Conceptos actuales en el diagnóstico y tratamiento de las lesiones del hueso subcondral / Current concepts in the diagnosis and treatment of subchondral bone injuries

La patología ósea subcondral incluye una amplia gama de patologías, como la artrosis, las fracturas por insuficiencia espontánea, la osteonecrosis y los traumatismos articulares. Todas muestran hallazgos típicos de imágenes de resonancia magnética (RM) denominados lesiones de la médula ósea (LMO). Sin embargo, la etiología y la evolución de las LMO en múltiples afecciones aún no están claras. Además, todavía no existe un protocolo de tratamiento estándar de oro para las LMO, es por esto que se están probando una variedad de modalidades de tratamiento con la esperanza de que puedan reducir el dolor y detener la progresión de la enfermedad. Nuestro propósito es presentar una revisión sobre los conceptos actuales para el diagnóstico y tratamiento de las LMO. Se realizó una revisión de la literatura que incluyó búsquedas en las bases de datos PubMed, Cochrane y Medline utilizando las siguientes palabras clave: lesiones de médula ósea subcondral, hueso subcondral, subcondroplastia, concentrado de médula ósea, plasma rico en plaquetas (PRP) y aumento óseo subcondral. Podemos concluir que el uso de nuevas técnicas biológicas para tratar las LMO, como el PRP y las células de la médula ósea, ha mostrado resultados clínicos prometedores. La investigación futura de las LMO será necesaria para abordar mejor las diferentes patologías y determinar las estrategias terapéuticas adecuadas. Todavía se necesitan estudios randomizados y controlados de alta calidad junto a revisiones sistemáticas para generar guías y recomendaciones para el tratamiento de las LMO.

Subchondral bone pathology includes a wide range of pathologies, such as osteoarthritis, spontaneous insufficiency fractures, osteonecrosis, and trauma. They show typical magnetic resonance imaging (MRI) findings termed bone marrow lesions (BMLs). However, the etiology and evolution of BMLs in multiple conditions remains unclear. There is still no gold standard treatment protocol in treating BML, and a variety of treatment modalities have been tested in the hope that they might reduce pain and stop disease progression.Our purpose was to write a current concepts review about diagnosis and treatment options for BMLs. A literature review was performed that included searches of PubMed, Cochrane, and Medline databases using the following keywords: Bone marrow lesions, subchondral bone, subchondroplasty, bone marrow concentrate, platelet-rich plasma (PRP), subchondral bone augmentation.The use of novel biologic techniques to treat BMLs, such as PRP and Bone Marrow Cells, has yielded promising clinical outcomes. Future research of BMLs will be mandatory to address the different pathologies better and determining appropriate treatment strategies. There is still a need for high-quality RCTs studies and systematic reviews in the future to enhance further treatment strategy in preventing or treating BMLs of the knee.

Caracterización del dolor torácico agudo en pacientes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández. Matanzas / Characterization of acute chest pain in patients of the Teaching Clinic- Surgical Hospital Comandante Faustino Perez Hernandez. Matanzas

RESUMEN Introducción: el dolor torácico agudo es una sensación dolorosa que se manifiesta entre el diafragma y la base del cuello. En Cuba, constituye una de las causas más frecuentes de consulta médica. La provincia de Matanzas muestra un comportamiento similar. Objetivo: caracterizar el perfil clínico de los pacientes con dolor torácico agudo en la Unidad de Cuidados Intensivos Emergentes, del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Materiales y métodos: se realizó un estudio transversal descriptivo con las historias clínicas de 418 pacientes que acudieron a la Unidad de Cuidados Intensivos Emergentes, refiriendo dolor torácico agudo, de enero a diciembre de 2019. Resultados: el rango de edad más afectado fue el de 50 a 59 años, para un 30,38 %. Predominó el sexo masculino con el 30,08 %. El ejercicio físico intenso elevó el riesgo de aparición de dolor torácico. Las primeras causas de dolor torácico agudo fueron, en orden de frecuencia, la osteocondritis esternocostal, la bursitis del hombro y el síndrome coronario agudo. Conclusiones: se evidenció que en la mayoría de los casos el origen del dolor fueron causas no cardiovasculares, afectando más al sexo masculino. Existió asociación estadística significativa entre la actividad física intensa y el inicio del dolor torácico agudo. Egresaron vivos de la unidad el 71,53 % de los pacientes. Se recomienda priorizar la atención de los pacientes que refieren dolor torácico agudo, para una correcta clasificación y atención en el menor tiempo posible (AU).

