Follow-up study on autogenous osteochondral transplantation for cartilage defect of knee joint / 中国骨伤

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). 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.

Treatment of Osteochondritis Dissecans of the Knee with Autologous Iliac Bone Graft and Hyaluronic Acid Scaffold

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.

Physiotherapy protocol during initial postoperative period of arthroscopy in horses / Protocolo fisioterápico durante o período pós-operatório inicial de cirurgia artroscópica em equinos

This study evaluated the effects of a physiotherapy protocol applied in joints with osteochondritis dissecans submitted to arthroscopy. Twelve horses totaling twenty joints were used and divided into two uniform groups, according to articular lesion grade. Treated Group (TG) received the physiotherapy protocol (cryotherapy, passive rage motion and controlled exercise) that initiate just after anesthetic recovery and extended for five days. Control Group (CG) remained resting in stall during the same period. Physical examination and synovial fluid analysis were used to evaluate the treatment. The synovial fluid examination consisted of physical analysis (color, aspect, and viscosity), mucin clot evaluation, Serum Amyloid A, Prostaglandin E2 and urea concentration. Synovial samples were collected by arthrocentesis at the beginning of the surgical procedure (D1), 48 hours (D3) and 96 hours (D5) after surgery. Before arthroscopy and daily during the postoperative period joints were evaluated by physical exam: superficial temperature (°C), range of motion (degrees) and circumference (centimeters). The joint physical examination showed no significant difference between groups and neither along the days for the same group. The parameters of synovial fluid showed difference over the moments in each group but didn't have difference between groups. Color and aspect had the same patterns across moments, in CG fluid had significant change when compared D1 with D3 (color and aspect: p<0.001) and D5 (color: p<0.001; aspect: p<0.05) becoming mostly bloody and cloudy in D3 and D5. However in TG the difference was significant just between D1 and D3 (color and aspect: p<0.05), showing an improvement of synovial fluid in D5 (color and aspect: p<0.05). Viscosity and mucin clot evaluation showed significant change in CG between D1 and D3 (viscosity: p<0.01; mucin clot: p<0.05) and between D1 and D5 (viscosity: p<0.01;mucin clot: p<0.01). In TG no significant difference of viscosity and mucin clot was observed over the moments, showing an early improvement of synovial fluid quality. The Serum Amyloid A concentration showed an extremely significant increase in CG (p<0.001) when compared D1 (1217.13±664.47µg/mL) and D3 (42423.80±52309.31µg/mL). The comparison between D1 and D5 in CG, and across moments in TG, had no statistical difference. The PGE2 eicosanoid remained statistically unchanged all over the time. Urea showed significant increase in D3 when compared to D1 (p<0.001) in CG, and had no variation in TG. The physiotherapy protocol minimized the inflammatory mediators and provided minor alterations in synovial fluid after arthroscopy.(AU)

Este estudo avaliou os efeitos de um protocolo fisioterápico, aplicado em articulações com osteocondrite dissecante, submetidas à artroscopia. Foram utilizados 12 cavalos, totalizando 20 articulações, divididas em dois grupos homogêneos de acordo com a graduação da lesão articular. O grupo tratado (GT) recebeu o protocolo fisioterápico (crioterapia, movimentação passiva e exercício controlado) que se iniciou imediatamente após a recuperação anestésica e se estendeu por cinco dias. O grupo controle (GC) permaneceu em repouso na baia, pelo mesmo período. Exame físico da articulação e análise do líquido sinovial foram utilizados para avaliar o tratamento. O exame do líquido sinovial consistiu em análise física (cor, aspecto e viscosidade), avaliação do coágulo de mucina e concentrações de amiloide sérica A, prostaglandina E2 e ureia. Amostras de líquido sinovial foram colhidas por artrocentese no início do procedimento cirúrgico (D1) e após 48 (D3) e 96 horas (D5) do procedimento cirúrgico. Antes da artroscopia e diariamente no período pós-operatório, as articulações foram avaliadas por exame físico: temperatura superficial (°C), ângulo de flexão (graus), circunferência (centímetros). A avaliação física das articulações não apresentou diferença significativa entre os grupos nem ao longo dos dias em cada grupo. Nas análises do líquido sinovial, observou-se uma variação diferente entre os momentos em cada grupo porém sem diferença significativa entre os grupos. A cor e o aspecto tiveram resultados semelhantes ao longo do tempo, no GC houve uma alteração significativa quando comparados D1 e D3 (cor e aspecto: p<0,001) e D1 e D5 (cor: p<0,001; aspecto: p<0,05) tornando-se sanguinolento e turvo na maioria das amostras em D3 e D5. Já no GT, houve diferença significativa apenas entre D1 e D3 (cor e aspecto: p<0,05), demonstrando melhora no líquido sinovial em D5 (cor e aspecto: p<0,05). A viscosidade e o coágulo de mucina apresentou alteração significativa no GC entre D1 e D3 (viscosidade: p<0,01; coágulo de mucina: p<0,05) e entre D1 e D5 (viscosidade e coágulo de mucina: P<0,01). No grupo tratado não foram observadas alterações significativas em viscosidade e coágulo de mucina, ao longo dos momentos, demonstrando uma melhora precoce na qualidade do líquido sinovial. A amiloide sérica A apresentou um aumento extremamente significante no GC (p<0,001) quando comparados D1 (1217,13±664,47µg/dL) e D3 (42423,80±52309,31µg/dL). Quando comparados D1 e D5 no GC e ao longo do tempo no GT não foram observadas diferenças significativas. A concentração de PGE2 permaneceu sem alterações. As mensurações de ureia apresentaram aumento significativo em D3 quando comparado a D1 (p<0,001) no GC e não apresentou variação no GT. O protocolo fisioterápico minimizou os mediadores inflamatórios e proporcionou menor alteração do líquido sinovial após artroscopia.(AU)

