Osteochondritis dissecans (OCD) is a condition that corresponds to an idiopathic focal lesion affecting the subchondral bone with possible compromise of the stability of the adjacent cartilage. Treatment depends on the size of the lesion, cartilage stability, and the physeal status. The case reported is about an 18-year-old male patient who complained of suffering from knee pain for a period of ten months. Magnetic resonance imaging (MRI) revealed a lesion of 2 cm² in the medial femoral condyle that compromised the subchondral bone, compatible with OCD. He underwent surgery that consisted of filling the subchonral defect with an iliac crest autograft and sealing the defect with a hyaluronic acid scaffold. At the 12-month follow-up, the MRI shows complete healing and the patient has resumed sports activities. Management with autologous iliac crest graft and hyaluronic acid scaffold represents an effective alternative treatment for OCD.
Adolescent ; Autografts ; Cartilage ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Knee ; Magnetic Resonance Imaging ; Male ; Osteochondritis Dissecans ; Osteochondritis ; Sports ; Tissue Scaffolds ; Transplants

OBJECTIVE: To evaluate clinical effect of autologous osteochondral transplantation in treating localized knee cartilage defects. METHODS: Fifteen patients with knee cartilage defects were treated by autologous osteochondral transplantation from January 2007 to January 2008, including 8 females and 7 males, aged from 23 to 45 years old. Preoperative and postoperative KSS score at 10 years were compared. RESULTS: All patients were followed up for 10.0 to 10.7 years, with an average of(10.2±0.3) years. Clinical score of KSS was improved from 38.86±4.09 to 85.07±2.19 at 10 years after operation(<0.05), functional score increased from 3.33±4.88 to 82.67±4.58 at 10 years after operation(<0.05), KSS score was improved form 42.20±7.84 befor operation to 167.73±6.29 at 10 years after operation, and had statistical differences before and after operation. While there was no statistical difference in stability of knee joint(>0.05). All patients had no other complications. CONCLUSIONS Through long-term follow-up of patients with cartilage defect in knee treated by autologous bone cartilage transplantation showed that this method could effectively improve function of knee joint and alleviate pain. So it is an effective method for repair of osteochondral defect.
Adult ; Bone Transplantation ; Cartilage, Articular ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; Male ; Middle Aged ; Osteochondritis Dissecans ; surgery ; Transplantation, Autologous ; Young Adult

PURPOSE: The purpose of this study is to identify bilateral differences of physeal closure of the lateral compartment of the elbow in osteochondritis dissecans (OCD) and related factors with premature physeal closure. METHODS: Initial radiographs of the bilateral elbows in 40 baseball players with OCD (group I) were reviewed for the status of physeal closure of the lateral compartment; capitellum, radial head, lateral epicondyle. Forty baseball players with medial epicondylar apophysitis (group II) were enrolled as a control. Relative status of physeal closure of dominant elbow was defined as early, same, and delayed. Bilateral differences of the status of physeal closure were analyzed between groups, and according to the radiographic stages, extent of the lesions and demographic factors in group I. RESULTS: Significant early physeal closures of dominant elbows were identified in group I in capitellum (group I, 55%; group II, 3%), radial head (group I, 53%; group II, 3%), and lateral epicondyle (group I 37%; group II, 5%). In group I, advanced stage and extended lesion showed early lateral compartment physeal closure especially in capitellum and radial head, and players with longer career length and limitation of motion showed early closure. CONCLUSION: Over the half of the adolescent baseball players with OCD demonstrated early radiocapitellar physeal closures of dominant elbow in initial presentation. Because premature physeal closure contributes to the development of arthritis without appropriate radiocapitellar remodeling, early detection of OCD is essential for prevention of arthritis and successful conservative management.
Adolescent* ; Arthritis ; Baseball* ; Demography ; Elbow* ; Head ; Humans ; Osteochondritis Dissecans* ; Osteochondritis*