ABSTRACT Introduction: acute chest pain is a painful sensation perceptible between the diaphragm and the base of the neck. It is one of the most frequent causes of medical consultation in Cuba. It shows a similar behavior in the province of Matanzas. Objective: to characterize the clinical profile of the patients with acute thoracic pain in the Emergency Intensive Care Unit of the Teaching Clinic-Surgical Hospital Comandante Faustino Perez Hernandez, of Matanzas. Materials and methods: a descriptive, cross-sectional study was carried out with the clinical records of 418 patients who attended the Emergency Intensive Care Unit referring acute thoracic pain, from January to December 2019. Results: the most affected age range was the one from 50 to 59 years, for 30.38 %. Male sex predominated, with 30.08 %. Intense physical exercise raised the risk of thoracic pain. The first causes of acute thoracic pain were, in order of frequency, sternocostal osteochondritis, shoulder bursitis, and acute coronary syndrome. Conclusions: It was evidenced that in most of the cases the source of the pain was non-cardiovascular causes, more affecting the male sex. There was significant statistic association between intense physical activity and acute thoracic pain. 71.53 % of the patients was discharged from the unit alive. It is recommended to prioritize the attention of patients referring acute thoracic pain, for their correct classification and care in the shortest possible time (AU).

Aloinjerto fresco de rótula y defectos osteocondrales / Fresh patellar allograft and osteochondral defects

Introducción: Las lesiones condrales de la rótula son un reto para el cirujano, principalmente en pacientes jóvenes y activos. La mayoría de los defectos condrales de la rótula son lesiones superficiales y pueden ser manejadas con técnicas de preservación articular; sin embargo, las lesiones profundas pueden requerir otro tipo de manejo. El objetivo de este artículo es comunicar el tratamiento de defectos osteocondrales de la rótula en pacientes jóvenes, mediante la técnica de aloinjerto fresco de donante cadavérico. materiales y métodos: Se seleccionaron pacientes con dolor anterior de rodilla, lesión condral de la rótula grado III-IV y que habían recibido o no algún tipo de manejo médico o quirúrgico. En estos pacientes, se usó un aloinjerto fresco de rótula con el fin de solucionar el cuadro y mejorar la función. Resultados: Todos los pacientes recuperaron la función y los arcos de movilidad, y no refirieron dolor. Se comprobó la integración del aloinjerto fresco al área receptora, sin evidencia de rechazos del tejido o infecciones. Conclusiones: El uso de aloinjerto fresco de rótula para tratar defectos osteocondrales amplios es una téc-nica quirúrgica valiosa, fácil de implementar, que no requiere una curva de aprendizaje extensa y que mejora considerablemente el dolor y la función en pacientes jóvenes. Nivel de Evidencia: IV

Introduction: Chondral lesions of the patella are a challenge for the surgeon, mainly in young and active patients. Most patellar chondral defects are superficial injuries and can be managed with joint preservation techniques; however, deep injuries may require other types of management. The objective of this article is to manage osteochondral defects of the patella in young patients, using the technique of fresh allograft from a cadaveric donor. Materials and methods: Patients with anterior knee pain, with grade III - IV chondral lesion of the patella and who had or had not undergone some type of medical or surgical management were included. They received a fresh patellar allograft that sought to provide a solution and improvement of the functionality. Results: In all cases, recovery of functionality and mobility, absence of pain and integration of the fresh allograft into the recipient area were achieved, without evidence of tissue rejection or infection. Discussion: The use of fresh patellar allograft for the management of wide osteochondral defects is a valuable surgical technique, easy to implement, that does not require a long learning curve and that considerably improves pain and functionality in young patients. Conclusions: The advent of fresh osteochondral grafts allows adequate management and evolution of patients, with the aim of favoring joint preservation and avoiding total knee arthroplasty over time. Level of Evidence: IV

Mosaicplasty Technique in the Treatment of Isolated Knee Femoral Condyle Osteochondral Lesions - a Retrospective Study / Técnica de mosaicoplastia no tratamento de lesões osteocondrais isoladas do côndilo femoral do joelho - estudo retrospectivo

