Predictors of Failure of Return to Play in Youth Baseball Players After Capitellar Osteochondritis Dissecans: Focus on Elbow Valgus Laxity and Radiocapitellar Congruity.

BACKGROUND: Osteochondritis dissecans of the humeral capitellum (capitellar OCD) is a common injury among youth baseball players, but there are only a few studies that report on return to play with nonoperative treatment. PURPOSE: To evaluate the medial elbow joint laxity under valgus stress and radiocapitellar congruity in patients with capitellar OCD and evaluate their relationship to predicting rehabilitation outcome. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Capitellar OCD was diagnosed in 81 patients included in our study. All patients were elementary school students who initially received rehabilitation treatment after injury. The rates of return to the same level of play or higher (RTSP) were calculated and correlated with the joint gap difference between the dominant and nondominant elbows using ultrasound and radiocapitellar congruity (proximal, lateral, and anterior radial translation length), which was assessed using plain radiographs of the dominant elbow. RESULTS: The overall RTSP rates of patients with nonoperative treatment was 70.4% (57/81). The multivariate logistic regression analysis identified OCD classification (stage I, odds ratio [OR], 4.076; 95% CI, 1.171-14.190) and 1 continuous variable (proximal radial translation length on anteroposterior view, OR, 0.661; 95% CI, 0.479-0.911) as the significant predictive factors for outcome after nonoperative treatment. CONCLUSION: The early stage of capitellar OCD in youth baseball players can be successfully treated nonoperatively in the majority of cases. The presence of proximal radial translation can predict the outcome of nonoperative management of capitellar OCD.

Osteochondritis dissecans located on the medial tibial plateau: a case report.

BACKGROUND: Osteochondritis dissecans are typically located mainly on the femoral condyle, with reported but less common cases of patella involvement. In this case report, we reported a rare case of osteochondritis dissecans located on the medial tibial plateau. CASE PRESENTATION: A 26-year-old Han Chinese woman presented with a lesion on her left medial tibial plateau. She was treated by arthroscopy for her knee condition. During the operation, a primary diagnosis of osteochondritis dissecans on her medial tibial plateau was indicated by an osteochondral fragment. Arthroscopic removal of the fragment was then performed. Histological examination which was done by a pathologist after the operation supported the positive pathology of osteochondritis dissecans. CONCLUSIONS: The common site of osteochondritis dissecans development in the knee is on the femoral condyle, and some develop on the patella. In this case report, it was proven that osteochondritis dissecans can also take place on the tibial plateau, although it is very uncommon.

Results of Hyaluronic Acid-Based Cell-Free Scaffold Application in Combination With Microfracture for the Treatment of Osteochondral Lesions of the Knee: 2-Year Comparative Study.

PURPOSE: To determine the clinical and radiographic efficacy of hyaluronic acid-based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint. METHODS: Clinical data of 43 patients between 24 and 55 years of age were evaluated. Hyaluronic acid-based cell-free scaffold was applied in combination with microfracture for 19 knees (group 1), whereas microfracture alone was the surgical intervention for 24 knees (group 2). All lesions were Outerbridge grade III or IV with a mean size of 3.6 ± 1.3 cm2. The mean follow-up time was 25.7 months. Visual analog scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments used to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. RESULTS: Better VAS and Lysholm scores were detected in group 1 at 12 and 24 months (P = .019 and P = .025). According to the Tegner activity scale, group 1 had also better activity level at the end of 24 months after surgery (P = .020). The mean time from surgery to return to nonimpact sports activities was 7.8 months in group 1, whereas it was 9.2 months in group 2 (P = .013). Complete repair with the filling of the defect was achieved in 7 (36.8%) of the knees in group 1, whereas it was 4 (16.6%) of the knees in group 2 according to the MOCART system at 24 months. CONCLUSIONS: Single-stage regenerative cartilage surgery using hyaluronic acid-based cell-free scaffold in combination with microfracture for focal osteochondral lesions of the knee revealed promising clinical outcomes at 24 months of follow-up, but the clinical significance of the differences seen is simply not known. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Direct comparison of different surgical approaches in a woman with bilateral osteochondrosis dissecans of her knees: a case report.

BACKGROUND: Osteochondrosis dissecans is a disorder of the subchondral bone potentially affecting the adjacent articular cartilage. There remains disunity with regard to treatment methods. CASE PRESENTATION: We present the case of a 21-year-old Swiss woman who presented with clinically symptomatic bilateral osteochondrosis dissecans lesions at both medial femoral condyles. She underwent sequential surgical intervention and was prospectively monitored using clinical scores and magnetic resonance imaging. Her left knee was treated with an open refixation of the osteochondrosis dissecans lesion with two 2.0 mm screws in combination with a cancellous bone graft and subchondral drilling since the cartilage of the osteochondrosis dissecans lesion was intact. On her right knee, she underwent open removal of the defective bone and cartilage, cancellous bone graft with subchondral drilling and coverage with a bilayered collagenous membrane (autologous matrix-induced chondrogenesis technique) since the cartilage of the osteochondrosis dissecans lesion was not intact. At final follow-up 12 months after surgery her Lysholm score had improved from 79 to 95 on her left side and from 74 to 78 on her right. Magnetic resonance imaging displayed good integration of the cancellous bone graft with a slight irregularity at the articular surface on her left side (magnetic resonance observation of cartilage repair tissue (MOCART) 75). The magnetic resonance imaging of her right knee depicted satisfying bony reconstitution with yet more irregularity at the joint surface (magnetic resonance observation of cartilage repair tissue 65) in comparison to her left femoral condyle. CONCLUSIONS: In cases of failed conservative treatment of osteochondrosis dissecans lesions of the knee joint surgery should be taken into consideration. Considering this case, we believe that the focus should be the preservation of the cartilaginous layer whenever possible or at least replacement with high quality replacement tissue, such as autologous chondrocyte implantation.

