Bilateral juvenile osteochondrosis dissecans in monozygotic twins: a case report.

INTRODUCTION: The etiology of osteochondrosis dissecans (OCD), a chondropathy associated with detachment of the subchondral bone and the overlaying cartilage, is not yet fully understood. While repetitive physical exercise-related stress is usually assumed to be the main risk factor for the occurrence of OCD, genetic predisposition could have an underestimated influence on the development of the disease. CASE REPORT: We report a case of monozygotic twins with almost identical stages of bilateral osteochondrosis dissecans of the knee joint. In both patients, initially, a unilateral lesion occurred; despite restricted physical exercise, in the further course of the disease a lesion also developed on the contralateral side. While the lesion found most recently demonstrated an ongoing healing process at a 6-month follow-up, the other three lesions showed a natural course of healing under conservative treatment with significant clinical as well as radiological improvements after one year and complete consolidation in magnetic resonance imaging (MRI) after 2 years. CONCLUSION: There could be a genetic component to the development of OCD, although this has not yet been proven. Based on a two-year MRI follow-up, we were able to show the self-limiting characteristics of juvenile osteochondrosis dissecans.

A comprehensive MRI investigation to identify potential biomarkers of Osgood Schlatter disease in adolescents: A cross sectional study comparing Osgood Schlatter disease with controls.

BACKGROUND: Osgood-Schlatter disease (OSD) is the most common knee pain complaint among adolescents playing sports. Despite this, there remains controversy over the pathophysiology and whether specific anatomical characteristics are associated with OSD. PURPOSE: This study aimed to systematically and comprehensively characterize adolescents with OSD using magnetic resonance imaging (MRI) compared to pain-free controls, including both tissue abnormalities that may be associated with OSD, as well as anatomical characteristics. A secondary objective was to identify potential imaging biomarkers associated with pain. STUDY DESIGN: Cross-sectional study. METHODS: Adolescents with OSD and controls were recruited from 2020 to 2022. Following a clinical exam, demographics, pain, sports participation, and Tanner stage were collected. Knee MRI was conducted on the participants' most symptomatic knee (OSD) or the dominant leg (controls). RESULTS: Sixty-seven adolescents (46 with OSD and 30 controls) were included. 80% of participants with OSD had at least one tissue alteration compared to 54% of controls. Compared to controls, OSD had 36.3 (95%CI 4.5 to 289.7) higher odds of bony oedema at the tibial tuberosity, and 32.7 (95%CI 4.1 to 260.6) and 5.3 (95%CI 0.6 to 46.2) higher odds of bony oedema at the  tibial epiphysis and metaphysis respectively. Participants with OSD also had higher odds of fluid/oedema at the patellar tendon (12.3 95%CI 3.3 to 46.6), and superficial infrapatellar bursitis (7.2).  Participants with OSD had a more proximal tendon attachment (mean tibial attachment portion difference, -0.05, 95% CI: -0.1 to 0.0, p = 0.02), tendon thickness (proximal mean difference, -0.09, 95% CI: -0.4 to 0.2, p = 0.04; distal mean difference, -0.6, 95% CI: -0.9 to -0.2, p = 0.01). Those with bony/tendon oedema had 1.8 points (95% CI: 0.3 to 3.2) higher pain on palpation than those without (t = -2.5, df = 26.6, p = 0.019), but there was no difference between these groups in a functional single leg pain provocation. CONCLUSION: Adolescents with OSD present with tissue and structural abnormalities on MRI that differed from age-matched controls. The majority had findings in the patellar tendon and bone, which often co-occurred. However, a small proportion of OSD also presents without alterations. It appears these findings may be associated with clinical OSD-related pain on palpation of the tibial tuberosity. CLINICAL RELEVANCE: Our highlight the pathophysiology on imaging, which has implications for understanding the mechanism and treatment of OSD.

Tibial tubercle avulsion fracture following preexisting Osgood-Schlatter disease in an adolescent: a case report.

