Autogenous Osteochondral Grafting for Treatment of Knee Osteochondritis Dissecans: A Case Series Study. OCD is a localized lesion in which a segment of subchondral bone and articular cartilage separates from the underlying bone, leaving either a stable or unstable bone fragment. COVID-19 is an emerging, rapidly evolving situation. Stable juvenile OCD lesions (ICRS OCD grades I and II) have substantial healing potential and are treated conservatively, with a healing potential of up to 75%. Your child may see their primary care provider at first with complaints of pain and swelling. Send a custom card to a child you know or brighten any child's stay with a smile by sending a card. Fixation of the osteochondral fragment was achieved with autogenous osteochondral plugs through a posterior arthrotomy. Epub 2018 Aug 24. 2019 Jun;27(6):1726-1738. doi: 10.1007/s00167-018-5316-5. The goal of surgery is to get the piece of bone to heal. If the lesion is still attached to the bone and stable,  the surgeon will use a small wire to poke tiny holes into the lesion to cause blood to flow to the area of damaged bone to help with healing. if the piece has separated from the bone. Preoperative International Knee Documentation Committee scores assessed 5 patients as nearly normal, 8 as abnormal, and 7 as severely abnormal. In unstable lesions, the underlying bone can be significantly abno… Melugin HP, Desai VS, Levy BA, Tanaka Y, Horibe S, Nakamura N, Krych AJ. Which form loose bodies within the joint. Epub 2011 Oct 28. Figure 1: Arthroscopic view of a fragmented, unstable OCD lesion. Unstable or detached lesions may need surgery to prevent long-term issues. Arthroscopy. OCD lesions can develop when the area of bone beneath the cartilage is injured. Results of arthroscopic fixation of osteochondritis dissecans lesion of the knee with cylindrical autogenous osteochondral plugs. We present a case series of 12 teenage patients that were treated with internal fi x-ation of unstable OCD lesions of the knee. Donor site evaluation after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint. For an elbow OCD, your child may be placed into a sling for up to 6 weeks. A small piece begins to separate from the surrounding bone due to the lack of blood supply. 3 However, in unstable lesions (grades III and IV) and in all symptomatic adult OCD lesions, surgical treatment is indicated. 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. Skeletal maturity, unstable lesions or lesions that have failed to heal with nonoperative management … Orthop Traumatol Surg Res. They may also be found in the talus bone in the ankle. While the majority of patients respond to conservative treatment, those with unstable lesions require arthroscopic management. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint. For an ankle OCD lesion, your child may be placed in a boot or cast for up to 6 weeks. 2007 Feb;35(2):216-22. doi: 10.1177/0363546506294360. In children, they are most often found in the knee and elbow. This site needs JavaScript to work properly. 2005 Feb;21(2):159-66. doi: 10.1016/j.arthro.2004.10.021. The separated flakes can then ossify due to nourishment by the synovial fluid.The cartilage is damaged and can form a loose body. This helps the providers to decide on the right treatment. Knee Surg Sports Traumatol Arthrosc. Osteochondritis Dissecans (os tee o kon DRY tiss  DIS uh kanz) (OCD) is a condition that develops in the joints, most often in children and adolescents. Cartilage. Chow JC, Hantes ME, Houle JB, Zalavras CG. treatment of OCD lesions, but the goal is the same: to improve the healing poten-tial of the lesion and to potentially pro-vide stability to the lesion depending on the size. Osteochondritis Dissecans of the Knee: Short-Term Outcomes of a Hybrid Technique to Restore a Partially Salvageable Progeny Fragment. If the cartilage is already worn down, the surgeon performs a procedure using a small tool to drill into the bone to stimulate blood flow and healing, called a microfracture. Advanced technologies. Our Global Patient Services team is here to help international and out-of-area families every step of the way. They may also be found in the talus bone in the ankle. 2020 Jul;11(3):300-308. doi: 10.1177/1947603518796132. Fixation of Unstable Osteochondritis Dissecans Lesions of the Knee Using Arthroscopic Autogenous Osteochondral Grafting (Mosaicplasty) Arthroscopy. In unstable lesions, the underlying bone can be significantly abnormal and necessitate treatment. Your child cannot participate in gym class until cleared by the practitioner. Other than arthroscopy, MRI is the most accurate method for staging lesions with Stages I and II being stable. Am J Sports Med. 2020 Jan 28;8(1):2325967119898413. doi: 10.1177/2325967119898413. The cause of Osteochondritis Dissecans is largely unknown but is thought to be caused by repetitive stress to the bone. 2019. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. eCollection 2020 Jan. Filardo G, Andriolo L, Soler F, Berruto M, Ferrua P, Verdonk P, Rongieras F, Crawford DC. Microfracture or drilling of the lesion has previously been described and has shown good results for small lesions and unstable lesions … A number of surgical techniques have been described for the operative fixation of an unstable osteochondritis dissecans (OCD) lesion in the knee that has failed appropriate nonoperative management. 