A systematic review on the management of idiopathic avascular necrosis of the scaphoid (Preiser's disease).

BACKGROUND: Treatment options for patients with Preiser's disease are challenging and varied. This article thus provides a systematic review of existing studies on the outcomes of the treatments for patients suffering from Preiser's disease in order to investigate the most appropriate management of Preiser's in each stage of the disease. METHODS: We followed PRISMA guidelines while performing the study, and reviewed 107 papers in all languages from 1981 till November 2020 and included 42 studies that met the eligibility criterion. Studies investigating the outcome of one or more treatment options for Preiser's disease were eligible. Besides, quantitative analysis on 130 individuals (135 wrists) of the included studies was performed. RESULTS: The results show that in stages II and III, pain score reduces more in surgical approach than in conservative treatment. In stage II of the Preiser's, Vascularized Bone Grafting (VBG) was more effective in pain alleviation and improvement in wrist range of motion (ROM) and Mayo Modified Wrist Score (MMWS) than immobilization. Proximal Row Carpectomy (PRC) in stage III causes more pain relief and ROM improvement than VBG and conservative treatments like prescribing NSAIDs. Inconsistent evidence was found in case studies of stage IV; however, they generally favour PRC and SILASTIC implants. Surgical studies of stage I are not yet enough for making a conclusive assessment. CONCLUSION: Surgical treatment outcomes seem more satisfactory in all Preiser's disease stages. Specifically, VBG for patients of stage II provided they have no scaphoid degenerative changes, and PRC seems more satisfactory for stage III. LEVEL OF EVIDENCE: IV; systematic review of case reports and case series on Preiser's disease.

[Juvenile osteochondrosis and osteonecrosis]. / Juvenile Osteochondrosen und Osteonekrosen.

BACKGROUND: Juvenile osteonecrosis is an important topic in orthopedics. A wide variety of body regions of the growing patient are affected, predominantly during adolescence. All are characterized by a usually unknown aetiology as well as a stadium-like course. The main problem is a local osseous circulatory disorder, which causes osteonecrosis. RISK FACTORS: Mechanical overloading due to increased body weight, axial misalignment, and sports activity is discussed as a risk factor. Healing depends on the localization and extent of the osseous necrosis. DIAGNOSTICS: Diagnostically, radiologic imaging is used, in which the typical bony remodeling can be followed. THERAPY: The therapeutic procedure depends on the affected region but is usually accompanied by a reduction of mechanical loading. If the clinical and radiological findings worsen, surgical treatment must be considered. The recognition and treatment of juvenile osteonecrosis is important and significantly influences the further development of the patient.

Dual diagnosis of osteogenesis imperfecta (OI) and short stature and advanced bone age with or without early-onset osteoarthritis and/or osteochondritis dissecans (SSOAOD) reveals a cumulative effect on stature caused by mutations in COL1A1 and ACAN genes.

Short stature is a feature when a person's height is more than 2 SDS below the corresponding mean height for a given age, gender and population. It can be influenced by many factors essential to growth plate. Here we report a three-generation family with 13 patients affected by osteogenesis imperfecta (OI) type I, short stature and advanced bone age, with or without early-onset osteoarthritis and/or osteochondritis dissecans (SSOAOD) or both. Panel sequencing of the proband revealed mutations in two extracellular matrix related genes: COL1A1 and ACAN. When comparing the quantitative trait, height within the family of different mutation carrier groups, we found an interesting cumulative effect, the ones with both mutations manifest shortest stature. Dual diagnoses of the family also suggest the necessity of a comprehensive molecular diagnosis method, such as panel/exome sequencing, especially encountering patients with novel phenotype or extreme trait.

Osteochondral lesion of the talus in children: Are there MRI findings of instability?