Tibial tubercle avulsion fractures (TTAFs) are rare but typical in children and adolescents and Osgood-Schlatter disease (OSD) may be involved in their pathogenesis. However, few publications have reported the relationship between OSD and TTAF. A 16-year-old healthy male adolescent presented with pain, swelling and limited range of motion of the right knee following sudden acceleration while running. Based on the radiographic evidence, the patient was diagnosed with an avulsion fracture of the right tibial tubercle and OSD. Open reduction and internal fixation were performed using two cannulated screws and two Kirschner wires. The patient returned to preinjury activity levels at the 12-month follow-up postoperatively. This case report aimed to highlight this unique injury pattern. For patients with TTAFs, not only should the fracture be treated, but the cause of the fracture, such as OSD, should also be given appropriate treatment.

Osteochondrosis in the central and third tarsal bones of young horses.

Recently, the central and third tarsal bones of 23 equine fetuses and foals were examined using micro-computed tomography. Radiological changes, including incomplete ossification and focal ossification defects interpreted as osteochondrosis, were detected in 16 of 23 cases. The geometry of the osteochondrosis defects suggested they were the result of vascular failure, but this requires histological confirmation. The study aim was to examine central and third tarsal bones from the 16 cases and to describe the tissues present, cartilage canals, and lesions, including suspected osteochondrosis lesions. Cases included 9 males and 7 females from 0 to 150 days of age, comprising 11 Icelandic horses, 2 standardbred horses, 2 warmblood riding horses, and 1 coldblooded trotting horse. Until 4 days of age, all aspects of the bones were covered by growth cartilage, but from 105 days, the dorsal and plantar aspects were covered by fibrous tissue undergoing intramembranous ossification. Cartilage canal vessels gradually decreased but were present in most cases up to 122 days and were absent in the next available case at 150 days. Radiological osteochondrosis defects were confirmed in histological sections from 3 cases and consisted of necrotic vessels surrounded by ischemic chondronecrosis (articular osteochondrosis) and areas of retained, morphologically viable hypertrophic chondrocytes (physeal osteochondrosis). The central and third tarsal bones formed by both endochondral and intramembranous ossification. The blood supply to the growth cartilage of the central and third tarsal bones regressed between 122 and 150 days of age. Radiological osteochondrosis defects represented vascular failure, with chondrocyte necrosis and retention, or a combination of articular and physeal osteochondrosis.

Detection of fragment migration into the biceps tendon sheath originating from a humeral osteochondrosis lesion - A case report and review of the literature.

The purpose of this report is to demonstrate that radiographic evaluation of the canine shoulder joint alone is not sensitive enough to detect migrated osteochondral fragments within the biceps tendon sheath, as a sequela to osteochondrosis dissecans of the caudal humeral head. A 6-months-old, male, 35 kg Hovawart was referred due to chronic intermittent lameness on the left forelimb. Survey radiographs revealed a semilunar radiolucency surrounded by a moderately sclerotic rim at the caudal aspect of the left humeral head, referred to as osteochondrosis dissecans. However, only computed tomography combined with ultrasonography could clearly confirm a dislodged osteochondral fragment within the left biceps tendon sheath and a consequent tenosynovitis. Arthroscopic treatment on the clinically affected left forelimb followed by an additional approach over the left biceps tendon sheath to remove the migrated fragment resulted in a complete remission of the lameness until the last follow-up one year after surgery. In our opinion, computed tomography should be applied in the medical work up of canine shoulder osteochondrosis (OC) as standard. Combined with ultrasonography, it can further aid in complete evaluation of the shoulder joint and reliable exclusion of displaced osteochondral fragments, which might also be missed during arthroscopy when located too far distally.

Developmental stage and lower quadriceps flexibilities and decreased gastrocnemius flexibilities are predictive risk factors for developing Osgood-Schlatter disease in adolescent male soccer players.