Osteochondritis dissecans of the trochlea: case report / Osteocondrite dissecante da tróclea: relato de caso

ABSTRACT The authors report a rare case of osteochondritis dissecans of the trochlea. The treatment of these lesions, in which the osteochondral fragment is not viable, is difficult and often limited in Brazil. A clinical case is presented with functional and radiological outcomes after treatment with microfracture technique, bone graft, and collagen membrane coverage.

RESUMO Os autores relatam um caso raro de osteocondrite dissecante de tróclea. O tratamento dessas lesões com inviabilidade do fragmento osteocondral é difícil e muitas vezes limitado no nosso meio. Os autores apresentam resultados clínicos e radiológicos após o tratamento com a técnica de microfratura, enxertia óssea e cobertura com membrana de colágeno.

Early Lateral Compartment Physeal Closure of the Elbow in Osteochondritis Dissecans of the Adolescent Baseball Players / 대한스포츠의학회지

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.

Transferência de autoenxerto osteocondral para tratamento de osteocondrite dissecante em côndilo femoral de cão / Osteochondral autograft transfer for treatment of osteochondritis dissecans of the femoral condyle in a dog

Na osteocondrite dissecante (OCD), a articulação do ombro é mais comumente afetada, mas o joelho é ocasionalmente lesionado, o que, muitas vezes, passa desapercebido. O tratamento cirúrgico precoce é indicado para remover cartilagem solta, aliviar a dor e minimizar a artrose. Benefícios putativos da transferência de autoenxerto osteocondral em relação às técnicas convencionais incluem a reconstrução exata do contorno subcondral e articular, recobrimento da superfície com cartilagem hialina e criação de uma barreira imediata entre o líquido sinovial e o osso subcondral. O objetivo deste trabalho é relatar a técnica de transferência de autoenxerto osteocondral para o tratamento da osteocondrite do côndilo femoral. Um cão da raça Bull Terrier foi tratado cirurgicamente por meio da técnica de transferência de autoenxerto osteocondral, após ter sido diagnosticado com OCD do côndilo femoral, apresentando melhora clínica significativa e completa recuperação aos 30 dias de pós-operatório.(AU)

In osteochondritis dissecans (OCD), the shoulder joint is most commonly involved, but the stifle is occasionally involved and often goes unnoticed. Early surgical treatment is indicated to remove loose cartilage and minimize osteoartrosis. Putative benefits of Osteochondral Autograft Transfer (OAT) over conventional techniques include accurate reconstruction of subchondral and articular contour, resurfacing with hyaline or hyaline-like cartilage, and creation of an immediate barrier between synovial fluid and subchondral bone. The purpose of this work is to report the technique of OATs for the treatment of osteochondritis of the femoral condyle. A canine attended the Laboratory of Comparative Orthopedics and Traumatology USP-FMVZ underwent surgery after being diagnosed with OCD of the femoral condyle, with significant clinical improvement at 30 days postoperatively.(AU)

Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus / 대한정형외과학회잡지

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.

Posterior Glenoid Lesions on Magnetic Resonance Imaging in Adolescent Baseball Players / 대한스포츠의학회지

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.

Simultaneous Osteoperiosteal Autologous Iliac Crest Graft and Lateral Meniscus Allograft Transplantation for Osteochondral Lesion with Bony Defect and Lateral Discoid Meniscus Tear

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.

Arthroscopic Bioabsorbable Screw Fixation of Unstable Osteochondritis Dissecans in Adolescents: Clinical Results, Magnetic Resonance Imaging, and Second-Look Arthroscopic Findings

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.