PURPOSE: The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. MATERIALS AND METHOD: This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March 1, 2011, and May 31, 2018. Blinded to the clinical outcome, 2 radiologists retrospectively assessed each MRI study for the presence or absence of various features on the articular side, along the interface, and on the subchondral side of each lesion. Regional skeletal maturity was recorded. Lesion stability was classified using clinical and surgical findings. Mann-Whitney U, Chi-square, Fisher's exact, and Cochran-Armitage tests were used to compare demographic and MRI findings between children with stable and unstable lesions. RESULTS: Of the 48 ankles identified, 36 were stable (12.7 + 3.9 years) and 12 were unstable (14.2 + 1.6 years) lesions. None of the lesions presented as a detached fragment. Skeletal immaturity (p = 0.01) was significantly more common in stable than unstable lesions. No other MRI features were found to be significantly different between stable and unstable lesions, which included the presence of an effusion (p = 0.27), intra-articular body (p = 0.25), cartilage changes (p = 0.19), subchondral disruption (p = 0.51), T2-weighted signal intensity rim (p = 0.16), cysts (p = 0.48), marginal sclerosis (p = 0.70), and perilesional marrow edema (p = 0.17). CONCLUSION: Results from our study suggest that previously published OCD criteria using conventional MRI are not sufficient for predicting stability of OLT in children. Regional skeletal maturity and older age were more predictive of unstable lesions.

An Unusual Case Report of a Stage IV Osteochondral Defect Imitating a Medial Malleolar Avulsion Fracture.

Osteochondral lesions of the talar dome are severely debilitating injuries that frequently can be missed on initial radiographic evaluation. In this case, we present the case of a 17-year-old male who injured his right ankle while skateboarding. Initial radiographic findings showed what appeared to be an avulsion fracture of the medial malleolus, and the patient was subsequently treated with immobilization. It was not until more advanced imaging of computed tomography was performed that the patient was appropriately diagnosed with a displaced talar dome fragment that was positioned in the medial gutter, requiring surgical intervention. This case report serves to show the importance of a proper workup, including advanced imaging, when clinical suspicion of a talar dome lesion is suspected. To the best of our knowledge, this is the only case in literature where a talar defect presents in the medial gutter of the ankle, imitating an avulsion of the medial malleolus.

Juvenile Osteochondritis Dissecans of the Trochlea: A Cohort Study of 34 Trochlear Lesions Associated With Sporting Activities That Load the Patellofemoral Joint.

BACKGROUND: Juvenile osteochondritis dissecans (JOCD) lesions are rarely located in the trochlea and few studies have focused on the causes and outcomes of JOCD lesions in this part of the knee. The purpose of this study is to (1) evaluate the clinical characteristics and outcomes of patients who undergo surgery for JOCD in this unusual location as well as (2) assess the association between trochlear JOCD and participation in sporting activities that load the patellofemoral joint. METHODS: We conducted a retrospective cohort study of 34 trochlear JOCD lesions in 30 patients. Cases that involved traumatic cartilage shear or patella instability were excluded. Preoperative and postoperative magnetic resonance images and x-rays were evaluated and demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from medical records. A case-control cohort of 102 femoral condyle lesions was used to assess the correlation between sports played and lesion location. RESULTS: The cohort comprised 34 consecutive trochlear JOCD lesions in 30 patients (26 males, 4 females). Average age at surgery was 13.8 years (9.3 to 18.0 y). In total, 27 (90%) patients were active, and of these active patients, soccer and basketball were the most common sports played. In the case-control comparison, the correlation between playing either basketball or soccer and the presence of a trochlear JOCD lesion was statistically significant (P=0.017). In total, 21 knees (62%) received operative treatment. Sixteen of the surgical patients underwent repair and fixation with bioabsorbable nails. The average length of clinical and radiographic follow-up was 21.1 months. All patients who underwent fixation showed radiographic and/or clinical indications of healing at most recent follow-up. Thirteen of the patients who underwent fixation were active, and all of these patients reported successful return to sports. Thirteen knees underwent nonoperative treatment, and the majority of these patients had limited follow-up. CONCLUSIONS: We report a significant association between pediatric athletes who play basketball and soccer and the development of trochlear JOCD, suggesting that repetitive loading of the patellofemoral joint may play a role in the development of JOCD lesions. Patients with trochlear JOCD lesions were likely to undergo surgery, and repair and fixation of the lesions produced good outcomes at short-term follow-up. LEVEL OF EVIDENCE: Level III-case-control study.