PURPOSE: This study aimed to elucidate the influential predictive risk factors of Osgood-Schlatter disease (OSD) on the support (non-kicking) leg among adolescent soccer players considering peak height velocity (PHV) age and investigate the cut-off values of the predictive variables. METHODS: A cohort of 302 Japanese adolescent male soccer players aged 12-13 years were followed over 6 months. All players underwent physical examination, tibial tubercle ultrasonography, anthropometric and whole-body composition measurements, and muscle flexibility test of the support leg at the baseline. The developmental stage was evaluated from the PHV age. The OSD of the support leg was diagnosed 6 months later; players were divided into the OSD and control (CON) groups. The predictive risk factors were analyzed by multivariate logistic regression analysis. RESULTS: There were 42 players who had developed OSD at baseline and they were excluded from the study. Among the 209 players, 43 and 166 belonged to the OSD and CON groups, respectively. The predictive risk factors of OSD development were PHV age ± 6 months at baseline (p = 0.046), apophyseal stage of tibial tuberosity maturity at baseline (p < 0.001), quadriceps flexibility ≥ 35° at baseline (p = 0.017), and decrease in gastrocnemius flexibility in 6 months (p = 0.009). CONCLUSION: PHV age ± 6 months at baseline, apophyseal stage of the tibial tuberosity at baseline, quadriceps flexibility ≥ 35° at baseline, and decrease in gastrocnemius flexibility in 6 months are predictive risk factors of OSD development in the support leg among adolescent male soccer players. It is crucial to know the PHV age of each player, and not only the flexibility of quadriceps muscle but also the gastrocnemius should be monitored to predict OSD. LEVEL OF EVIDENCE: II.

A Predictive Score for Infantile Blount Disease Recurrence After Tibial Osteotomy.

INTRODUCTION AND OBJECTIVE: Several predictive factors for infantile Blount disease recurrence after tibial osteotomy were discovered. This study aimed to examine and utilize various predictors to develop a prediction score for infantile Blount disease recurrence after tibial osteotomy. METHODS: We conducted a retrospective cohort study of infantile Blount disease patients who underwent tibial osteotomy between January 1998 and December 2020. Potential predictors, including clinical and radiographic parameters, were examined for their association with the disease recurrence after receiving tibial osteotomy. A predictive score was subsequently developed based on those potential predictors through multivariable logistic regression modeling. RESULTS: A total of 101 extremities diagnosed with infantile Blount disease from 58 patients who underwent tibial osteotomy were included. Of those, 15 extremities (14.9%) recurred. Univariable logistic regression analysis identified age older than 42 months [odds ratio (OR)=4.28; P =0.026], Langenskiöld classification stage III (OR=9.70; P <0.001), LaMont classification type C (OR=15.44; P <0.001), preoperative femorotibial angle <-14 degrees (OR=4.21, P =0.021), preoperative metaphyseal-diaphyseal angle >16 degrees (OR=8.61, P =0.006), preoperative medial metaphyseal slope angle >70 degrees (OR=7.56, P =0.001), and preoperative medial metaphyseal beak angle >128.5 degrees (OR=13.46, P =0.001) as potential predictors of infantile Blount disease recurrence after tibial osteotomy. A predictive score comprised of age younger than 42 months, LaMont classification type C, and medial metaphyseal beak angle >128 degrees demonstrated an excellent predictive performance (area under the receiver operating characteristic curve =0.87), good calibration, and high internal validity. CONCLUSIONS: Our developed predictive score accurately predicted infantile Blount disease recurrence after tibial osteotomy. The results from our developed prediction tool allow physicians to inform prognosis, increase awareness during the follow-up period, and consider additional interventions to prevent disease recurrence. LEVEL OF EVIDENCE: Level II.

A method for labelling lesions for machine learning and some new observations on osteochondrosis in computed tomographic scans of four pig joints.