Abstract Objective Focal osteochondral lesions of the knee are found in two thirds of patients undergoing arthroscopy; their treatment, when isolated and especially in young individuals, remains a debating topic. The present study analyzes the results obtained by the application of the mosaicplasty technique on the treatment of isolated knee femoral condyle osteochondral lesions. Methods Retrospective study of patients submitted tomosaicplasty and to subjective analyseswith pre- and postsurgery International KneeDocumentation Committee (IKDC) scores. Results A total of 13 cases with an average age of 34 years old, with male patients (n = 4; 31%) with an average age of 23 years old (range: 17-31 years old), and female patients (n = 9; 69%) with an average age of 39 years old (range: 16-56 years old); medial versus lateral femoral (n = 11; 85% versus n = 2; 15%); the average size of the lesion was 1.8 cm2 (range: 0.6-4 cm2); average follow-up time: 5.045 ± 3.47 years (range: 1.15-11.01 years). The average preoperative IKDC score was of 31.63 points (± 20.24), the average postoperative IKDC score was of 74.18 points (± 20.26). The difference between the post- and preoperative IKDC scores was of 42.55 (± 21.05) points, being theminimal score increase of 8.1 points andthemaximumscore increaseof82.8 points.Astatistically significant difference (p < 0.001) was found between the IKDC scores before and after the surgery. A statistically significant relation (p = 0.038) was found between the IKDC score increase (the difference between the postoperative and the preoperative scores) and the dimension of the lesion. Conclusions Mosaicplasty with osteochondral autograft transfer, when adequately used, can produce excellent results with great durability and functional impact, low morbidity rates and costs. Expansion of the indication criteria shows promising midterm and long-term results.

Resumo Objetivo Lesões osteocondrais focais do joelho são encontradas em dois terços dos pacientes submetidos a artroscopia; seu tratamento, quando isoladas e, principalmente, em indivíduos jovens, ainda é debatido. O presente estudo analisa os resultados obtidos com a aplicação da técnica de mosaicoplastia no tratamento de lesões osteocondrais isoladas do côndilo femoral do joelho. Métodos Estudo retrospectivo de pacientes submetidos à mosaicoplastia e análise subjetiva com pontuações do International Knee Documentation Committee (IKDC, na sigla em inglês) antes e após a cirurgia. Resultados Um total de 13 casos, com média de idade de 34 anos; pacientes do sexo masculino (n = 4; 31%) apresentaram média de idade de 23 anos (17-31 anos), e pacientes do sexo feminino (n = 9; 69%) apresentaram média de 39 anos; (16-56 anos); femoral medial ou lateral (n = 11, 85% versus n = 2, 15%, respectivamente); o tamanho médio da lesão foi de 1,8 cm2 (0,6-4 cm); o tempo médio de acompanhamento foi de 5,045 ± 3,47 anos (1,15-11,01 anos). A pontuação IKDC média préoperatória foi 31,63 pontos ( ± 20,24), e a pós-operatória foi 74,18 pontos ( ± 20,26). A diferença entre as pontuações IKDC obtidas depois e antes da cirurgia foi de 42,55 ( ± 21,05) pontos, com o aumento mínimo de 8,1 pontos e o aumento máximo de 82,8 pontos. Uma diferença estatística significativa (p < 0,001) foi encontrada entre a pontuação IKDC antes e após a cirurgia. Uma relação estatisticamente significativa (p = 0,038) foi observada entre o aumento da pontuação IKDC (a diferença entre a pontuação pré- e pós-operatória) e as dimensões da lesão. Conclusões A mosaicoplastia com transferência de autoenxerto osteocondral, quando adequadamente usada, pode produzir resultados excelentes com grande durabilidade e impacto funcional, baixas taxas de morbidade e baixos custos. A expansão dos critérios de indicação mostra resultados promissores no médio e longo prazo.

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.

Femoral condyle osteochondral fracture treated with bone suture after acute patellar dislocation: a case report / Lesão condral do fêmur tratada com sutura óssea após luxação aguda de patela: um relato de caso

ABSTRACT Osteochondral fracture after acute patellar dislocation in teenagers is relatively common (up to 60% of cases of patellar dislocation), but poorly diagnosed. There are several treatments proposed for this type of injury, but none well defined in the literature.A male patient, 13 years old, with a diagnosis of osteochondral fracture of the lateral femoral condyle after acute dislocation of the right patella. He underwent surgical treatment of the chondral injury, which consisted of suturing of the chondral fragment to the cartilage defect and, in a second approach, reconstruction of the medial patellotibial ligament and medial patellofemoral ligament with autologous flexor graft. Currently, the patient has been followed up for 16 months postoperatively for the suture of the chondral fragment and for 8 months for the ligament reconstruction. He has been evaluated through functional scores and T2 weighted magnetic resonance imaging. Acute fixation through direct bone suturing of a purely chondral fragment can be considered in special situations.