Stable childhood osteochondral lesions of the talus: short-term radiographic outcomes suggest risk for early osteoarthritis.

Recent literature suggests that adults do not necessarily develop osteoarthritis if they have an osteochondral lesion of the talus (OLT). The purpose of this study was to determine if children with OLT are at risk to develop any radiographic evidence of early joint degeneration despite treatment efforts. Fifty-six ankles were identified over 6 years with stable OLT that underwent operative treatment. Preoperatively, each lesion was classified according to Berndt-Hardy for radiographs, Hepple for MRI, and Ferkel and Sgaglione for computed tomography. Radiographs were also evaluated for physeal status, OLT characteristics (location, border, size), and signs of osteoarthritis (Kellgren and Lawrence Scale). Despite incomplete treatment to radiographic resolution, the Kellgren-Lawrence scores still worsened in 23% of the children (pre-op score: mean 0.42 and median 0 versus post-op score: mean 0.69 and median 1). No risk factors (preoperative classification, age, physeal patency) were associated with advancing radiographic evidence of articular degeneration utilizing univariate analysis. However, a classification and regression tree analysis revealed that a patient age of 11.5 years old could be predictive of advancing Kellgren-Lawrence scores with one-third of older children worsening (P = 0.038). Despite active treatment of OLT, the ultimate prognosis is guarded with approximately one out of four children advancing their Kellgren and Lawrence score during treatment. In contrast to the natural history of adult OLT, the short-term advancement of degenerative disease in childhood OLT suggests a potentially different outcome and warrants further investigation into better treatment methods to preserve ankle health in these young patients.

Osteochondritis Dissecans in the Knee of Skeletally Immature Patients: Rates of Persistent Pain, Osteoarthritis, and Arthroplasty at Mean 14-Years' Follow-Up.

OBJECTIVE: Osteochondritis dissecans (OCD) is a knee disorder of predominately pediatric populations. Because of low incidence, it has traditionally been difficult to study OCD. The purpose of this study was to report long-term outcomes of skeletally immature OCD lesions and determine risk factors for persistent knee pain at final follow-up. DESIGN: A geographic database of more than 500,000 patients was reviewed to identify patients with knee OCD. Clinical course including operative management, persistent knee pain, and total knee arthroplasty (TKA) were analyzed through review of radiographs, magnetic resonance images, and physician notes. RESULTS: A total of 95 skeletally immature patients (70 male, 25 female, mean age 12.5 ± 2.0 years) were followed for a mean of 14 years (range, 2-40 years). Fifty-three patients were treated operatively and 42 were treated nonoperatively. At final follow-up, 13 patients noted persistent knee pain, 8 treated operatively versus 5 treated nonoperatively. Risk factors for knee pain were female gender, patellar lesions, and unstable lesions. Four patients (8%) treated operatively and 2 patients (5%) treated nonoperatively developed symptomatic osteoarthritis at a mean of 28.6 years following diagnosis. Three patients underwent TKA at a mean age of 52 years, significantly younger than that observed for primary TKA at our institution (P = 0.004). CONCLUSIONS: Skeletally immature OCD patients have promising histories, with an estimated 14% risk of persistent knee pain, 6% symptomatic osteoarthritis, and 3% conversion to TKA at 14 years' mean follow-up. Females, patellar lesions, and unstable lesions demonstrated increased persistent knee pain risk. Patients with OCD undergo TKA at a significantly younger age than the general population.

Osteochondritis Dissecans of the Knee: Short-Term Outcomes of a Hybrid Technique to Restore a Partially Salvageable Progeny Fragment.

