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.

Clinical report of microsurgical treatment of Kohler's disease.

The conservative treatment for Kohler's disease will take several months, but some patients still have flatfoot and persistent pain. From October 2013 to July 2015, 3 children with Kohler's disease underwent navicular decompression and micro-circulation reconstruction surgery in our hospital. All the patients have received conservative treatment for more than 3 months and the effect was poor. X-ray showed the bone density of navicular increased significantly. All patients were followed up over 1 year. The 3 patients recovered well. VAS score decreased from 7.0 to 2.6 at 1 month after the operation. The pain symptom disappeared completely on 3 months after surgery. The density of navicular bone recovered to normal. Navicular decompression and micro-circulation reconstruction surgery may quickly improve the ischemic status of navicular bone, alleviate pain symptom and enable patients to resume normal activity as soon as possible.

Relationship between coordination variability and Osgood-Schlatter disease in male junior youth soccer players -cross-sectional study using an inertial measurement unit.

BACKGROUND: Osgood-Schlatter disease is a common overuse injury, and motor coordination is discussed as a risk factor; however, no reports have examined motor coordination in young soccer players with Osgood-Schlatter disease. This study aimed to investigate the difference in motor coordination between Osgood-Schlatter disease-affected and non-affected soccer players on a junior youth soccer team. METHODS: This cross-sectional study investigated 35 young soccer players of 12-15 years of age, who completed a self-administered questionnaire covering general information, injury history, and athletic experience. An inertial measurement unit was attached to the participant's thoracic spine, lumbar spine, pelvis, thigh, and lower leg. The sagittal plane tilt angle of each body segment during squatting was analyzed. The continuous relative phase was calculated using the sagittal plane tilt angle. The mean absolute relative phase and continuous relative phase variabilities were calculated and compared between Osgood-Schlatter disease-affected and non-affected players. FINDINGS: The sagittal plane tilt angle of each body segment during static standing and maximum flexion did not differ between the two groups. However, the Osgood-Schlatter disease group had significantly less continuous relative phase variability between the lumbar spine and pelvis (P < 0.01, Cohen's d = 0.91). The Osgood-Schlatter disease group had significantly fewer participants with other sports experience (P = 0.032, φ = 0.36). INTERPRETATION: Dysfunctional lower trunk and hip muscles may be leading to Osgood-Schlatter disease. It is suggested that a variety of physical activities should be performed in the junior age group to allow players to acquire a variety of movement patterns.

The Effect of Guided Growth Surgery on Langenskiold Stage and Mechanical Axis in Early-Onset Blount Disease: A Retrospective Case Series.

INTRODUCTION: Our understanding of the efficacy of guided growth surgery with tension-band plating (TBP) in early-onset Blount disease is evolving. Preliminary work has demonstrated that TBP can normalize the mechanical axis, yet its effect on Langenskiöld stage (LS) has not previously been reported. The primary outcome of this study was improvement in LS after TBP. Secondary outcomes were improvement in LS at most recent follow-up and improvement in mechanical axis deviation (MAD), mechanical medial proximal tibial angle, and mechanical lateral distal femoral angle at treatment completion and most recent follow-up. METHODS: A retrospective review was done of patients with early-onset Blount disease treated with TBP between January 1, 2010, and December 31, 2019, across two institutions. Inclusion criteria were a radiographic diagnosis of early-onset Blount disease (LS changes present), surgery with TBP, and follow-up beyond implant removal. Radiographs before surgery, at removal of hardware (ROH), and at most recent follow-up were evaluated. RESULTS: Twenty-five limbs in 16 children who underwent TBP at a mean age of 5.8 ± 2.3 years were included. Implants were in situ a mean of 1.9 ± 0.7 years. The mean follow-up after ROH was 3.6 ± 1.4 years. LS ranged from 1 to 5 preoperatively with 14 of 25 limbs (56%) staged ≥3. LS improved in 15 of 25 limbs (60%) at ROH and in 21 of 25 limbs (84%) at most recent follow-up. Langenskiöld changes resolved in 7 of 25 limbs (28%) at most recent follow-up. Preoperatively, the MAD was varus in all limbs, but at ROH, the MAD had improved in 22 of 23 limbs with neutral or valgus alignment in 20 of 23 limbs (87%). At most recent follow-up, 16 of 23 limbs (70%) maintained improved alignment. DISCUSSION: There was improvement/resolution of LS and varus deformity in early-onset Blount disease in most patients who underwent TBP. Based on these results, TBP for early-onset Blount disease should be the first-line surgical treatment. LEVEL OF EVIDENCE: IV.