Osteochondritis Dissecans of the Glenoid in a Major League Baseball Prospect: A Case Report.

CASE: A 16-year-old Major League Baseball prospect presented with persistent shoulder pain associated with throwing. Magnetic resonance imaging (MRI) demonstrated a large osteochondritis dissecans lesion in the posterosuperior aspect of the glenoid. The patient was restricted from throwing and underwent therapy to improve range of motion and throwing mechanics. Eight months after initiating nonoperative treatment, an MRI arthrogram demonstrated a healed lesion. At follow-up 2 years after treatment, full relief of symptoms had persisted. CONCLUSION: Osteochondritis dissecans lesions of the glenoid are extremely rare, but have the potential to heal in overhead-throwing athletes. To our knowledge, this is the only case reported in the literature that demonstrates a healed osteochondritis dissecans lesion of the glenoid following nonoperative treatment.

Physical therapy management of patients with osteochondritis dissecans: a comprehensive review.

Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. Rehabilitation interventions can vary based on factors such as the lesion characteristics, lesion location, articular cartilage involvement, skeletal maturity of the patient, presenting impairments at the time of evaluation, and concomitant injury. It is the responsibility of the rehabilitation professional to address all corresponding factors and mindfully advance the patient with a systematic and evidence-based progression to protect healing tissue and optimize outcome.

Relationship between CTX-II and patient characteristics, patient-reported outcome, muscle strength, and rehabilitation in patients with a focal cartilage lesion of the knee: a prospective exploratory cohort study of 48 patients.

BACKGROUND: C-telopeptide fragments of type II collagen (CTX-II) are created during articular cartilage breakdown and CTX-II is considered useful as a biomarker of osteoarthritis. The primary objective of the present study was to explore the relationship between urinary CTX-II concentration and patient characteristics, patient-reported outcome, muscle strength, and rehabilitation in patients with isolated focal knee cartilage lesions. Furthermore, the secondary objective was to examine differences in urinary CTX-II concentration between patients with focal cartilage lesions and healthy controls. METHODS: 48 patients (mean age 33.4 years, standard deviation 9.0) with a focal full-thickness (International Cartilage Repair Society grade 3 or 4) cartilage lesion on the medial or lateral femoral condyle were included. After baseline assessments, the patients completed a 3-month rehabilitation program and 44 patients attended the 3 month follow-up. Baseline and follow-up assessments consisted of urinary CTX-II, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and isokinetic quadriceps and hamstring muscle strength measurements. CTX-II was also analysed in urine samples from 6 healthy individuals, serving as normal controls. Correlations were classified as very weak (correlation coefficient [r] < 0.20), weak (r = 0.20 - 0.39), moderate (r = 0.40 - 0.59), strong (r = 0.60 - 0.79), and very strong (r > 0.80). RESULTS: Except for age and quadriceps strength, no significant correlations were found between CTX-II concentrations and baseline characteristics, KOOS, or muscle strength. Except for age, all correlations were considered as weak or very weak. The patients with a focal cartilage lesion had significantly higher mean CTX-II concentration than the healthy control individuals both at baseline (p = 0.001) and at follow-up (p = 0.001). The mean CTX-II concentration tended to decrease during rehabilitation, but the reduction was not significant (p = 0.076). CONCLUSIONS: The current exploratory study demonstrated that patients with a focal cartilage lesion of the knee had higher concentrations of urinary CTX-II than healthy individuals. In addition, CTX-II concentration tended to decrease during rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT00885729.

Osteochondritis dissecans of the talar head: natural history and review of literature.

Osteochondritis dissecans (OCD) of the talar dome is relatively common, however, OCD of the talar head is extremely rare. We present two cases of OCDs of the talar head. This report describes the natural history of this rare condition and its evolution until skeletal maturity. The literature of OCD in this unusual location is reviewed.

Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee.

Autologous chondrocyte implantation (ACI) and mosaicplasty are methods of treating symptomatic articular cartilage defects in the knee. This study represents the first long-term randomised comparison of the two techniques in 100 patients at a minimum follow-up of ten years. The mean age of the patients at the time of surgery was 31.3 years (16 to 49); the mean duration of symptoms pre-operatively was 7.2 years (9 months to 20 years). The lesions were large with the mean size for the ACI group being 440.9 mm(2) (100 to 1050) and the mosaicplasty group being 399.6 mm(2) (100 to 2000). Patients had a mean of 1.5 previous operations (0 to 4) to the articular cartilage defect. Patients were assessed using the modified Cincinnati knee score and the Stanmore-Bentley Functional Rating system. The number of patients whose repair had failed at ten years was ten of 58 (17%) in the ACI group and 23 of 42 (55%) in the mosaicplasty group (p < 0.001). The functional outcome of those patients with a surviving graft was significantly better in patients who underwent ACI compared with mosaicplasty (p = 0.02).