OBJECTIVE: This retrospective case series describes a hybrid fixation technique and determines the clinical outcomes, knee function, and activity level of patients at short-term follow-up. DESIGN: Seventeen patients (18 knees) with unstable osteochondritis dissecans (OCD) lesions involving the knee were treated with a hybrid fixation technique in which the salvageable fragment was fixed and osteochondral autograft transplantation system (OATS) was used for the unsalvageable fragment. Thirteen lesions involved the medial femoral condyle, 4 involved the lateral femoral condyle, and 1 involved the patella. Mean patient age was 17 years (range 12-28 years). All lesions were International Cartilage Repair Society (ICRS) grade III or IV. The patients were prospectively followed postoperatively. Outcome measures included the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Tegner activity scale. RESULTS: At mean follow-up of 36 months (range 24-67.2 months), the mean postoperative KOOS scores, given as mean (SD), were as follows: Quality of Life (QoL) 91.1 (17.0), Activities of Daily Living (ADL) 99.5 (1.5), Sport 94.5 (11.2), Pain 97.4 (5.8), and Symptoms 95.9 (6.5). Mean IKDC score was 96.2 (7.0). There was no significant difference between mean preinjury (7.95, SD = 1.1) and mean postoperative (7.45, SD = 1.5) Tegner scores (P = 0.363). The mean Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was 87.5 at a mean 7.8 months (range 3-18 months) postoperation. There were no reported complications. CONCLUSION: The results of this case series suggest that patients with partially salvageable OCD lesions involving the knee can have positive short-term outcomes and can expect a low complication rate when treated with a hybrid technique of fixation with osteochondral autograft transfer.

Arthroscopic Meniscopexy for the Treatment of Nontraumatic Osteochondritis Dissecans in the Knee Joint of Adult Patients.

OBJECTIVE: The etiology of osteochondritis dissecans (OCD) is still uncertain. Recently, it has been hypothesized that instability of the anterior horn of the meniscus is an important cause for the development of a nontraumatic OCD in adolescents with good results after surgical stabilization. This case series aims to evaluate the treatment results after meniscus stabilization in adults with nontraumatic OCD. DESIGN: Ten patients with magnetic resonance imaging (MRI)-confirmed OCD of the knee joint, meniscal instability, and closed epiphyseal plates were enrolled in this study. The instable meniscus was stabilized by direct suturing of the anterior horn of the meniscus. MRI examinations were performed preoperative and 6 and 12 months postoperative. The OCD was classified arthroscopically according to Guhl and according to Hughes in the MRI. The overall knee function was evaluated by the Lysholm score before treatment and 12 months postoperative. RESULTS: Four women and 6 men with a mean age of 20.6 ± 1.9 years were included in this study. Preoperatively 60% of the patients showed a grade II or III lesion arthroscopically and 70% a grade III or IVa lesion in the MRI examination. After arthroscopic meniscus stabilization the Lysholm score increased in average from 48.1 ± 14.12 before treatment to 97.5 ± 3.1 postoperative. At final follow-up after 12 months, an improvement of the OCD in the MRI could be demonstrated in all patients (100%). In 80% of the patients a complete healing of the OCD could be noted. CONCLUSION: The clinical concept of an instable anterior horn of the meniscus as a cause for the development of a nontraumatic OCD seems to be transferable to adults and arthroscopic stabilization can lead to a sufficient healing of this knee pathology.

Osteochondral lesions of the lateral trochlear ridge: a rare, subtle but important finding on advanced imaging in patients with elbow pain.

OBJECTIVE: To characterize the radiographic, CT, and MRI appearance of clinically and/or surgically proven osteochondral lesions of the lateral trochlear ridge. MATERIALS AND METHODS: Ten years of medical charts with elbow radiographic, CT, and MRI studies were retrospectively reviewed. Patients with pathology isolated to the lateral trochlear ridge were included. Studies were reviewed by two radiologists. Identifiable pathology on each type of study was noted and characterized. RESULTS: Ten elbow studies were included, all from males aged 15 to 58 years (mean 29 years). Five elbow radiographs were normal, one showed mixed lucency and sclerosis of the lateral trochlear ridge, and four demonstrated small osseous fragments adjacent to the ridge. In all cases, CT demonstrated focal lucency at the cortical surface of the lateral trochlear ridge; 8 contained small osseous fragments, axial plane maximum width ranged from 5 to11 mm, depth from 1 to 2 mm. Focal bone marrow edema in the subchondral lateral trochlear ridge was found in the 6 cases with MR images. Two demonstrated linear high signal underlying the in situ osseous fragment, faintly visible on MRI. In 9 cases, arthroscopy was performed within 3 months of imaging. The remaining patient was treated conservatively with casting. CONCLUSIONS: Osteochondral lesions of the lateral trochlear ridge are rare but important, as these patients go on to arthroscopy at a high rate. If an abnormality of the lateral trochlear ridge is seen or suspected, we recommend CT as the best imaging study to define these lesions.