The purpose of this study is to evaluate the characteristics of posterior glenoid lesion (PGL) on magnetic resonance imaging (MRI) in adolescent baseball players. Seventy-two adolescent baseball players (mean age, 15.1 years) who underwent MRI scan for dominant shoulder pain were enrolled and the location and morphologic features of PGLs were assessed on MRI. All players were divided into three groups based on the physeal status of proximal humerus: group I, open; group II, partial closure; and group III, complete closure. Of the 72 players, posterior glenoid rim rounding (69%) and periosteal thickening (88%) were the main PGL on axial imaging. Osteochondritis dissecans (OCD) of glenoid (10%), Bennett lesion (6%), and posterior labral tear (21%) were also identified. On oblique sagittal imaging, bony PGL including OCD involves mid-portion of posterior glenoid consistent with the level of the infraspinatus muscle, but Bennett lesion was located relatively lower than PGL. Posterior glenoid rim rounding was more prevalent in younger players (group I, 86%; group II, 78%; group III, 43%; p=0.015), and posterior labral tears were in older players (group I, 0%; group II, 19%; group III, 38%, p=0.027). Factors related with prevalence of posterior glenoid rim rounding were increased body mass index (p=0.016), pitchers (p=0.024), and players with posterior shoulder tightness (p=0.023), but career length was not statistically significant (p=0.089). Decreasing the rate of posterior glenoid rim rounding with skeletal growth implies that it may be recovered through the remodeling process, and labral tears are increasing internal impingement lesion after physeal closure.
Adolescent* ; Baseball* ; Body Mass Index ; Humans ; Humerus ; Magnetic Resonance Imaging* ; Osteochondritis Dissecans ; Prevalence ; Shoulder ; Shoulder Pain ; Tears

PURPOSE: We compared the results between conservative and surgical treatment methods in a group of children and adolescents with osteochondritis dissecans of the talus. MATERIALS AND METHODS: A total of 24 patients (31 ankles), who were younger than 18 years old, were included in this study. Group 1 consisted of 14 ankles (mean age at the time of treatment was 13.0 years) treated conservatively. Group 2 consisted 17 ankles (mean age at the time of treatment was 15.1 years) treated surgically. According to the Berndt and Harty classification, there were 6 ankles in class I, 4 in class II, 3 in class III, and 1 in class IV in group 1; 1 ankle in class I, 9 in class II, and 7 in class III in group 2. In group 1, there were 13 medial lesions and 1 lateral lesion; and in group 2, there were 14 medial lesions and 3 lateral lesions. The mean follow-up period was 31.9 months for group 1 and 28.9 months for group 2. Clinical and radiologic results were analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the classification by Higuera et al. RESULTS: The mean AOFAS clinical score was 91.4 in group 1 and 87.5 in group 2. According to the classification by Higuera et al., regarding clinical results, there were 6 excellent, 7 good, and 1 fair in group 1, and 5 excellent, 2 good, and 10 fair in group 2. As for radiological results, there were 13 good and 1 fair in group 1, and 10 good and 7 fair in group 2. There was no statistical difference between the two groups. CONCLUSION: Conservative treatment provided satisfactory results for osteochondritis dissecans of the talus in children and adolescents.
Adolescent ; Ankle ; Child ; Classification ; Follow-Up Studies ; Foot ; Humans ; Osteochondritis Dissecans* ; Osteochondritis* ; Talus*

BACKGROUND: This study aimed to evaluate the clinical and radiological outcomes of arthroscopic bioabsorbable screw fixation in osteochondritis dissecans (OCD) in adolescent patients with unstable lesions causing pain. METHODS: The study included 11 patients (10 males and 1 female) with OCD who underwent arthroscopic bioabsorbable screw fixation between July 2007 and February 2014 and were available for follow-up for more than 12 months. The mean age at diagnosis was 16.3 years (range, 11 to 19 years), and the average follow-up period was 51 months (range, 12 to 91 months). Clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, and International Knee Documentation Committee (IKDC) score measured before surgery and at follow-up. Functional evaluation was made using the Tegner activity scale. Magnetic resonance imaging (MRI) and second-look arthroscopy were performed at the 12-month follow-up. RESULTS: Between the preoperative assessment and follow-up, improvements were seen in the KOOS (range, 44.9 to 88.1), Lysholm knee score (range, 32.6 to 82.8), and IKDC score (range, 40.8 to 85.6). The Tegner activity scale also improved from 2.8 to 6.1. Based on postoperative MRI, there were eight Dipaola grade I cases and three grade II cases. No complications due to fixation failure developed in any case. Second-look arthroscopy at 12 months postoperatively revealed that the lesion was covered with cartilage in all cases. CONCLUSIONS: For unstable OCD lesions causing pain in adolescents, arthroscopic bioabsorbable screw fixation provided favorable outcomes with reduced pain and restoration of movement. Therefore, it should be considered as an effective treatment for OCD.
*Absorbable Implants ; Adolescent ; Adult ; Arthroscopy/adverse effects/*instrumentation/methods ; *Bone Screws ; Child ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Osteochondritis Dissecans/*diagnostic imaging/*surgery ; Range of Motion, Articular ; Treatment Outcome ; Young Adult