RESUMO A fratura osteocondral após luxação aguda de patela em adolescentes é relativamente comum (até 60% dos casos de luxação patelar), porém pouco diagnosticada. Existem diversos tratamentos propostos para esse tipo de lesão, mas nenhum está bem definido na literatura. Paciente do sexo masculino, 13 anos, com diagnóstico de fratura osteocondral do côndilo femoral lateral, após luxação aguda da patela direita. Foi submetido a tratamento cirúrgico da lesão condral, que consistiu em sutura do fragmento condral ao defeito da cartilagem e, em um segundo tempo, a reconstrução do ligamento patelotibial medial (LPTM) e reconstrução do ligamento patelofemoral medial (LPFM) com enxerto autólogo de flexores. Atualmente o paciente encontra-se com o seguimento de 16 meses de pós-operatório da sutura do fragmento condral e oito meses da reconstrução ligamentar, foi avaliado através de escores funcionais e ressonância magnética com mapeamento de T2. Em casos especiais, pode-se considerar o uso de fixação aguda por sutura óssea direta de um fragmento puramente condral.

Relation between osteoarthritis and HLA-A in Iraqui patients

Relación entre osteoartritis y HLA - A en pacientes iraquíes. (HLA: acrónimo inglés de antcígenos leucocitarios humanos - Human Leucocyte Antigens). La osteoartritis e la afección más común que involucra el aparato osteo-articular. Representa a un grupo heterogéneo de condiciones resultante de cambios comunes histopatológicos y radiológicos. Existen múltiples factores de riesgo para la osteoartritis: edad, obesidad, y el antígeno genético. El leococitario humano (HLA) como parte del sistema inmune, teniendo un rol en el proceso nosológico. Diversos estudios han determinado la diferente asociación entre la clase HLA - I y la II. El objetivo de esta investigación fue el de determinar la eventualidad de una relación entre el HLA-I y el II en la osteocondritis. Los resultados obtenidos se discuten en el artículo.

Background: Osteoarthritis (OA) is the most common type of joint disease. It represents a heterogeneous group of conditions resulting in common histopathologic and radiologic changes. There are multiples risk factors for osteoarthritis includes the following: Age, Obesity and Genetics. Human leukocyte antigen (HLA) as part of immune system has a role in the disease process. Many reported studies have pointted to different HLA classs I and II association. Aim: To investigate whether there is an association between HLA class II and OA. Patients and methods: A cross sectional comparatives study including patient with primary osteoarthritis attending the department of orthopedic in Al-Kindy teaching hospital Baghdad, Iraq between September 2016-September 2017. Patient's selection was done by the orthopaedics. The HLA-A tuping was performed in HLA research unit at Al-Kindy College of Medicine using PCR-SSO according to the manufacturer instruction using both Amplification and Hybridization kit by Automated method using Autolipa - 48Innogenities-Belgium. The results ewre interepted using LIRAS version 5.0 software innogenetics - Belgium, odds ratio were used to test signifcant differences. Results: Thirty five Iraqi Arab Muslims patients with primary osteoarthritis. The control group was comprised from 75 healtht unrelated sex and age matched volunteers among the staff of Al-Kindey college of medicine that didn't have a history of osteoarthritis. There was an increased frequencies of HLA-A*0101,0202,6802 in patients with osteoarthritis compared with healthy controls (P value=0.001,<0.001,<0.001 respectively)

Trasplante osteocondral autólogo para tratar lesiones osteocondrales de la rodilla: evaluación de 62 pacientes con un seguimiento promedio de ocho años / Osteochondral autograft transplantation for the treatment of osteochondral injuries of the knee: evaluation of 62 patients with an average follow-up of 8 years