Concomitant Osteochondral Autograft Transplantation and Fixation of Osteochondral Fragment for Treatment of a Massive Osteochondritis Dissecans: A Report of 8-Year Follow-up Results

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.

Treatment of osteochondritis lesion in the knee with reduction and fixation under arthroscopy / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical results of reduction and fixation under arthroscopy for the treatment of osteochondrotical lesion in the knee.</p><p><b>METHODS</b>From 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.</p><p><b>RESULTS</b>All 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.</p><p><b>CONCLUSION</b>Treatment 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.</p>

Ubicación inusual de lesiones osteocondrales en la rodilla del adolescente / Unusual location of osteochondral lesions in adolescent’s knees

Las lesiones osteocondrales en la rodilla del adolescente se localizan principalmente en las áreas de carga a nivel de los cóndilos femorales, las lesiones ubicadas en la tróclea son excepcionales abarcando menos de 1%. La etiología de la ODJ sigue siendo desconocida; puede ser causa de lesiones osteocondrales los traumatismos directos frontales en los cóndilos femorales y por trauma directo de la patela sobre la tróclea en las luxaciones de ésta. En este nivel, ambos mecanismos pueden causar lesiones tanto condrales como osteocondrales. En este trabajo presentamos dos casos, en que se incluye a un paciente con afectación bilateral de la tróclea; ambos de las mismas características, se realizó artroscopía con extracción de cuerpos libres, regularización del lecho y perforaciones con resultados satisfactorios a largo plazo. La presencia de lesiones osteocondrales en la tróclea es muy rara; en la literatura hay descritos muy pocos casos de bilateralidad. La etiología exacta de la ODJ en la rodilla sigue siendo discutida. En nuestros casos, el mecanismo podría explicarse por un impacto de baja presión pero a alta velocidad de la patela sobre la tróclea. Este tipo de lesiones podría encontrarse sobre defectos u anomalías de la osificación de la infancia, la bilateralidad de uno de estos casos apoyaría esta hipótesis. El tratamiento depende de la estabilidad de la lesión y de la edad del paciente. El tratamiento quirúrgico debe ser considerado en los pacientes con fisis abierta que tengan lesión inestable o desprendida y en aquellos en que la fisis está por cerrar, pero que no han respondido al tratamiento conservador, como también en aquellos pacientes con cuerpo libre intraarticular. Otro punto a considerar es que la fijación sin pastilla ósea o insuficiente ofrece resultados mediocres.

Osteochondral knee lesions in adolescents are primarily located in loading areas at the level of the femoral condyles. Lesions located in the trochlea are exceptional and account for less than 1%. The etiology of juvenile osteochondritis dissecans (JOCD) is still unknown. Osteochondral lesions may be caused by direct frontal trauma of the femoral condyles and by direct trauma of the patella on the trochlea in dislocations of the latter. At this level both mechanisms may cause both chondral and osteochondral lesions. We present herein two cases with the same characteristics that include one patient with bilateral involvement of the trochlea. Arthroscopy was performed with removal of loose bodies, regularization of the bed and perforations, with appropriate long term results. Osteochondral lesions are rarely found in the trochlea; the literature contains very few bilateral cases described. The exact etiology of JOCD of the knee continues to be debated. In our cases the mechanism could be explained by a low-pressure high-speed impact of the patella on the trochlea. This type of lesions may be added to defects or abnormalities of ossification during childhood. The bilaterality of one of these cases would support this hypothesis. Treatment depends on lesion stability and patient age. Surgical treatment should be considered in patients with open physes with an unstable or detached lesion and in those in whom the physis is about to close but have not responded to conservative treatment, as well as in patients with an intraarticular loose body. Another point to consider is that insufficient fixation or fixation without a bone chip leads to mediocre results.

Progress on osteochondritis dissecans / 中国骨伤

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.

Osteochondritis dissecans in bilateral lateral femoral condyle in knees / Osteocondrite dissecante em côndilo femural lateral bilateral nos joelhos

The osteochondritis dissecans (OCD) is a disease of unknown cause that classically affects the knee lateral border of the medial femoral condyle. We present a rare case of OCD in bilateral lateral femoral condyle.

A osteocondrite dissecante (OCD) é uma patologia de causa desconhecida, que classicamente acomete no joelho a borda lateral do côndilo femural medial. Apresentamos um raro caso de OCD no côndilo femural lateral bilateral.