The optimal treatment for combined osteochondritis dissecans (OCD) with considerable bony defect of the lateral femoral condyle (LFC) and torn discoid lateral meniscus is unclear. We present a case of a 15-year-old female who was a gymnast and had a large OCD lesion in the LFC combined with deficiency of the lateral meniscus. The patient underwent the "one-step" technique of osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation after a failure of meniscectomy with repair at another hospital. Twenty-four months postoperatively, clinical results were significantly improved. Follow-up imaging tests and second-look arthroscopy showed well incorporated structured bone graft and fibrous cartilage regeneration as well as stabilized lateral meniscus allograft. She could return to her sport without any pain or swelling. This "one-step" surgical technique is worth considering as a joint salvage procedure for massive OCD lesions with torn discoid lateral meniscus.
Adolescent ; Allografts ; Arthroscopy ; Autografts ; Cartilage ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Menisci, Tibial ; Osteochondritis Dissecans ; Regeneration ; Sports ; Tears ; Transplantation ; Transplants

OBJECTIVETo study clinical results of reduction and fixation under arthroscopy for the treatment of osteochondrotical lesion in the knee.

METHODSFrom December 2012 to December 2013, 4 patients with the knee joint osteochondritis lesion and free bone fragments were treated with arthroscopy to detect the stripped cartilage, and then the cartilages were reduced with small incision and fixed by cartilage nail. There were 3 males and 1 female, with age of 15, 15, 20 and 27 years old. The durations of the disease were 1 d, 5 d, 1 month and 1 year. All the patients had swelling and effusion in the knee joint, and the floating patellar test was positive. CT examination showed bone defects and loose bodies. The Lysholm, VAS, and Tegner scale were used to evaluate the knee joint functions before and after operation.

RESULTSAll the patients underwent successful surgery. Postoperative CT showed good location of the cartilage without loss of reduced bone and cartilage. All the patients were followed up, and the duration ranged from 10 to 13 months, with a mean of 12 months. In one patient, arthroscopy examination was conducted for a second time to examine the connection of the fracture part to the surrounding cartilage, and it showed that the internal fixator was not absorbed. The Lysholm, VAS and Tegner scale of all patients were better than those before operation.

CONCLUSIONTreatment of osteochondritis lesion with the fixation of absorbable cartilage nails may reconstruct the integrity of articular surface and recover the stability of joints, and it is an effective treatment method.

Adolescent ; Adult ; Arthroscopy ; methods ; Female ; Humans ; Knee Joint ; surgery ; Male ; Osteochondritis Dissecans ; etiology ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Visual Analog Scale

Numerous procedures exist to treat osteochondritis dissecans (OCD); however, it remains a topic of debate which procedure is most ideal. When restoring a massive osteochondral defect, the use of only one procedure may not always allow complete filling of the defect. This case report presents a massive OCD with displaced osteochondral fragment and loose body in the knee joint that occupied almost all of the weight bearing area of the medial femoral condyle and was treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. To our knowledge, this is a rare report on OCD treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. At 8 years after surgery, the clinical outcome was excellent, and radiographs revealed congruence of the medial femoral condyle. The patient returned to sports activities. In massive and complex OCD lesions, individual techniques have limitations. Two or more techniques are needed to increase the rate of success.
Autografts ; Follow-Up Studies ; Humans ; Knee Joint ; Osteochondritis Dissecans ; Osteochondritis ; Sports ; Transplantation, Autologous ; Weight-Bearing

Along with the popularity of youth movement, the incidence of osteochondritis dissecans (OCD) showed a trend of increase, but its pathogenesis is not yet clear. Previous studies suggested that trauma is the main potential cause, but with the emergence of vast family cases, hereditary factor is also gradually taken seriously. Arthroscopy is the "gold standard" for diagnosing OCD, but for the patient with early incomplete joint surface lesions, the diagnositic value of MRI is better than the arthroscopy. For the patients with stable form OCD, nonoperative management should be used such as adjusting activity, fixator and drugs; for the patient with unstable form OCD or failing after conservative treatment, surgery should be generally used such as joint clearing, drilling, microfracture method, fixation and transplantation. With the progress of research, stem cell technology and platelet-rich plasma gradually applied in cartilage repair, which will improve the curative effect of OCD, but still further clinical and experimental research, and also a long-term effective follow-up are needed.
Humans ; Osteochondritis Dissecans ; diagnosis ; etiology ; therapy