In specific cases, if caught early enough, a harmless dye will be injected into the blood stream to show where calcium will accumulate. The moderator was familiar with the methods and procedures of aaos appropriate use criteria and led the panel as a nonvoter in discussions. Osteochondritis dissecans is a long recognized yet poorly understood condition. Osteochondritis dissecans wikimili, the best wikipedia reader. Ocd is a focal lesion of subchondral bone and subsequently the. The mri findings of unstable and stable osteochondritis dissecans of the capitellum are similar to the findings described for osteochondritis dissecans of the femoral condyles and talar dome. Patientreported questionnaires were collected at the final followup. Lower extremity alignment should be assessed with a fulllength lower extremity film. David lintner he also specializes in injuries to throwers shoulders and elbows, having written more than thirty scientific articles about acl injuries, throwers injuries, and other sports medicine issues.
Management of osteochondritis dissecans of the knee. Role of magnetic resonance imaging and clinical criteria in predicting successful nonoperative treatment of osteochondritis dissecans in children retrospective case series jurgensen 2002 arthroscopic versus conservative treatment of osteochondritis dissecans of the knee. The incidence of surgery in osteochondritis dissecans in children and adolescents. To diagnose osteochondritis dissecans, an xray, ct scan or mri scan can be performed to show necrosis of subchondral bone, formation of loose fragments, or both. Internal fixation of osteochondritis dissecans of the knee. A retrospective cohort study was performed at 5 to 19 years followup. Jan 31, 2014 osteochondritis osteochondrosis dissecans ocd is a common condition in children, adolescents, and young adults. Osteochondritis dissecans ocd of the elbow is a condition that occurs in children and adolescents who participate in sports that place a large amount of stress on the elbow joint. However, affected people may experience pain, weakness andor decreased range of motion in the affected joint if the cartilage and. Juvenile versus adult osteochondritis dissecans of the knee. It results in significant pain and swelling in the affected joint, depriving it of its normal range of function.
Describing ocd together with osteochondral fractures and epiphyseal ossification disturbances and considering these three conditions as one entity has caused much confusion. Feb 07, 2018 the name osteochondritis dissecans ocd is a misnomer. Osteochondritis dissecans of the elbow occurs when a portion of bone or cartilage is cut off from its blood supply. Osteochondritis dissecans ocd is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Management depends on the stability of the lesion, which can be determined using clinical history, physical examination, mri, and bone scans. A small area of cartilage fails to mature into bone and becomes thickened and necrotic. Osteochondritis dissecans ocd is defined as an inflammatory pathology of bone and cartilage. Osteochondritis dissecans of the shoulder clinicians brief.
Osteochondritis dissecans ocd is a common cause of knee pain and dysfunction in both adult and skeletally immature patients. Age distribution and localization combined with the radiologic and surgical presentation. Age distribution and localization combined with the radiologic and surgical presentation distinguishes. Although the symptoms of ocd can be vague, plain radiographs can make the diagnoses. Osteochondritis dissecans ocd of the knee is an idiopathic, focal, subchondralbone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis.
Osteochondritis dissecans ocd is an acquired condition affecting subchondral bone that manifests as a pathologic spectrum including softening of the overlying articular cartilage with an intact articular surface, early articular cartilage separation, partial detachment of an articular lesion, and osteochondral separation with loose bodies. Osteochondritis dissecans occurs in 1529 people per 100,000 each year 14. Osteochondritis dissecans osteochronditis dissecans aka ocd is a condition in which the bone that supports the cartilage inside a joint undergoes softening. Osteochondritis dissecans is a joint condition that occurs when a piece of cartilage and the thin layer of bone beneath it, separates from the end of the bone. This piece of bone and cartilage can become loose and even break off into the joint. However, the disease can be confirmed by xrays, computed tomography ct or magnetic resonance imaging mri scans. A decision to progress each patient to the next phase should be. Nonsurgical treatment is successful in 50% of the cases. A patient s guide to osteochondritis dissecans of the knee. Magnetic resonance imaging mri offers promise as a noninvasive method to determine the potential of an osteochondritis dissecans ocd lesion to heal without surgical intervention.