The transphyseal osteotomy for the slipped proximal tibial epiphysis in tibia vara.

This study aimed to describe a novel transphyseal osteotomy (TPO) for acute deformity correction in children with bilateral tibia vara and the atraumatic 'slipped proximal tibial epiphysis' (SPTE) entity. We described the clinical and radiological findings in five children (10 limbs) with tibia vara that were treated with the TPO. The criteria for the SPTE were met in nine (9/10) cases. The surgical technique and short-term results of the TPO are reported. The median age was 9 years (range, 6-9), with obesity (BMI > 95th centile) present in all children. The medial tibial plateau was not significantly depressed (the median angle of depression of the medial plateau measured 30° (range, 20°-32°). The mean medial proximal tibial angle of 33° (range, 8°-71°) was corrected to 82° (range, 77°-86°), the mean anatomic posterior proximal tibial angle of 48° (range, 32°-70°) was corrected to 72° (range, 61°-86°), and the median internal tibial rotation of 45° (range, 20°-50° internal rotation) was corrected to neutral rotation (range, 10° internal-10° external rotation). There were two complications: one case of recurrent deformity and one case of intra-articular extension of the osteotomy. We describe a novel TPO that aims to simultaneously correct all aspects of the deformity, stabilise the physis, and prevent recurrence through epiphysiodesis. Further research is required to determine its efficacy and safety. The atraumatic SPTE appears to represent a specific morphological presentation in tibia vara. Level of evidence: 4.

Fixed-Bearing Unicompartmental Knee Arthroplasty in Tibia Vara Knees Results in Joint Surface Malalignment and Varus Joint Line Obliquity, but Does Not Affect Functional Outcomes at Greater Than 5 Years Follow-Up.

BACKGROUND: This study aimed to investigate the clinical outcomes of fixed-bearing medial unicompartmental knee arthroplasty (UKA) for tibia vara knees and the associated changes in joint space malalignment (JSM) and joint line obliquity (JLO). METHODS: We retrospectively analyzed a consecutive group of 100 patients who underwent fixed-bearing medial UKA with a preoperative medial proximal tibia angle (MPTA) ≥86° (n = 50) and MPTA <86° (n = 50) and who had a minimum 5-year follow-up. Radiological parameters, including the hip-knee-ankle angle, MPTA, and the postoperative JSM and JLO, were measured. Functional evaluation was performed using the range of motion, visual analog scale, Knee Society Knee Score, Knee Society Function Score, and Western Ontario and McMaster Universities Osteoarthritis Index score. RESULTS: The MPTA <86° group showed significantly higher postoperative JLO (91.8 versus 90.4°, respectively; P = .002) and JSM (6.1 versus 4.2°, respectively; P = .026) compared to the MPTA ≥86° group. Functional outcomes, including range of motion, visual analog scale, Knee Society Knee Score, Knee Society Function Score, and Western Ontario and McMaster Universities Osteoarthritis Index scores, were not significantly different between the 2 groups. CONCLUSIONS: Fixed-bearing medial UKA is a safe and effective surgical option for patients who have tibia vara knees, as an increase in JLO and JSM postoperatively does not have a clinically relevant impact, even after a minimum 5-year follow-up.

The Effect of Socioeconomic Deprivation on Radiographic Deformities in Children With Blount Disease.