BACKGROUND: Osteochondrosis is a major cause of leg weakness in pigs. Selection against osteochondrosis is currently based on manual scoring of computed tomographic (CT) scans for the presence of osteochondrosis manifesta lesions. It would be advantageous if osteochondrosis could be diagnosed automatically, through artificial intelligence methods using machine learning. The aim of this study was to describe a method for labelling articular osteochondrosis lesions in CT scans of four pig joints to guide development of future machine learning algorithms, and to report new observations made during the labelling process. The shoulder, elbow, stifle and hock joints were evaluated in CT scans of 201 pigs. RESULTS: Six thousand two hundred fifty osteochondrosis manifesta and cyst-like lesions were labelled in 201 pigs representing a total volume of 211,721.83 mm3. The per-joint prevalence of osteochondrosis ranged from 64.7% in the hock to 100% in the stifle joint. The lowest number of lesions was found in the hock joint at 208 lesions, and the highest number of lesions was found in the stifle joint at 4306 lesions. The mean volume per lesion ranged from 26.21 mm3 in the shoulder to 42.06 mm3 in the elbow joint. Pigs with the highest number of lesions had small lesions, whereas pigs with few lesions frequently had large lesions, that have the potential to become clinically significant. In the stifle joint, lesion number had a moderate negative correlation with mean lesion volume at r = - 0.54, p < 0.001. CONCLUSIONS: The described labelling method is an important step towards developing a machine learning algorithm that will enable automated diagnosis of osteochondrosis manifesta and cyst-like lesions. Both lesion number and volume should be considered during breeding selection. The apparent inverse relationship between lesion number and volume warrants further investigation.

Gross, histopathologic, microbiologic, and radiologic characterization of lesions associated with clinical lameness in a cohort of group-housed sows euthanized for lameness.

Lameness in sows is reported as the most frequent cause of early culling from commercial farms and results in reduced productivity, economic losses, and a negative impact on animal welfare. Osteochondrosis was reported as the leading cause of lameness in North American sows and, although more recent European studies report infectious arthritis as the leading cause, lameness in US production facilities using group housing for gestating sows has not yet been evaluated. This study's aim was to characterize lesions associated with lameness in the appendicular musculoskeletal system of 26 sows euthanized for lameness using pathologic, radiologic, and microbiologic analyses. Of 178 total lesions, infectious lesions were most common (54%), predominated in distal limb segments (ie, at or distal to carpi and tarsi) and more often correlated with the clinically lame limb, whereas osteochondrosis and degenerative osteoarthritis predominated in proximal limb segments (ie, at or proximal to cubital and stifle joints) and rarely correlated with the clinically lame limb. The location and characteristics of infectious lesions, including mixed bacterial growth isolated from 22/22 orthopedic sites representing 19 sows with Trueperella pyogenes isolated in 16/22 (73%) of samples, suggest an etiologic component involving trauma. Radiography had a 70.6% sensitivity and 93.9% specificity for detecting infectious lesions affecting tarsocrural, antebrachiocarpal, and digital (ie, claw) regions combined. The frequency, type, and location of infectious lesions identified in this cohort of sows euthanized for lameness differ from previous reports, indicating the need for further investigation of the etiopathogenesis, earlier detection methods, and prevention.

Osteochondrosis (Osteochondritis Dissecans) in Lusitano Horses: Prevalence and Characteristics.

