If you log out, you will be required to enter your username and password the next time you visit. Rogers WM, Gladstone H. Vascular foramina and arterial supply of the distal end of the femur. [13, 14] : Arthroscopic subchondral drilling, to create channels that link the subchondral bone to the fragment, Arthroscopic debridement and fragment stabilization, Arthroscopic excision, curettage, and drilling, Open removal of loose bodies, reconstruction of the crater base, mosaicplasty for fragment healing, and potential replacement with fixation, Radical removal of sclerotic bone with bone grafting of the defect and autologous chondrocyte transplantation (ie, sandwich technique). 2017;45(8):1799-1805. Diagnosed in Feb, we were told that this type of injury has a very low success rate of recovering with no form of surgery. 1977 Aug. 59(3):366-7. At a mean of 31 months postoperatively (range, 2-262 months), fragment union was observed in 18 of 22 knees (82%). J Trauma. As with knee OCD, surgical progression for ankle OCD did not significantly differ based on either sex and, in contrast to knee OCD, location within the ankle did not seem to correlate with nonoperative treatment failure. "The effects of OCD are highly variable," said Madison. [Full Text]. Despite the study weaknesses, it does provide new information regarding the patient factors associated with progression to surgery and is based on a large patient population with a consistent electronic medical record. 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. 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. Postoperative MRI coronal view showing pinning of the osteochondral defect. MRI coronal view of an osteochondral defect in the medial femoral condyle. [Medline]. [Medline]. Magnetic Resonance Imaging After Arthroscopic Microfracture of Capitellar Osteochondritis Dissecans. Following all other surgeries, immobilization is not necessary. Combinations of the different graft sizes are used to allow a greater filling rate. This does occur in other joints of the body but is more common in the knee. TABLE 5 Types of Osteochondritis Dissecans Surgerya, Progression to surgery for OCD of the knee, elbow, and ankle strongly correlated with patient age at the time of diagnosis. 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. We are unaware of any previous literature that specifically assessed age, race, lesion location, and sex as risk factors for progression to surgery as is done in this study. 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. Fixation with bone pegs had 100% effectiveness in one study of 17 patients with knee OCD. J Bone Joint Surg Am. Logistical regression analysis was performed by sex, age, and ethnicity. 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. Juvenile OCD in the knee, without a loose body lesion, frequently heals with conservative therapy. The knee is the location most often requiring surgery, with 58% of procedures for OCD lesions being performed on the knee. #References 12, 14, 18, 22, 23, 29, 30, 34-37, 41-44. Long-term follow-up, Osteochondritis dissecans of the capitellum: autologous osteochondral mosaicplasty. 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. 1975 Aug. 15(8):689-96. Osteochondritis dissecans of the humeral head. Four continued to compete in gymnastics at the 3-year follow-up. Tech Shoulder Elbow Surg. However, the study by Hefti et al20 included both adults and children and did not specifically assess surgical progression by age group. Therapy for OCD of the ankle is guided primarily by two considerations, the location of the lesion and the radiographic findings. 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. The goal of surgery is to get the piece of bone to heal. 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. The graft is usually harvested from the patient's knee on the same leg, from an area of that joint that does not bear any load. Osteoarthritis is the most common form of arthritis and can be found in many joints, but the knee is commonly affected. Chondrocytes are arthroscopically harvested and cultured in a cell culture laboratory for 2-3 weeks. Arthroscopic drilling with fixation in patients with knee OCD yields good or excellent results in approximately 94% of patients. J Bone Joint Surg Am. OCD occurs not just in the knee, but in the ankle and elbow as well. J Bone Joint Surg Am. All lesions except 1 healed after retroarticular drilling, and healing was achieved at a mean of 4.4 months on plain radiographs and 7.6 months on magnetic resonance imaging. Surgical technique. Anteroposterior radiograph showing lucency in the medial femoral condyle. While the cause is still unknown, the same treatment is possible. The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described. Similarly, in our cohort, just over half of the elbow lesions progressed to surgery. Robert D Bronstein, MD Associate Professor, Department of Orthopedics, Division of Athletic Medicine, University of Rochester School of Medicine They are used to repair combined defects of articular cartilage and bone. The OCD can however, affect any part of the joint, although it is very rare that it affects the tibial surface. 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. Adult ankle OCD seems to respond better than juvenile ankle OCD when surgical intervention is required. 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). “Success with the technique depends on introducing the blood supply from underlying healthy bone, which likely helps to support ingrowth of new bone, as well as fibrocartilage growth and repair,” explains Black. [Medline]. it is unstable, surgery will be recommended. The lack of blood supply causes the cartilage to become damaged and crack and loosen. Although mosaicplasty was effective for medial and lateral femoral condyle lesions, it was inferior to autologous chondrocyte implantation. Their endurance is one reason that this procedure is so popular. [20]. Some society journals require you to create a personal profile, then activate your society account, You are adding the following journals to your email alerts, Did you struggle to get access to this article? 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. Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Br. A second periosteal flap is then used for the autologous chondrocyte transplantation, which is performed as previously described. After 3 months, patients who are still symptomatic or whose repeat radiographs do not show improvement should be offered surgery. The hole should be drilled through the fragment to the desired depth and screwed into place. If the patient has open physes, care must be taken to avoid penetrating too deeply into the physis. 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