BACKGROUND: Blount disease can occur at any time during the growth process, primarily with a bimodal distribution in children younger than 4 years old and adolescents. The disease process most commonly presents in Black adolescents, with disease severity positively correlated with obesity. Given the known associations among race, obesity, and socioeconomic status, we investigated the relationship between the degree of social deprivation and severity of lower extremity deformities among a community-based cohort with Blount disease. METHODS: A retrospective review of hospital records and radiographs of patients with previously untreated Blount disease was conducted. Patients were classified as having early-onset or late-onset Blount disease based on whether the lower limb deformity was noted before or after the age of 4 years. The area deprivation index (ADI), a nationally validated measure that assesses socioeconomic deprivation by residential neighborhood, was calculated for each patient as a surrogate for socioeconomic status. Higher state (range: 1 to 10) or national (range: 1 to 100) ADI corresponds to increased social deprivation. Full-length standing radiographs from index clinic visits were evaluated by 2 reviewers to measure frontal plane deformity. The association of ADI with various demographic and radiographic parameters was then analyzed. RESULTS: Of the 65 patients with Blount disease, 48 (74%) children were Black and 17 (26%) were non-black children. Nineteen children (32 limbs) had early-onset and 46 children (62 limbs) had late-onset disease. Black patients had significantly higher mean state (7.6 vs. 5.4, P =0.009) and national (55.1 vs. 37.4, P =0.002) ADI values than non-black patients. Patients with severe socioeconomic deprivation had significantly greater mechanical axis deviation (66 mm vs. 51 mm, P =0.008). After controlling demographic and socioeconomic factors, the results of multivariate linear regression showed that only increased body mass index (ß=0.19, 95% CI: 0.12-0.26, P <.001) and state ADI (ß=0.021, 95% CI: 0.01-0.53, P =.043) were independently associated with greater varus deformity. CONCLUSIONS: Socioeconomic deprivation was strongly associated with increased severity of varus deformity in children with late-onset Blount disease. Our analysis suggests that obesity and socioeconomic factors are the most influential with regard to disease progression. LEVEL OF EVIDENCE: Level III.

Enhanced Pain Relief and Function Improvement in Children with Osgood-Schlatter Disease: Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) as a Complementary Treatment to Standard Conservative Therapy.

BACKGROUND Osgood-Schlatter disease (OSD) causes pain and loss of function of the knee in growing children. This study aimed to evaluate pain and function of the knee joint in 152 growing children with chronic OSD before and after treatment with LR-PRP when used with standard conservative treatment. MATERIAL AND METHODS Treatment efficacy was evaluated using the VAS, Tegner, Lyshom, and KOOS scales. Patient satisfaction, post-surgery athletic performance, and X-ray assessment were also used to determine the success of the procedure. RESULTS We found that 75% of the subjects were satisfied with the results of the treatment, and 72% of the subjects returned to full physical activity. The analysis showed a significant decrease in the median VAS score after treatment compared to the pre-treatment score (P<0.05), and an increase in the median scores of the Tegner, Lysholm, and KOOS scales compared to the pre-treatment score (P<0.05; P<0.05; P<0.05, respectively). The results showed that the shorter the duration of the disease, the better the treatment results were received. Return to activity and patient satisfaction were highest in the study group previously rehabilitated. CONCLUSIONS LR-PRP injection of the tibial tuberosity in patients with chronic OSD with open growth cartilage is an effective and uncomplicated method. We did not observe any adverse effects, which suggests the relatively high safety of the procedure. The use of PRP in the earlier phase of the disease and additional rehabilitation before treatment significantly increases the effectiveness of treatment.

The development of an informative leaflet for children and adolescents suffering from Osgood-Schlatter disease.

The mainstay in the treatment of Osgood-Schlatter Disease (OSD) is guidance on activity modification alongside exercises. The purpose of this study was to create an informative leaflet for patients with OSD, based on evidence and stakeholders perspectives. A synthesis of the literature, including national reference work, clinical research, and systematic reviews informed the initial leaflet. Twelve children with OSD and four clinical experts provided feedback through semi-structured interviews. After incorporating stakeholder input, the leaflet 'Osgood-Schlatter-Information and guidance' was developed. This provides a resource to assist the provision of information and translation of the current evidence.

CLINICAL FEATURES OF CONNECTIVE TISSUE DYSPLASIA, OSGOOD-SCHLATTER DISEASE AND MULTIPLE CORTICAL DISORDERS IN A CHILD.