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 etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Figure 3: Fibrocartilage beginning to grow over the bone at four weeks. Surgery often involves an arthroscopic procedure. Access resources for you to use during your baby's hospital stay and at home. In the elbow, the most common area affected is the capitellum, although it has been reported to affect the olecranon and the trochlea. Technique In our experience, the described technique works Methods: Clinically relevant articles of high levels of evidence are required to change surgical practice. PURPOSE: Several bioabsorbable and metal options are available for internal fixation of an unstable osteochondritis dissecans (OCD) lesion, but currently there are little data on outcomes with metal headless compression screws in the adult knee. Purpose: To determine the (1) healing rate after internal fixation of unstable OCD between skeletally immature and mature knees, (2) risk factors for failure, and (3) patient-reported outcomes among healed patients. 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. HHS Osteochondritis Dissecans (os tee o kon DRY tiss DIS uh kanz) (OCD) is a condition that develops in the joints, most often in children and adolescents. Nonoperative management is primarily reserved for skeletally immature patients with stable lesions. of unstable OCD lesions.6,8,12 These re-ports mostly consisted of small case se-ries with comparatively short follow-up, but reported 80% good and excellent results with this technique. Contralateral Lateral Femoral Condyle Allografts Provide an Acceptable Surface Match for Simulated Classic Osteochondritis Dissecans Lesions of the Medial Femoral Condyle. Knee Surg Sports Traumatol Arthrosc. Iwasaki N, Kato H, Kamishima T, Suenaga N, Minami A. A high signal rim and a high signal interface on T2 MR images of OCD lesions in the humeral capitellum reportedly suggest that the lesion is unstable [3, 12]. 2020 May;8(3):426-431. doi: 10.22038/abjs.2019.39026.2038. We report the results of a new fixation technique for unstable OCD lesions using arthroscopic autogenous osteochondral grafting (mosaicplasty). Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Prior reports have described debridement, microfracture, retrograde drilling, osteochondral autologous transplantation surgery, distal humeral realignment osteotomy, and direct repair with pins or osteochondral pegs. The average preoperative visual analog pain score out of 10 was 8.3, which was reduced to 0.8 at 6 months and to 0 at 1 year after surgery. In the talus, 96% of lateral lesions and 62% of m… Figure 4: Healed OCD lesion (by MRI) with intact layer of fibrocartilage. Abstract Background: Limited data exist regarding the indications and expected outcomes of internal fixation of unstable in situ osteochondritis dissecans (OCD) lesions of the capitellum. For a while, your child will not be able to bear weight on the affected limb. They will be out of sports and activities for several months to give the lesion time to heal. Expertise.  |  USA.gov. Clipboard, Search History, and several other advanced features are temporarily unavailable. arthroscopic technique used to treat an unstable OCD lesion of the femoral condyles. Early on the cartilage over this diseased bone is intact, but it can later break off with the underlying bone and float freely within the knee joint. Miura K, Ishibashi Y, Tsuda E, Sato H, Toh S. Am J Sports Med. OCD usually occurs in the anterolateral portion and must be distinguished from the normal pseudodefect in the posterior capitellum. Purpose:  |  Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up study. You can expect to have regular follow-up appointments with your child's doctor. For unstable OCD lesions not amenable to conservative treatment, previous studies have shown excellent outcomes in patients undergoing osteochondral fixation, with hardware placement and technique being critical determinants of patient outcomes. Please enable it to take advantage of the complete set of features! Signs of infection after surgery include one or more of the following: The practitioner will discuss with you what activity restrictions your child will have. The small piece of bone and the cartilage covering it begins to crack and loosen (see Picture 1). It will open tomorrow at 3:00PM. Epub 2007 Aug 27. Epub 2017 Jun 22. Unstable juvenile OCD with displaced fragment References [1] Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW (2018) Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Versier G, Dubrana F; French Arthroscopy Society. At 8 months after surgery, the patient was able … They may be referred to Orthopedics or Sports Medicine for an appointment. The Importance of Having a Relationship With Your Child's Pediatrician, Questions to Ask When Choosing a Pediatrician, Attention Deficit Hyperactivity Disorder (ADHD), Ear, Nose & Throat (Otolaryngology) Services, Gastroenterology, Hepatology & Nutrition, Hematology, Oncology & Blood and Marrow Transplant, Preparing for a Primary Care or Clinic Visit, Partners For Kids: Pediatric Accountable Care, The location is currently closed. An OCD lesion involves the bone under the articular cartilage in part of the knee starting to die. OCD can mean one or more flakes of articular cartilage have become separated. The objective of this investigation was to characterize healing rates, clinical results, and functional outcomes of internal fixation of unstable in situ OCD lesions in adolescents. This leads to breakdown of the bone and causes an OCD lesion. OCD lesions can develop when the area of bone beneath the cartilage is injured. In children, they are most often found in the knee and elbow. Although many techniques exist, we favor an open surgical approach to ensure that the bone is properly managed. Epub 2018 Dec 6. Since 2018, CE-certified MAGNEZIX pins are