Ocorrência da osteocondrite dissecante na articulação tibiotársica em equinos da raça Brasileiro de Hipismo por meio da radiografia digital / Occurrence of osteochondritis dissecans in tibiotarsal joints of equines "Brasileiro de Hipismo" using digital radiography

A osteocondrite dissecante (OCD) é uma doença ortopédica do desenvolvimento que acomete os humanos e os animais e é considerada como o distúrbio de desenvolvimento esquelético mais importante nos potros em crescimento. É uma falha no processo de ossificação endocondral, que compromete as cartilagens articular e de crescimento, principalmente a articulação tibiotársica. Sua ocorrência é importante para a equinocultura mundial pelo risco de produzir incapacitação nos cavalos atletas e de comprometer o bem-estar dos mesmos. O estudo radiográfico das articulações se mantém como método auxiliar de diagnóstico mais utilizado no campo e atualmente os equipamentos portáteis digitais permitem a rápida aquisição de imagens de alta qualidade. Os animais deste estudo foram escolhidos seguindo critérios descritos a seguir. A idade de três anos, a partir da qual as lesões se apresentam bem definidas e com remota possibilidade de reabsorção dos fragmentos. A sanidade, porque os animais sem sinais clínicos de OCD podem ter a avaliação radiográfica negligenciada e ser portadores sãos. A docilidade dos animais foi um critério de escolha, que permitiu um exame rápido e seguro, tanto para os operadores, quanto para os equipamentos utilizados. Pelo registro dos animais radiografados na Associação Brasileira dos Criadores de Cavalos de Hipismo (ABCCH) foi possível investigar a genealogia dos garanhões. O exame radiográfico consistiu na captação de duas projeções oblíquas bilaterais das articulações tibiotársicas. As imagens radiográficas digitais obtidas foram armazenadas e avaliadas posteriormente por profissional com experiência em radiologia e os achados classificaram os animais em positivos e negativos para OCD. Os resultados demonstraram ocorrência de 7,7% (2/26) de OCD na articulação tibiotársica dos garanhões selecionados para o estudo, criados no estado de São Paulo.

Osteochondritis dissecans (OCD) is a developmental orthopaedic disease which can involves both humans and animals and is considered the most important skeletal disorder in growing foals. It is a failure of the endochondral ossification which affects both articular and growth-plate cartilages, primary the tibiotarsal joint. Its occurrence is remarkable for the worldwide horse industry for the risk in disabling sport horses and concerns animal welfare. The radiographic investigation of joints remains the most common diagnostic auxiliary method employed in the field and updated portable digital X-rays machines provide fast acquisition of high quality images. The animals in this study were chosen by the following criteria. The age of three years old when the articular fragments are well defined and stable with low possibilities of resorption. The soundness because horses with no clinical signs are normally neglected and misdiagnosed for OCD. The good-behaviour of the horses provided a safe radiographic approach either for the operators or for the equipment. The genealogical background of the animals was investigated by their breeding record in the Brazilian Association of Sport Horses (ABCCH). The radiographic evaluation consisted in two bilateral oblique views of both tibiotarsal joints. The digital images were stored and further interpreted by an expert radiologist and the results scored the animals into a positive and a negative group for OCD. The results yielded an incidence of 7.7% (2/26) of tibiotarsal OCD in the stallions selected for this study, all of them bred in São Paulo State.

Multiple Osteochondritis Dissecans of Knee Joint in a Patient with Wilson Disease, Focusing on Magnetic Resonance Findings

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.

Bilateral Osteochondritis Dissecans of the Femoral Condyles in Both Knees: A Report of Two Sibling Cases

Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful.

Searching for Hidden, Painful Osteochondral Lesions of the Ankle in Patients with Chronic Lower Limb Pain: Two Case Reports

It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle.

Outcomes of Operative Management of Juvenile Osteochondritis Dissecans of the Knee in Athletes / 대한스포츠의학회지

The purpose of this study was to investigate clinical and radiological outcomes of multiple drilling in case of failed conservative treatment of juvenile osteochondritis dissecans in athletes. We treated 37 lesions from 30 athletic patients who failed conservative treatment for juvenile osteochondritis dissecans. Multiple drillings were done for 32 lesions and multiple drilling and bioabsorbable pin fixations were done for 5 lesions. Lysholm score, Hughston clinical scale were used for clinical evaluation before and last follow up of treatment. For radiologic evaluation we used magnetic resonance imaging at 3 months and 12 months after operation. Of all 37 lesions, 11 lesions were located on medial femoral condyle, 2 lesions on lateral femoral condyle and 24 lesions on trochlear groove. There were clinical and radiological improvement from Hughston scale after operative treatment. Twenty-five patients among 30 returned to the sports activity. There were no specific complications after operation. Multiple drilling and bio-absorbable pin fixation of juvenile athletic osteochondritis dissecans patients after failure of conservative treatment showed good clinical and radiologic results. So it would be helpful for juvenile athletic patients to return to sports activities.