Introducción: El trasplante osteocondral autólogo es una alternativa quirúrgica en lesiones focales del cartílago articular. El objetivo de este estudio fue evaluar una serie de 62 pacientes tratados con trasplante osteocondral autólogo de rodilla y un seguimiento promedio de ocho años. Materiales y Métodos: Se evaluó retrospectivamente a 62 pacientes operados entre 2001 y 2014. Se incluyeron pacientes con lesión focal de cartílago sometidos a un trasplante osteocondral autólogo aislado o asociado a otros procedimientos quirúrgicos, con un seguimiento mínimo de dos años. Para las evaluaciones se emplearon las escalas de Lysholm y de Kellgren-Lawrence, y el puntaje IKDC. Se evaluó a 45 hombres y 17 mujeres (edad promedio 36 años). La localización de las lesiones era: cóndilo interno (35), cóndilo externo (12), rótula (12) y combinadas (3). A 42 pacientes se los sometió a un trasplante osteocondral autólogo aislado y a 20, a uno asociado a otro procedimiento. Resultados: El valor promedio en la escala de Lysholm al momento de la evaluación fue 80,1 y el IKDC fue de 66,7. No hubo diferencias significativas en las escalas de Lysholm e IKDC entre los grupos con trasplante osteocondral autólogo aislado y asociado a otro procedimiento. En 30 pacientes evaluados con radiografía, se observó una inclusión satisfactoria del taco óseo. En nuestra serie de pacientes, las evaluaciones clínicas mostraron resultados satisfactorios. Conclusión: El trasplante osteocondral autólogo para tratar lesiones osteocondrales es un procedimiento con un alto grado de satisfacción y buenos resultados funcionales en pacientes con lesiones focales del cartílago articular. Nivel de Evidencia: IV

Introduction: Osteochondral autograft transplantation is a surgical alternative for osteochondral defects of the knee. The aim of this study was to analyze a series of 62 patients treated with osteochondral autograft transplantation of the knee and an average follow-up of 8 years. Methods: A total of 62 patients treated with osteochondral autograft transplantation between 2001 and 2014 were evaluated. Patients with focal osteochondral lesions who underwent osteochondral autograft transplantation alone or associated with another procedure and a minimum follow-up of 2 years were included. Lysholm score, IKDC, and Kellgren- Lawrence radiographic scale were used. Forty-five men and 17 women (average age 36 years) were evaluated. Lesions were localized in medial condyle (35), lateral condyle (12), patella (12), and three were combined. Forty-two patients underwent isolated osteochondral autograft transplantation while 20 patients underwent associated surgical procedures. Results: Mean Lysholm score was 80.1 and IKDC score was 66.7. There were no significant differences in the Lysholm and IKDC scores between groups. Radiographic results demonstrated complete graft incorporation in 30 patients. Clinical evaluation revealed satisfactory results. Conclusion: Osteochondral autograft transplantation to treat osteochondral lesions is a procedure with a high clinical satisfaction and good functional results in patients with focal osteochondral lesions. Level of Evidence: IV

Surgical Technique for Distal Femur Varization Osteotomy / 대한정형외과학회잡지

A closing wedge distal femoral osteotomy is a procedure to reduce pain and delay the progression of degenerative arthritis of knee by moving the weight bearing line from the lateral compartment to the medial side while preserving the knee joint. Age, weight bearing line, and the degree of arthritis are the essential factors to be considered at the time of surgery. The indications for distal femoral osteotomy are as follows. All patients are aged less than 65 years old, normal medial compartment of the knee with normal patello femoral joint, valgus deformity with lateral degenerative arthritis, younger patients with lateral osteochondritis, congenital osteochondrosis, and recurrent patellar dislocation with genu valgum. The distal femoral osteotomy provides the advantages of rapid pain reduction and short rehabilitation in young and active patients and patients who are subjected to heavy loads on the knee.

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.

Lesión osteocondral extensa de cóndilo femoral; tratamiento en un tiempo con matriz colágena y concentrado de médula ósea: reporte de un caso / Big osteochondral lesion; treatment with collagen scaffold and bone marrow concentrate: case report

El tratamiento de las lesiones osteocondrales de gran tamaño y profundidad resultan un desafío debido a que las técnicas habituales (microfractura o transplante osteocondral autólogo), son insuficientes para cubrir el defecto; eso es particularmente importante en pacientes jóvenes, pues se debe intentar técnicas que generen la menor comorbilidad posible. Presentamos un caso de un paciente de 18 años con una lesión osteocondral de 6 cm2 por 14 mm de profundidad, tratado mediante autoinjerto óseo, concentrado de médula ósea y matriz colágena, con resultados satisfactorios tanto en lo funcional como en lo imagenológico. Esa técnica presenta la ventaja de realizarse en un tiempo y con una fuente de células troncales mesenquimáticas (Médula ósea), validada en la literatura y altamente reproducible.