Osteochondrosis (osteochondritis dissecans), OC(D), is an important joint disorder that has been studied through the years in different breeds but, to our knowledge, there are no reports of its prevalence in Lusitano horses. The aim of this study was to assess the prevalence of OC(D) in Lusitanos, define the characteristics of the disorder in this breed and compare with Spanish Purebred horses. This is a retrospective study that analysed the radiographs from the metacarpometatarsophalangeal, tarsocrural and femoropatellar joints that were taken in 302 Lusitano horses (1-12 years; obtained from 2007 until 2019). The classification of the radiographs for OC(D) was performed using a 0-4 scale and scored by three veterinarians. Radiographical evidence of OC(D) was diagnosed in 53.3% of the horses examined. Most of the findings were lesions of score 1 or 2 corresponding to flattening, (36.8%). The distal intermediate ridge of the tibia in the tarsocrural joint was the most affected predilection site (31.0%, n=187/604 joints assessed). Overall, the tarsocrural joints were more likely to be affected, followed by metatarso-metacarpophalangeal joints and finally the femoropatellar joints. The prevalence of horses with scores 3 or 4 (fragments) in any of the joints was 16.6%. A positive correlation was found between the scores of contralateral joints. We can conclude that the prevalence of OC(D) in Lusitano horses is similar to the prevalence in Spanish Purebred, but there is a lower percentage of fragmentation. The present phenotypic description can provide valuable information for further quantitative and molecular genetic studies.

A systematic review evaluating the use of ultrasound in the identification of osteochondrosis in horses.

Osteochondrosis is commonly encountered in young horses, with welfare, performance, and economic effects. Consequently, pre-purchase radiographic screening for osteochondrosis is routinely performed. Ultrasonographic examination of articular cartilage and osteochondrosis lesions are described in the literature with many case series or single case reports published. This systematic review was undertaken to examine the evidence for using ultrasonography in comparison to traditional radiography, arthroscopy or necropsy findings in the detection of osteochondrosis. The systematic review identified a paucity of studies in which there was marked variation in the populations, sample size, methods and results reported. Currently, there is no strong evidence confirming the diagnostic accuracy and validity of ultrasonography in the detection of osteochondral lesions in the relevant joints in horses.

Osgood-Schlatter Disease in youth elite football: Minimal time-loss and no association with clinical and ultrasonographic factors.

BACKGROUND: Osgood-Schlatter Disease is the most common cause of knee pain in youth. Scientific research in youth elite football is limited. OBJECTIVES: To assess clinical and ultrasonographic factors associated with Osgood-Schlatter Disease and calculate point prevalence of clinical diagnosis and time-loss in youth elite male football. STUDY DESIGN: Nested case-control study and cross-sectional prevalence study; Level of evidence: 3. METHODS: We obtained data during the pre-season periodic health evaluation. Osgood-Schlatter Disease diagnosis was defined as (1) athlete-reported anterior knee pain and (2) clinical confirmation by pain provocation at the tibial tuberosity. Time-loss was defined as inability to participate in team training and/or competition. For the nested-case control study, we examined clinical and ultrasonographic factors in the U13 to U16 teams. We matched on calendar-age. The clinical factors were: self-reported history of Sever's disease, growth measures, leg muscles flexibility and strength and ultrasonographic bone maturity stages according to Ehrenborg, For the cross-sectional study, we included players of the U13 to U19 teams to calculate the point prevalence. RESULTS: The case-control study consisted 30 players and the cross-sectional study 127 players. Previous Sever's disease was strongly associated with Osgood-Schlatter Disease (OR = 16.8; p = 0.02; 95% CI = 1.6-174.5). None of the other clinical or ultrasonographic factors were associated. The point prevalence was 17% and 80% had no time-loss despite presence of clinical symptoms. CONCLUSION: Considering the 16.8OR, previous Sever's disease indicates a strong association with Osgood-Schlatter Disease. Although generally suggested, growth velocity and bone maturity are not associated in an age-matched comparison.

Comparative Evaluation of the Radiographic Parameters for Screening Early Blount Disease.