The forces needed to cause ocd are produced primarily in athletes participating in baseball and gymnastics. Osteochondritis dissecans of the knee is a disorder in which fragments of bone or cartilage come loose and float around in the knee joint. Unstable osteochondritis dissecans lesions are surrounded by a rim of high signal intensity or a fluidfilled cyst on t2weighted images. In osteochondritis dissecans of the knee, juvenile osteochondritis dissecans tends to be stable at presentation, whereas adolescent and adult osteochondritis dissecans tend to be unstable at presentation 5. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. The treatment for osteochondritis dissecans is to rest your elbow until the symptoms are gone. This case shows an atypical presentation of an osteochondritis dissecans ocd lesion of the radial head with detachment diagnosed on plain radiographs and magnetic resonance imaging mri. This can result in localised necrosis and fragmentation of bone and cartilage.
Ocd usually causes pain and swelling of the affected joint which catches and locks during movement. Osteochondritis dissecans definition of osteochondritis. Some symptoms of late stages of osteochondritis dissecans are found with other diseases like rheumatoid disease of children and meniscal ruptures. Apr 28, 2017 heywood cs, benke mt, brindle k, fine km. Figure caption and citation for the preceding image starts. In this view we can see the meniscus and the ocd lesion. Magnetic resonance imaging all abnormalities on plain film or ct should be evaluated for stability by mri. 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. In this case, you can see disruption of the bone and some cysts forming near the ocd lesion. If the piece of cartilage and bone remain close to where they detached, they may not cause any symptoms. Osteochondritis dissecans of the patella is a rare cause of anterior knee pain. See the main osteochondritis dissecans article for a general discussion on. If malalignment exists and the weightbearing line passes through the involved compartment, some orthopedic surgeons will consider an osteotomy to unload the involved compartment. Osteochondritis dissecans radiology reference article.
It involves localized avascular necrosis of subchondral bone and subsequent loss of structural support for the adjacent articular cartilage. Osteochondritis dissecans ocd or od is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. The exact cause and natural history remain elusive in the literature. Introduction osteochondritis dissecans ocd is a problem that affects the knee, mostly at the end of the big bone of the thigh the femur. Osteochondritis dissecans of the ankle radiology reference. Nov 04, 2015 osteochondritis dissecans ocd is a pathological process affecting the subchondral bone of the knee in children and adolescents with open growth plates juvenile ocd and young adults with closed growth plates adult ocd. See the main osteochondritis dissecans article for a general discussion on this condition, which mostly affects the knees. Joints nonneoplastic disease osteochondritis dissecans. Compared with the knee, however, osteochondritis of the capitellum is much less common. How to read an mri of an osteochondritis dissecans lesion. Osteochondritis of left humeral head with secondary deformation of bone, eighth to ninth century from iona.
A decision to progress each patient to the next phase should be made solely on the ability to demonstrate the. Management of osteochondritis dissecans springerlink. The scope of this guideline is specifically limited to osteochondritis dissecans of the knee. Magnetic resonance imaging mri of knee demonstrating healing from the collection of h. Osteochondritis dissecans approach bmj best practice. A 26yearold han chinese woman presented with a lesion on her left medial tibial plateau. Bioabsorbable lag screw fixation of knee osteochondritis dissecans in the skeletally immature. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement. Osteochondritis dissecans affects joints of children and young adults and forms a common cause for loose bodies in the synovial joints, most often in the knees.
Ocd of the elbow is most commonly seen in the sporting adolescent population ages 1214 in particular throwing sports or upper limb dominant sports such as baseball or hockey. A joint surface damaged by ocd doesnt heal naturally. Osteochondritis dissecans ocd fixation knee osteochondritis is a condition in which the blood supply to an area of bone is disrupted. The next sequence in how to read an mri of an osteochondritis dissecans lesion is the sagittal view. Osteochondritis dissecans of the knee sciencedirect. This softening is caused by an interruption in the blood flow to that portion of the bone. Other terms for this condition are chondral fracture and osteochondral fracture. Osteochondritis dissecans ocd is a pathological process affecting the subchondral bone most often in the knee joint of children and adolescents with open growth plates juvenile ocd and young adults with closed growth plates adult ocd. A nonvoting moderator, who is an orthopaedic surgeon, but is not a specialist in the treatment of osteochondritis dissecans, moderated the voting panel. Specifically, magnetic resonance imaging mri and arthroscopic knee surgery are. Coronal magnetic resonance image mri of the talus showing an osteochondral lesion on the medial aspect of the talar dome gupta rk, kansay r, aggarwal v, et al. Mri findings of osteochondritis dissecans of the capitellum.