used in our institution in these cases. Write down a list of all your questions as you think of them. At the 18-month follow-up, all of the knees were scored as normal. indications unstable lesion seen on arthroscopy or MRI >2cm in size; outcomes 85% healing rates in juvenile OCD; chondral resurfacing. These activities will be reviewed before surgery and again at your child’s first office doi: 10.1016/j.otsr.2011.09.007. *, Clicking, catching, locking sensation in the joint, Cannot participate in sports or other activities due to constant pain. This lesion, or area of damaged bone, can be: An unstable or detached lesion may become loose in the joint. Fixation of unstable osteochondritis dissecans (OCD) lesions and displaced osteochondral fragments are frequently performed procedures in pediatric orthopedic surgery. Request PDF | Osteochondritis Dissecans of the Elbow | Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. Level IV, therapeutic case series. Takahara et al. Management is similar to OCD lesions of the knee and ankle. Be sure to call your doctor if you cannot keep the appointment. If the unstable osteochondral fragment or loose bodies of OCD lesions are left in the joint with … Learn more about the symptoms of Coronavirus (COVID-19), how you can protect your family, and how Nationwide Children's Hospital is preparing. X-rays are often taken at 3 months after surgery to evaluate healing. X-rays will be taken. Serial magnetic resonance imaging scans showed healing of the bony part of the lesion in all of the knees 6 months after surgery and continuous articular cartilage healing at 9 months. reported that MR assessment agreed with the surgical findings in six of the six cases. Your child should participate in only low energy activities. If the OCD does not heal or if it is unstable, surgery will be recommended. Patients can have three different kinds of complaints, whether or not in combination: 1. OCD occurs in children, especially in pediatric athletes such as gymnasts and pitchers, who do repetitive motions, and those who participate in contact activities. Osteochondritis dissecans is a common osteochondral abnormality affecting the knee. Keyhani S, Soleymanha M, Verdonk R, Abbasian M. Arch Bone Jt Surg. 2011 Dec;97(8 Suppl):S140-53. HH-I-469 4/2020 | Copyright 2020, Nationwide Children’s Hospital. This will need surgery to repair. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. For unstable yet salvageable OCD lesions, the senior author’s preferred treatment is fixation with bone grafting. This means the surgeon will make small incisions to insert a tiny camera and tools to evaluate the area of bone damage. indications large lesions, >2cm x 2cm; knee arthroplasty If the loose piece of bone cannot be fixed, it is removed from the joint to prevent long term issues. MRI has a 97 percent sensitivity for detecting unstable lesions. During this arthroscopic procedure, the unstable fragment is hinged open, the bony bed is prepared by removing fibrous tissue, and the lesion is fixed with Bio-Compression screws (Arthrex, Naples, FL). Osteochondritis dissecans … Initial treatment involves an examination in the office. If the x-rays show a lesion, an MRI will be ordered to find out the size and stability of the lesion. Epub 2006 Dec 27. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Osteochondritis dissecans is a common osteochondral abnormality affecting the knee. Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies-The advantages of allografts to address an osteochondral challenge. Level of evidence: The cause of this lesion remains elusive. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. If you would like to schedule an appointment with one of our nationally ranked specialists or Primary Care physicians please click or call 800-881-7385. However, no one technique has been universally successful. The lesion was initially fixed with an osteochondral graft passing through the center of the fragment and then stabilized by using further grafts inserted around its periphery. Twenty patients with OCD lesions (16 International Cartilage Repair Society [ICRS] OCD type II, 3 ICRS OCD type III, and 1 ICRS OCD type IV) who had failed an appropriate course of nonoperative management underwent autogenous osteochondral grafting. In the long term OCD can lead to subsequent deg… Arthroscopy. The condition may require surgical treatment if: decreased activity has failed to make the condition better; the child is older and has less growth remaining (which means less healing potential); the lesion is larger than 1cm in diameter; or. 2007 Aug;23(8):803. doi: 10.1016/j.arthro.2007.06.001. Orthop J Sports Med. There is a possible genetic (runs in families) link, but this has not been proven. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. NLM If the xrays are normal the diagnosis is almost certainly not OCD.All OCD lesions seen on xray should be staged for stability with MRI. If the lesion has become completely detached or loose from the bone, surgery involves placing the loose piece of bone back where it belongs with screws. The OCD lesions were assessed arthroscopically and then fixed in situ by using multiple 4.5-mm osteochondral dowel grafts harvested from the edges of the femoral trochlea. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. For lesions that are unstable, cause mechanical symptoms, or fail conservative management, surgical intervention may be considered. A loose piece of bone in the joint can cause pain, swelling, and issues with range of motion. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 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