The treatment of large osteochondral defects represent a challenge, because the common techniques used (micro fracture or osteochondral autologous transplantation) are insufficient to cover the defect; this is particularly important in young patients where we expect the least comorbidity. We report a case of an 18-year-old patient with an ostechondral injury of 6 cm2 and 14 mm deep, treated with bone autograft, bone marrow concentrate and a matrix of collagen with satisfactory functional and images results. This technique has the advantage to be performed in one single time and with a source of mesenchymal stem cells (bone marrow) validated in the literature.

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.

Diagnosis and treatment of osteochondral lesions of the ankle: current concepts / Diagnóstico e tratamento das lesões osteocondrais do tornozelo: conceitos atuais

ABSTRACT We conducted a wide-ranging review of the literature regarding osteochondral lesions of the ankle, with the aim of presenting the current concepts, treatment options, trends and future perspectives relating to this topic.

RESUMO Os autores fazem uma revisão ampla da literatura a respeito das lesões osteocondrais do tornozelo, com o intuito de expor os conceitos atuais sobre o tema, as opções de tratamento, as tendências e as perspectivas.

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.

A importância do desfecho em ortopedia e traumatologia: traduzindo pesquisa em prática clínica / Outcomes in orthopedics and traumatology: translating research into practice

A pesquisa clínica tem como objetivo final gerar evidência factível paraa aplicação cotidiana. No entanto, traduzir os resultados de pesquisabaseada em evidências em prática clínica pode ser desafiador. Opresente estudo tem como objetivo salientar estes desafios, sugerire revisar ferramentas metodológicas de boas práticas, tendo comoexemplo tratamentos com plasma rico em plaquetas para lesões musculotendínease também o atual estado da arte do tratamento daslesões osteocondrais. Exploramos estudos e revisões sistemáticasenvolvendo os seguintes conceitos: diferenças clinicamente relevantes,erros sistemáticos, cálculo amostral, validade interna e externa. Autorese clínicos devem considerar estes conceitos para a execução e aplica-ção das melhores evidências. Deve-se contrabalancear os resultadosde pesquisa por meio de uma análise ponderada de sua robustezmetodológica e aplicabilidade prática. Nível de Evidência V, EstudosTerapêuticos - Investigação dos Resultados do Tratamento...

Clinical research is focused in generating evidence that is feasible tobe applicable to practitioners. However, translating research-focused evidenceinto practice may be challenging and often misleading. This articleaims is to pinpoint these challenges and suggest some methodologicalsafeguards, taking platelet-rich plasma therapies and knee osteochondralinjuries as examples. Studies and systematic reviews involving the followingconcepts will be investigated: clinically relevant outcomes, systematicerrors on sample calculation, internal and external validity. Relevant studieson platelet-rich plasma for muscle-tendon lesions and updates on osteochondrallesions treatment were included in this analysis. Authors andclinicians should consider these concepts for the implementation andapplication of dissemination of the best evidence. Research results shouldbe challenged by a weighted analysis of its methodological soundnessand applicability. Level of Evidence V, Therapeutic Studies - Investigatingthe Results of Treatment...

Fixation of an osteochondral fragment after acute patellar dislocation in an immature skeleton / Fixação do fragmento osteocondral após luxação aguda da patela no esqueleto imaturo

Fixation of an osteochondral fracture after acute patellar dislocation is an infrequent form of treatment. Likewise, the location of this fragment in the lateral region of the lateral femoral condyle, functioning as a free body, is uncommon. The aim of this study was to present a case of osteochondral fracture of the patella at an unusual site, along with the therapy used and the clinical follow-up...

A fixação da fratura osteocondral após a luxação aguda da patela é um tratamento infrequente, bem como a localização desse fragmento na região lateral do côndilo femoral lateral que funciona como um corpo livre. O objetivo desta pesquisa foi apresentar um caso de fratura osteocondral da patela em sítio não usual, assim como a terapêutica adotada e o seguimento clínico...