BACKGROUND: Radiographic findings in young children with physiological bowing sometimes difficult to distinguish from early Blount disease. However, early diagnosis of the disease is critical because of the poor treatment outcomes for Blount disease. In this study, we aim to evaluate the accuracy of the metaphyseal-diaphyseal angle (MDA) compared with the medial metaphyseal beak (MMB) angle for differentiating between physiological bowing and early Blount disease and to determine which parameter to adequately screen for the subsequent development of Blount disease. METHODS: A retrospective study was conducted on children aged 1 to 3 years old who were brought to our outpatient clinic with bowed leg between 2000 and 2017. Data on the patients' age, sex, and affected sides were collected. Radiographic measurements of the femorotibial angle (FTA), MDA, and MMB angle were evaluated from the initial radiographs. An observer repeated the measurements on all the radiographs 2 weeks after they were first done. RESULTS: In total, 158 legs were considered from 79 children (48 males/31 females), whose average age was 26.0±6.1 months old. Eighty-seven legs were diagnosed with Blount disease and 71 legs had physiological bowing. Using single cutoff values of 16 degrees for the MDA showed low sensitivity (50.6%), very high specificity (100.0%), and a very high positive predictive value (PPV); while using MMB angle cutoff values ≥122 degrees showed very high sensitivity (92.0%), high specificity (80.3%), and a high PPV. Considering the MDA and MMB angle simultaneously showed very high sensitivity (93.1%), high specificity (80.3%), and a high PPV. The area under the receiver operating characteristic curve of the MDA and MMB showed excellent (0.89) and outstanding (0.93) discriminative ability, respectively. When combining the MDA and MMB angles, it was also considered outstanding performance (area under the receiver operating characteristic curve=0.95). CONCLUSIONS: The MMB angle represents a potential radiographic screening parameter for predicting early Blount disease in children 1 to 3 years old, offering high sensitivity and specificity. The MDA showed excellent specificity as a confirmation parameter for Blount disease patients. Applying both the MDA and MMB angles is another option to increase early recognition and confirm the diagnosis in early Blount disease patients. LEVEL OF EVIDENCE: Level II.

Osteochondrosis and other lesions in all intervertebral, articular process and rib joints from occiput to sacrum in pigs with poor back conformation, and relationship to juvenile kyphosis.

BACKGROUND: Computed tomography (CT) is used to evaluate body composition and limb osteochondrosis in selection of breeding boars. Pigs also develop heritably predisposed abnormal curvature of the spine including juvenile kyphosis. It has been suggested that osteochondrosis-like changes cause vertebral wedging and kyphosis, both of which are identifiable by CT. The aim of the current study was to examine the spine from occiput to sacrum to map changes and evaluate relationships, especially whether osteochondrosis caused juvenile kyphosis, in which case CT could be used in selection against it. Whole-body CT scans were collected retrospectively from 37 Landrace or Duroc boars with poor back conformation scores. Spine curvature and vertebral shape were evaluated, and all inter-vertebral, articular process and rib joints from the occiput to the sacrum were assessed for osteochondrosis and other lesions. RESULTS: Twenty-seven of the 37 (73%) pigs had normal spine curvature, whereas 10/37 (27%) pigs had abnormal curvature and all of them had wedge vertebrae. The 37 pigs had 875 focal lesions in articular process and rib joints, 98.5% of which represented stages of osteochondrosis. Five of the 37 pigs had focal lesions in other parts of vertebrae, mainly consisting of vertebral body osteochondrosis. The 10 pigs with abnormal curvature had 21 wedge vertebrae, comprising 10 vertebrae without focal lesions, six ventral wedge vertebrae with ventral osteochondrosis lesions and five dorsal wedge vertebrae with lesions in the neuro-central synchondrosis, articular process or rib joints. CONCLUSIONS: Computed tomography was suited for identification of wedge vertebrae, and kyphosis was due to ventral wedge vertebrae compatible with heritably predisposed vertebral body osteochondrosis. Articular process and rib joint osteochondrosis may represent incidental findings in wedge vertebrae. The role of the neuro-central synchondrosis in the pathogenesis of vertebral wedging warrants further investigation.

Co-occurrence of Blount's disease and Legg-Calvé-Perthes disease: is obesity a factor?

