases of OCD of the knee in a mixture of adults and children. Overall, 317 patients with a total of 334 OCD lesions were found. Introduction. Weckström M, Parviainen M, Kiuru MJ, Mattila VM, Pihlajamäki HK. J Orthop Sports Phys Ther. Osteochondritis Dissecans Knee | Knee Specialist | Minnesota Three of 4 femoral trochlear lesions went on to surgery. In the ankle, medial and lateral talar lesions required surgery in 20 of 61 (32.8%) and 6 of 19 (31.6%) lesions, respectively, while central talar lesions and tibial plafond lesions failed conservative treatment in 1 of 3 and 0 of 2 lesions (Table 3). Patients can develop knee problems after this procedure. The hole should be drilled through the fragment to the desired depth and screwed into place. J Hand Surg [Am]. 85(2):223-30. 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. Once the piece has broken off, surgery is almost always necessary. 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. 2007 Sep. 35(9):1467-76. Juvenile OCD in the knee, without a loose body lesion, frequently heals with conservative therapy. 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. 2017;45(8):1799-1805. These differences were not statistically significant. 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%). OCD occurs not just in the knee, but in the ankle and elbow as well. Clinical Musculoskeletal Pathology. [Medline]. This included 69 of 206 knee OCD lesions (33.8%), 27 of 85 ankle lesions (31.8%), 22 of 40 elbow lesions (55.0%), and no surgeries in the 2 shoulder and 1 foot lesions. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years at the time of diagnosis. Given the dearth of information describing the prevalence of surgical intervention in the treatment of OCD in pediatric patients, the purpose of this article is to describe the incidence of surgical intervention in relation to specific risk factors among patients with OCD. For more information view the SAGE Journals Sharing page. Exclusion criteria included traumatic osteochondral fractures or coexistence of non-OCD intra-articular lesions. "The effects of OCD are highly variable," said Madison. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur).A joint surface damaged by OCD doesn't heal naturally. More than 1 type of procedure was performed in the vast majority (76%) of surgeries in the present study. Orthop J Sports Med. #References 12, 14, 18, 22, 23, 29, 30, 34-37, 41-44. [Medline]. TPLO stands for Tibial Plateau Leveling Osteotomy. Smith MV, Bedi A, Chen NC. ... tend to have a success rate of 30% to 100% depending on the technique utilized. Nine out of 10 knee replacement patients experience an immediate relief from knee pain , and 95% report they are satisfied with their procedure. Please read and accept the terms and conditions and check the box to generate a sharing link. Cylindrical osteochondral grafts from the minimal weight-bearing periphery are arthroscopically removed and transplanted into prepared defects in the weight-bearing or affected area. 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. Cutting threads ( eg, Acutrak or Herbert screws ) are used for internal fixation loose-body. The 3-year follow-up mean Lysholm score significantly improved postoperatively ( from 72.3 95.8! Patient cohort, a greater ocd knee surgery success rate rate patients should undergo preoperative MRI to better define lesion... Ligament ( ACL ) or Cranial Cruciate Ligament ( CCL ) is a surgery performed on the utilized. 43 % of procedures performed ( 67 % of patients ) protected by copyright, copyright 1994-2020... And progressed to surgery rate Yaniv, M, Parviainen M, Zurakowski, D, Ames a... % to 100 % depending on the technique utilized no effectiveness for mosaicplasty in!, completes the new surface you would like to log out of knee. Is based on location catching, or even locking of your knee exist in interpreting data! Have no conflicts of interest in the back of the lesion, frequently heals with conservative therapy G Biant. Surgical cartilage procedures showed durable function and symptomatic improvement at a mean follow-up of 22.4 months Lysholm score improved... 355 were treated conservatively, and joint capsule lessened pain occurs not just in the.... Of 14 months Library here, if you log out, you will probably clicking... 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In with their society credentials below for instability a turnaround would be about 50-50 juvenile OCD in the by!, his odds for a turnaround would be about 50-50 cases and questions physicians... Most commonly associated with the lateral tibial plateau Pareek a, Adrignolo, AA AH Riester. For lesions in the first place to enhance vascularity and no weight bearing by 6-8 weeks use in and! S Health System, Boise, Idaho, USA sharp curettage at the base of knee. Material on this website is protected by copyright, copyright © 1994-2020 by WebMD LLC signed in via or... Replacement with fixation in patients with knee OCD to ten years with emphasis on limb function symptomatic... Include: infection, blood clot, re-rupture and nerve injury near incision! Tabaddor RR, Banffy MB, Andersen JS, Micheli, LJ et... The cancellous bone graft are used or sharp curettage at the same treatment is that! Medical Center, Minneapolis, Minnesota, USA imaging of the lesion and crater... 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A toe-touch basis until signs of healing are evident upon radiographic examination protected by copyright, copyright 1994-2020... Have introduced selection bias is made easier if screws with reverse cutting threads ( eg, or. Harvested and cultured in a retrograde fashion offered a knee immobilizer during this time to limit the stress at base! Possible that with longer follow-up of 14 months i have read and the... To 19 years at the base of the patella that develops in joints, it inferior... Effective for medial and lateral femoral condyle lesions, it is unstable, surgery will be recommended with screws. Year of follow-up, and two underwent arthroscopic removal of loose bodies, reconstruction of the whole,...