Long-term results of closed-wedge osteotomy of the lateral humeral condyle for osteochondritis dissecans of the capitellum.

BACKGROUND: Various surgical methods are used for osteochondritis dissecans of the capitellum; however, we have consistently performed a closed-wedge osteotomy of the lateral humeral condyle since 1983. The purpose of this study is to clarify the long-term results of closed-wedge osteotomy for osteochondritis dissecans of the capitellum. METHODS: Seventy-seven elbows with all lesion types of osteochondritis dissecans of the capitellum were treated with closed-wedge osteotomy. Unstable osteochondral fragments were fixed with a bone graft and bone pegs in combination with osteotomy. The mean age of the patients was 14.0 years. The patients were clinically and radiographically evaluated at a median value of 9.0 years after surgery. RESULTS: The range of elbow motion and standard deviation were increased significantly from 119° ± 22° preoperatively to 131° ± 18° postoperatively (P < .001). The Timmerman and Andrews score were improved significantly from 141 ± 26 points preoperatively to 184 ± 21 points postoperatively (P < .001). The Timmerman and Andrews score and the range of elbow motion at final examination in patients with preoperative osteoarthritic changes were significantly inferior to those in patients without preoperative osteoarthritic changes. Good remodeling of the capitellar lesions was radiographically observed in 53 elbows (69%). In the long-term follow-up evaluation, although 41 elbows (53%) had advanced osteoarthritic changes that were classified as grade II or III, disease progression was controlled in most of these cases. CONCLUSIONS: Good or excellent long-term clinical results were maintained in most of our patients. Closed-wedge osteotomy of the lateral humeral condyle is a useful method that can provide acceptable long-term clinical results.

One step treatment of talus osteochondral lesions with microfracture and cell free hyaluronic acid based scaffold combination.

OBJECTIVE: The aim of this study was to assess the effectiveness of microfracture and cell free hyaluronic acid (HA) based scaffold combination in the treatment of talus osteochondral defects (OCD). METHODS: This study retrospectively evaluated the clinical results of the 20 patients (14 males and 6 females, mean age at the time of surgery: 32.9 years (range: 16-52 years)) who were treated with MFx and cell-free HA-based scaffold combination for talus OCD smaller than 1.5 cm2 and deeper than 7 mm. Results were evaluated with AOFAS and VAS scores. Also, patients' satisfaction was questioned. RESULTS: Patients were evaluated after an average follow-up of 20.3 months. Intraoperative measurements showed that mean depth of the lesions were 10.4 ± 1.9 mm after debridement. The mean preoperative AOFAS score was 57.45 ± 9.37, which increased to 92.45 ± 8.4 postoperatively (p < 0.05). VAS score was improved from 7.05 ± 2.45 to 1.65 ± 2.20 postoperatively (p < 0.05). CONCLUSION: MFx and cell-free HA-based scaffold combination appear to be a safe and efficient technique that provide good clinical outcomes for lesions deeper than 7 mm. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Decreased Defect Size and Partial Restoration of Subchondral Bone on Computed Tomography After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum.