Legg-Calvé-Perthes disease (LCPD) and Blount's disease share a similar presenting age in addition to similar symptoms such as limp or knee pain. A little overlap is mentioned about both diseases. We sought to present cases of children having both conditions to discuss the implications of this co-occurrence on diagnosis and management. After institutional review board approval, we retrospectively reviewed records of four children who developed both Blount's disease and LCPD. Patient details and outcomes were analyzed. Radiographs were evaluated for the lateral pillar classification, Stulberg classification, tibial metaphyseal-diaphyseal angle and tibiofemoral angle. Two of the cases were initially diagnosed with Blount's disease and subsequently developed Perthes, one case presented initially with both disorders and the final case had Perthes followed by Blount's. Three children were obese and one was overweight. The common symptom to all patients was an abnormal gait, which was painless in two children and painful in two. Blount's disease required surgery in three children. Radiographs showed Lateral Pillar B, B/C border and C hips, and the final Stulberg was stage II (n = 2) or stage IV (n = 2). Obesity is associated with Blount's disease and LCPD, so obese children can be at an increased risk of developing both disorders. Therefore, a child with Blount's disease who has persistent, recurrent or worsening symptoms such as gait disturbance or thigh or knee pain might benefit from a careful physical exam of the hips to prevent a delayed or even missed LCPD diagnosis.

Surgical treatment of atraumatic osteochondrosis dissecans of the immature talus-Clinical results and prevalence of radiographic joint degeneration after a median follow-up of 72.5 months.

BACKGROUND: This study aimed to assess the clinical and radiographic outcomes of different surgical procedures in atraumatic osteochondrosis dissecans (OCD) of the talus in youth and adolescence. METHODS: 32 joints in 30 patients (mean age 14.7 ± 2.2 years) were evaluated. Numeric Rating Scale (NRS), Foot and Functional Index (FFI), American Orthopedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Pediatric Outcome Data Collection Instrument (PODCI), and sport participation were recorded. We compared preoperative and follow-up ankle radiographs to identify specific features in the OCD morphology and any signs of joint degeneration. RESULTS: After a median follow-up period of 72.5 months the drilling group showed significantly better scores than the combined fixation and reconstruction groups (AOFAS, p = 0.024; PODCI, p = 0.003; NRS, p = 0.027). Signs of joint degeneration were observed in 50% of all ankles, especially in those treated by OCD-fixation and reconstruction. CONCLUSIONS: Advanced fixation and reconstruction procedures in unstable and non-salvageable atraumatic talar OCD resulted in inferior clinical scores and a higher prevalence of joint degeneration than drilling procedures in stable OCD in young patients.

Guided growth using a tension-band plate in Blount's disease.

Our observational study's objective was to determine how effective guided growth with tension-band plates was to correct the deformity in Blount's disease. We reviewed the records of 14 children (18 limbs) with Blount's disease who were treated with tension-band plates as the only surgical intervention at a single institution over eight years. Five children (seven limbs) had infantile Blount's disease with Langenskiöld stage ≤2. Nine children (11 limbs) had late-onset Blount's disease. The mean age at operation was 7.2 years (SD, 3.1, range, 2.9-11.8). The tension-band plate effectively corrected the varus deformity in 78% (14/18) of limbs. Correction to normal mechanical alignment was achieved in 67% (n = 12) of limbs at a mean of 18 months (SD, 7, range, 9-31). Failure to achieve correction of the mechanical axis was due to delayed implant removal and overcorrection in 11% (2/18), mechanical failure due to screw fixation failure in 11% (2/18) and in 6% (1/18) due to a misplaced epiphyseal screw. There was a greater magnitude of correction in the Infantile Blount's disease group (mean, 26°, SD, 9°) when compared to the children with late-onset Blount's disease (13°, SD, 4°) (P = 0.021). The mean correction rate was 1.8°/month in the Infantile Blount's disease group and 0.7°/month in the late-onset Blount's disease group, respectively (P = 0.014). Our findings support the use of tension-band plating in Blount's disease. Further research is required to determine the ideal indications and to investigate the long-term outcome of guided growth in Blount's disease. Level of evidence: Level 4.

