While a complete understanding of the factors that predict lesion healing has yet to be elucidated, it has long been noted that patients at or near skeletal maturity show a reduced capacity to heal after fractures or ligamentous injury compared with younger patients. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). Continuous passive motion is administered on the same day as surgery and continued for 48 hours. Manuscript content on this site is licensed under Creative Commons Licenses, The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents, http://www.creativecommons.org/licenses/by-nc-nd/3.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage. While the cause is still unknown, the same treatment is possible. However, our results indirectly support the findings of several authors who, though not necessarily documenting a lower rate of surgery in MFC lesions, have noted either a greater rate of healing in MFC lesions9 or better clinical results in classic MFC lesions in the central or lateral MFC21 as opposed to lesions elsewhere in the knee. Therapy for OCD of the ankle is guided primarily by two considerations, the location of the lesion and the radiographic findings. 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. There is still incomplete understanding, however, as to what patient factors may correlate with success or failure of conservative management and the frequency of particular procedures. 96869-overview Various modalities and techniques exist, such as fixation, debridement, microfracture, and cartilage grafting/transplantation. Cylindrical osteochondral grafts from the minimal weight-bearing periphery are arthroscopically removed and transplanted into prepared defects in the weight-bearing or affected area. This also is well described in the literature.3,23,45 Surgery may be required more often in the treatment of OCD of the elbow due to presentation of the lesions in older patients at a higher, less stable grade. [Medline]. They are used to repair combined defects of articular cartilage and bone. 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. In addition, there is no uniformity in the treatment algorithms of the many physicians involved in the care of these patients, both in terms of the indications for surgery and the types of surgeries performed. Therapy for osteochondritis dissecans of the knee is guided in large part by the age of the patient. View or download all the content the society has access to. Petrie PW. for: Medscape. About 60 percentof the recipients a… As opposed to OCD of the ankle and knee, loose body removal was also frequently performed (63.6%). Wiesler E, Poehling GG. [Medline]. 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. If the patient has open physes, care must be taken to avoid penetrating too deeply into the physis. Juvenile OCD in the knee, without a loose body lesion, frequently heals with conservative therapy. 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? MRIs showed interval healing in 16 of 17 knees at a mean follow-up of 22.4 months. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI1MzA3NC10cmVhdG1lbnQ=. Following all other surgeries, immobilization is not necessary. [Medline]. In the breakdown by ethnicity, non-Hispanic white patients had the greatest likelihood of progression to surgery (Table 4). In the breakdown by both age and joint, in patients aged 12 to 19 years, surgeries were performed for 147 OCD lesions of the knee (42.9%), 26 surgeries were performed on 72 OCD lesions of the ankle (36.1%), and 22 surgeries for 37 OCD lesions of the elbow (59.5%) (Table 2). However, it is possible that with longer follow-up of the present patient cohort, a greater rate of revision surgery could be seen. [Medline]. Long-term results of excision of the fragment, Antegrade drilling for osteochondritis dissecans of the knee, Osteochondritis dissecans of the talus: long-term results of surgical treatment, Multifocal juvenile osteochondritis dissecans of the knee: a case series, Osteochondritis dissecans of the capitellum, Osteochondritis dissecans of the ankle. 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. In the analysis by sex, no significant differences were seen for any joints (Table 4). For OCD of the ankle, progression to surgery was 38.5% among females and 21.2% among males, which, despite the difference, was not statistically significant (P = .25). Introduction. Now that surgery is completed, your horse will require special attention during the recovery period. In addition, the literature often describes juvenile and adult OCD as the same condition. Juvenile patients with ankle OCD seem to respond significantly better to conservative treatment than do their adult counterparts. Please read and accept the terms and conditions and check the box to generate a sharing link. Adult OCD in the knee, by contrast, rarely responds to conservative measures. Three of these gymnasts were treated conservatively, and two underwent arthroscopic removal of a loose body. Earlier surgical intervention should be considered for lesions in children who are approaching physeal closure. Adult ankle OCD seems to respond better than juvenile ankle OCD when surgical intervention is required. [Medline]. J Bone Joint Surg Am. Open removal of loose bodies, reconstruction of the crater base, and replacement with fixation yield a success rate of approximately 70%. One prospective study found excellent or good results in 82% of adult patients treated with arthroscopic excision, curettage, and drilling of the ankle OCD defect at a mean follow-up of 4.8 years. Nine out of 10 knee replacement patients experience an immediate relief from knee pain , and 95% report they are satisfied with their procedure. Comparison of bioabsorbable pins and nails in the fixation of adult osteochondritis dissecans fragments of the knee: an outcome of 30 knees. Nonabsorbable screws (eg, Acutrak or Herbert screws) may be used in larger lesions with a firm crater. Overall, 317 patients with a total of 334 OCD lesions were found. Lunden JB, Legrand AB. 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. Above is a photo of a typical OCD lesion within the knee. No surgeries were performed for the 2 OCD lesions in the shoulder and 1 OCD lesion of the foot (metatarsal head). 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. If bone loss is significant, cancellous bone grafting may be required. The overall progression to surgery for this younger age group was 9.2%, which was significantly lower than the progression to surgery among the older patients (P < .0001). Tech Shoulder Elbow Surg. This study found that patients younger than 45 years, patients who do not smoke, and patients with active lifestyles had the best chance for optimal outcome. 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). The leading thought as to why knee OCD happens relates to the thin layer of growth cartilage that caps the end of long bones, such as the femur or thigh bone. 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. Differences in progression to surgery were compared between different age groups, sexes, and joint locations. [Medline]. 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. After 3 months, patients who are still symptomatic or whose repeat radiographs do not show improvement should be offered surgery. Osteochondritis dissecans. J Bone Joint Surg Br. [Medline]. Various modalities and techniques exist, such as fixation, debridement, microfracture, and cartilage grafting/transplantation. Simply select your manager software from the list below and click on download. The average age is about 70. An arthroscopic surgery may be done to make small drill holes in the healthier bone around the OCD to improve the blood supply to the OCD piece (fig 3). 2007 Jun. Fixation with bone pegs had 100% effectiveness in one study of 17 patients with knee OCD. Possible interactions between age, sex, ethnicity, and progression to surgery were examined using this multivariate logistic regression analysis. Postoperative MRI coronal view showing pinning of the osteochondral defect. In this large cohort study of pediatric OCD patients, 35% progressed to surgery. 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