Osteochondritis dissecans is a common cause of forelimb lameness in large, rapidly growing breeds. Osteochondritis dissecans located on the medial tibial. The objective of our study was to correlate specimens of juvenile osteochondritis dissecans ocd lesions of the knee to mri examinations to elucidate the histopathologic basis of characteristic imaging features. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with. Osteochondritis dissecans genetic and rare diseases. Jun 10, 2016 osteochondritis dissecans ocd is a pathological process affecting the subchondral bone most often in the knee joint of children and adolescents with open growth plates juvenile ocd and young adults with closed growth plates adult ocd. 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. It is an inherited disease that disrupts the normal ossification of cartilage in growing dogs. Diagnosis and treatment luiz aurelio mestriner abstract osteochondritis dissecans ocd is a pathological process affecting the subchondral bone of the knee in children and adolescents with open growth plates juvenile ocd and young adults with closed growth plates adult ocd. Osteochondritis dissecans is typically seen more often in young athletes, particularly young baseball pitchers. As a result, the area of bone and its overlying cartilage can separate from the rest of the bone. Feb 24, 2012 osteochondritis dissecans is a long recognized yet poorly understood condition. 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 may happen.
The fragments may also be referred to as a joint mouse or loose bodies. Osteochondritis dessicans of the talus in a 26yearold woman. Sports medicine center for musculoskeletal care 333 east 38th street new york, ny 10016 tel. Osteochondritis dissecans of the elbow physiopedia.
An illustrative case in a 22yearold man demonstrates the current imaging modalities and surgical treatment. Osseous manifestation of juvenile osteochondritis dissecans. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. Osteochondritis dissecans an overview sciencedirect topics. A patients guide to osteochondritis dissecans of the knee compliments of. Osteochondritis dissecans ocd is a pathological process affecting the subchondral bone of the knee in children and adolescents with open growth plates juvenile ocd and young adults with closed growth plates adult ocd. In this case report, we reported a rare case of osteochondritis dissecans located on the medial tibial plateau. Osteochondritis dissecansocd of the elbow is a condition that occurs in children and adolescents who participate in sports that place a large amount of stress on the elbow joint.
To determine whether pains are osteochondritis dissecans, an mri, ct scan or xray can be performed to show necrosis of subchondral bone andor formation of loose fragments. Osteochondritis dissecans ocd of the ankle is the end result of the aseptic separation of an osteochondral fragment of the talar dome with the gradual fragmentation of the articular surface. The etiology and pathogenesis of the disease remains largely unknown. Even with surgery, ocd usually leads to future joint problems. Longterm results after operative treatment of osteochondritis dissecans of the knee joint30 year results. You should apply ice to the elbow for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain and swelling go away. Mri can further characterize the lesions stability. Your doctor may prescribe an antiinflammatory medication. Rehabilitation guidelines for osteochondritis dissecans. Prognostic factors related to successful conservative treatment include absence of mri features of instability, small size, and. Treatment of osteochondritis dissecans is jointspecific.
Osteochondritis osteochondrosis dissecans ocd is a common condition in children, adolescents, and young adults. Feb 08, 2015 osteochondritis dissecans is a joint condition that occurs when a piece of cartilage and the thin layer of bone beneath it, separates from the end of the bone. Clinical guidelines for ocd osteochondritis dissecans. Osteochondritis dissecans are typically located mainly on the femoral condyle, with reported but less common cases of patella involvement. Osteochondritis dissecans ocd is the end result of the aseptic separation of an osteochondral fragment with the gradual fragmentation of the articular surface. Time frames below are provided for reference, but should not be used as criteria to progress each patient to the subsequent phase of rehabilitation. Osteochondritis dissecans is a fracturing or cracking of the articular cartilage, the material lining the end of a bone, and the subchondral bone underneath it. Osteochondritis dissecans of the capitellum is similar to osteochondritis dissecans in other joints, such as the knee. Osteochondritis dissecans wikimili, the best wikipedia.
746 402 1210 1286 116 679 870 1422 171 367 1501 459 729 497 754 88 337 243 43 1386 753 1382 170 1397 716 816 1385 693 439 482 806 1163 363 1157 1247 814 165 1452