BACKGROUND: Arthroscopic debridement and microfracture are considered the primary surgical treatment for capitellar osteochondritis dissecans (OCD). Healing of the subchondral bone plays an essential role in cartilage repair, while lack of healing is related to the development of osteoarthritis. To date, it is unknown to what extent healing of the subchondral bone occurs after this technique in the elbow. PURPOSE: To analyze defect size changes and subchondral bone healing with computed tomography (CT) after arthroscopic debridement and microfracture for advanced capitellar OCD. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 2009 and 2016, 67 patients underwent arthroscopic debridement and microfracture for advanced capitellar OCD. Fifty-four patients (81% follow-up rate) with CT scans were included (mean ± SD: preoperative, 4.0 ± 1.7 months; postoperative, 29 ± 9.0 months). OCD defect size was assessed by measuring the largest diameter in 3 directions: medial-lateral direction (coronal plane) and anterior-posterior direction and depth (both in sagittal plane). Healing of the OCD was divided into 3 categories: good-complete osseous union or ossification; fair-incomplete osseous union or ossification but improved; poor-no changes between pre- and postoperative scans. Postoperative clinical outcome was assessed with the Oxford Elbow Score (OES) at the same time as the postoperative CT scan. RESULTS: There were 30 female and 24 male patients (age, 15.7 ± 3.2 years). Defect size decreased ( P < .001) in all 3 directions (medial-lateral × anterior-posterior × depth) at 29 ± 9.0 months: preoperatively, 7.9 ± 2.8 × 8.0 ± 3.2 × 4.1 ± 1.5 mm; postoperatively, 3.5 ± 3.3 × 4.0 ± 3.5 × 1.6 ± 1.4 mm. Healing of the subchondral bone was graded as good in 19 defects (35%), fair in 27 (50%), and poor in 8 (15%). The mean postoperative OES score was 40 ± 8.4. Neither postoperative defect size nor healing grade correlated with the OES ( P > .05). CONCLUSION: Arthroscopic debridement and microfracture for advanced capitellar OCD result in improved (ie, decreased) defect size at a mean follow-up of 29 months, both in width and in depth. Healing of the subchondral bone was either good or fair in 85%. Interestingly, CT findings did not correlate with clinical outcomes.

Osteochondritis dissecans shows a severe course and poor outcome in patients with juvenile idiopathic arthritis: a matched pair study of 22 cases.

Juvenile osteochondritis dissecans (JOCD) and juvenile idiopathic arthritis (JIA) are both common diseases which may affect joints and bony structures in pediatric patients. In some cases, JOCD and JIA occur at the same time. In this study, the course of JOCD in patients with JIA was therefore evaluated to provide possible recommendations for further treatment opportunities and control examinations. From 06/2012 to 03/2018 55 children with JOCD with or without JIA were examined. Inclusion criteria were: (1) age ≤ 16 years, (2) diagnosis of a JOCD with or without JIA and (3) two routine MRI controls. The JOCD evaluation based on the classification according to Bruns and the measurement of the largest extent via MRI. 18 of these 55 children met our criteria: 11 JOCD findings of 7 patients with JIA (group A) were matched according to age and localization of JOCD to 11 patients without JIA (group B). Mean age of disease onset of JIA was 8.2 years (oligo JIA) and of JOCD 11.6 years. The mean time follow-up was 17.7 months. At all observation time points more JOCD findings (with stage III° and IV°, respectively) along with a significant deterioration was seen in group A compared to group B. The comparison of the last MRI control between group A and group B shows a significant smaller defect size (decrease of 54.5%, p = 0.028) in group B (97.9 ± 48.9 mm2) as in group A (185.1 ± 102.9 mm2). In comparison of first (169.7 ± 84.2 mm2) and last MRI (97.9 ± 48.9 mm2) a significant decrease in lesion size of JOCD in group B was seen (decrease of 58.4%, p = 0.048). Patients with JIA show a more progressive and severe course of JOCD. Therefore, we recommend (1) the early use of MRI in patients with JIA and persistent joint pain to detect potential JOCD and (2) in presence of JIA and JOCD regular MRI follow-up controls to identify deteriorating JOCD findings and prevent early joint destruction in pediatric patients.

Osteochondral Injuries of the Knee in Pediatric Patients.

Osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. Lateral patella dislocation is a common traumatic cause of osteochondral injury that typically occurs at the medial facet of the patella or at the lateral aspect of the distal femur. Multiple theories have been proposed for the cause of an OCD lesion in the knee, including trauma or repetitive microtrauma, local vascular insufficiency, and family history. The most "classic" location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. Multiple treatment options are available for both traumatic osteochondral injuries and OCD lesions, with important determining factors of treatment being skeletal maturity of the patient, instability of the fragment, lesion location, and size of the lesion. Nonsurgical management is appropriate in some situations. Surgical options range from simple fragment excision to internal fixation of the fracture fragment to more complex cartilage restoration or replacement procedures. This special focus section will discuss the diagnosis and treatment options for traumatic osteochondral knee injuries, including the subset secondary to juvenile OCD lesions.

Comparison of sonography and MRI in the evaluation of stability of capitellar osteochondritis dissecans.

PURPOSE: To compare the diagnostic accuracies of ultrasonography (US) and magnetic resonance imaging (MRI) with intraoperative capitellar osteochondritis dissecans (COCD) fragment stability findings. METHODS: Patients whose International Cartilage Repair Society (ICRS) osteochondritis dissecans (OCD) classifications were I/II (stable) or III (unstable) were included. Patients underwent preoperative US and MRI. On US, lesions were evaluated as unstable when irregular contours of the chondral surface were observed. On MRI, lesions were evaluated as unstable when articular bone irregularity, a T2 high signal intensity interface, or a high signal intensity line through the articular cartilage was observed. Using the surgical assessment as the gold standard, accuracies of fragment stability diagnoses were calculated for US and MRI. RESULTS: Thirty-four patients with OCD classifications of I/II (stable) or III (unstable) were included. Twenty-four patients (stable: 12, unstable: 12) underwent preoperative US; 22 (stable: 11, unstable: 11) underwent preoperative MRI. Preoperative US and MRI stability assessments correctly matched intraoperative fragment findings in 23 of 24 patients and 16 of 22 patients, respectively. US criteria in this study achieved superior accuracy compared with MRI criteria (96% vs. 73%; P < .05). CONCLUSION: US was a useful tool for evaluating fragment instability in COCD.

Osteochondritis dissecans of the knee.

Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The diagnosis is usually made during adolescence. Mechanical factors play a major role in the pathophysiology of OCD. When the radiographic diagnosis is made early in a patient with open physes, healing can often be obtained simply by restricting sports activities. The degree of lesion instability can be assessed by magnetic resonance imaging. When the lesion remains unstable and the pain persists despite a period of rest, surgery is indicated. Arthroscopic exploration is always the first step. Drilling of the lesion produces excellent outcomes if the lesion is stable. Unstable lesions require fixation and, in some cases, bone grafting. Defects must be filled, depending on their surface area. Although many surgical techniques are available, the therapeutic indications are now standardized.

The effect of autologous adipose derived mesenchymal stem cell therapy in the treatment of a large osteochondral defect of the knee following unsuccessful surgical intervention of osteochondritis dissecans - a case study.

BACKGROUND: A prospective analysis of the effect of autologous adipose derived mesenchymal stem cell (MSC) therapy in the treatment of an osteochondral defect of the knee with early progressive osteoarthritis following unsuccessful surgical intervention of osteochondritis dissecans (OCD). CASE PRESENTATION: After failed conventional management of OCD a patient undergoes intra-articular MSC therapy. Patient outcome measures included the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Structural outcome was assessed using MRI with the novel technique of T2 mapping used to indicate cartilage quality. Following MSC therapy the patient reported improvement in pain and function as measured by NPRS, WOMAC and KOOS. Repeat MRI analysis showed regeneration of cartilage. MRI T2 mapping indicated hyaline like cartilage regrowth. CONCLUSION: In this report, the use of MSCs, after unsuccessful conventional OCD management, resulted in structural, functional and pain improvement. These results highlight the need to further study the regenerative potential of MSC therapy. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry Number - ACTRN12615000258550 (Date registered 19/03/2015 - retrospectively registered).