Radiological, vascular osteochondrosis occurs in the distal tarsus, and may cause osteoarthritis.

BACKGROUND: Osteochondrosis occurs due to failure of the blood supply to growth cartilage. Osteochondrosis lesions have been identified in small tarsal bones and suggested to cause distal tarsal osteoarthritis; however, it has not been determined whether distal tarsal osteochondrosis lesions were the result of vascular failure. OBJECTIVES: To perform post-mortem arterial perfusion and micro-computed tomography (CT) of the central (CTB) and third tarsal bones (TIII) of fetuses and foals up to 5 months old, to describe tarsal development and any lesions detected. STUDY DESIGN: Descriptive, nonconsecutive case series. METHODS: Twenty-three animals that died or were euthanased from 228 days of gestation to 5 months old were collected, comprising two fetuses and nine foals of miscellaneous breeds and 12 Icelandic Horse foals, a breed with high prevalence of distal tarsal osteoarthritis. One hindlimb from each foal was perfused arterially with barium, and the CTB and TIII were examined with micro-CT. RESULTS: Perfusion yielded partial information from 41% of the animals. The CTB and TIII were supplied by nutrient arteries and perichondrial vessels with vertical, transverse and circumferential configurations. Fourteen of the 23 (61%) animals had focal defects in the ossification front, that is, radiological osteochondrosis. The majority of lesions matched the configuration and development of vertical vessels. Additionally, full-thickness, cylindrical defects matched transverse vessels, and the long axes of some dorsal lesions matched circumferential vessels. MAIN LIMITATIONS: Lack of histological validation. CONCLUSIONS: Post-mortem perfusion was poor for examination of the blood supply to the growth cartilage of the CTB and TIII. Radiological osteochondrosis lesions were compatible with vascular failure because they were focal, and because lesion geometry matched vessel configuration. The relationship between osteochondrosis and distal tarsal osteoarthritis warrants further investigation.

Therapeutic interventions in Osgood-Schlatter disease: A case report.

RATIONALE: The purpose of this case study was to identify factors of bilateral etiopathogenesis of Osgood-Schlatter disease (OSD) and those supporting the effectiveness of the therapeutic process in a 12-year-old elite female Olympic karateka. PATIENT CONCERNS: The present case study concerns OSD female karateka who started her sport-specific training at the age of 4 years. DIAGNOSES: The results of subjective palpation by the orthopedic surgeon and objective medical examination using ultrasonography, wall slide test, magnetic resonance imaging, and body height and weight measurements were collected. INTERVENTIONS: The therapeutic intervention for the athlete's knee joints lasted 20 months (5 stages). Physical therapy, kinesiotherapy, and pharmacological treatment were administered, and physical activity was gradually introduced. OUTCOMES: The developmental trajectory was uniform for body height and labile for body weight. OSD was diagnosed after the second growth spurt, and significant progression was reported during the subsequent height and weight gains and increased volume and intensity of sports training. The rate and dynamics of changes in the distance from the patellar ligament to the tibial apophysis were irregular, with dominance in the right knee with the highest rate of change (-3.3 mm) and twice the regression of the rate of change (-2.5 mm). The analyzed distance never exceeded the baseline value (5.5 mm), which was the case in the left knee. Return to sports competition was possible from the second month of therapy, in which kinesiotherapy and static stretching were the most effective. A relatively correct distance of the patellar ligament from the tibial apophysis was recorded at the time of stabilization of the body height and weight gain. No pathological changes were observed following OSD, and full recovery was observed. LESSONS: In the case discussed in this study, growth spurt, the specificity of the sport practiced, and early specialization including high-volume and high-intensity training should be considered as factors causing OSD and its progression. Kinesiotherapeutic management and static stretching are crucial for the treatment of OSD. Quick return to sports competition was possible due to early therapeutic intervention, which could also lead to the absence of pathological changes in the tibial tubercle and the absence of recurrence of OSD.