OBJECTIVE: The aim: To analyze scientific data on the problems of disorders of bone morphogenesis in children, in particular, non-ossifying fibroma. To analyze modern methods of diagnosis and treatment of this disease in the context of the latest scientific achievements. PATIENTS AND METHODS: Materials and methods: The latest data of scientists from the world's leading clinics describing various forms of fibrous skeletal lesions in children of differ¬ent ages were analyzed. We examined a boy with fibrous lesions of the cortical layer of the knee joint bones and a girl with a large fibrous focus of the distal femoral metaphysis, which resulted in a closed pathological bone fracture. Surgical treatment, osteosynthesis, marginal resection of the tumor, bone grafting and histological examination were conducted. CONCLUSION: Conclusions: Despite numerous studies of this disease, the etiopathogenesis of this disease has not been studied. There are no early symptoms of fibrous bone lesions in children. Diagnosis is possible only when a pathological fracture of the affected bone occurs due to extensive growth of fibrous tissue and a significant decrease in the mechanical strength of the bone. Most cases of recognition of such a disease occur accidentally when performing X-ray examinations for other reasons - bruises, sprains, arthralgias, osteochondropathy, infectious diseases, etc. It is known that boys are more mobile and require more frequent X-ray examinations for limb injuries than girls, so the likelihood of accidental detection of such changes increases significantly. Thus, long-term observations of children with fibrous bone lesions have shown that after 40 years, patients rarely developed malignant tumors - osteogenic sarcoma, fibrosarcoma, malignant fibroma of tubular bones, pelvic bones. There are no early symptoms of fibrous bone lesions in children. Recognition of such a disease occurs by chance when X-ray examinations are performed for other reasons.

Long-term outcomes after arthroscopic treatment of dogs affected by osteochondrosis dissecans of the humeral trochlea, with or without medial coronoid disease: 23 cases (2012-2020).

The objective of this study was to report long-term clinical and radiographic outcomes following arthroscopic reparative treatment - flap removal, curettage, and osteostixis of subchondral bone - in dogs with humeral trochlea osteochondritis dissecans (OCD). Dogs were included in this retrospective multicenter case series if they had a computed tomography diagnostic of humeral trochlear OCD, with or without medial coronoid disease, that was treated by arthroscopic reparative technique, and a detailed follow-up at least 6 mo postoperatively. The latter included a clinical examination, assessment of lameness, measurement of the brachial circumference and elbow amplitude, International Elbow Working Group (IEWG) radiographic score, owner-completed canine brief pain inventory (CBPI) score, and visual analogue scale (VAS) rating. A generalized linear model and tests for symmetry and marginal homogeneity were used to compare data. Twenty-three dogs (30 affected elbows) were included. Long-term (median: 22 mo; range: 6 to 98 mo) postoperative lameness, CBPI, VAS, joint distension, and pain scores were significantly improved compared with the preoperative values. Long-term postoperative range of motion and brachial circumference did not reveal any significant difference between OCD-affected and unaffected elbows. Long-term IEWG scores were similar to preoperative values in 56% of elbows and had progressed by 1 grade in 44%. Long-term complications included persistent Grade-1 lameness and occurred in 23% of dogs. Long-term outcomes based on lameness and CBPI scores were considered excellent in 67% of dogs, good in 27%, and intermediate in 6%. Arthroscopic treatment is thus a suitable surgical procedure for OCD of the humeral trochlea in dogs and provides good long-term results.

Cette étude rapporte les résultats cliniques et radiographiques à long terme après un traitement arthroscopique chez des chiens atteints d'ostéochondrite disséquante (OCD) de la trochlée humérale. Les chiens inclus ont reçu un diagnostic d'OCD de la trochlée humérale par tomographie, un traitement réparateur par arthroscopie et un suivi post-opératoire d'au moins 6 mois. Ce dernier comprenant un examen clinique et orthopédique, la mesure de la circonférence brachiale et de l'amplitude du coude, le score radiographique de l'International Elbow Working Group (IEWG), le score Canine Brief Pain Inventory (CBPI) et l'échelle visuelle analogique (EVA). Un modèle linéaire généralisé et des tests de symétrie et d'homogénéité marginale ont permis de comparer les données. Vingt-trois chiens (30 coudes affectés) ont été inclus. Les scores postopératoires à long terme (médiane, 22 mois), de boiterie, de CBPI, d'EVA, de distension articulaire et de douleur étaient significativement améliorés. L'amplitude de mouvement et la circonférence brachiale postopératoires à long terme entre les coudes affectés et non affectés n'ont pas révélé de différence significative. Les scores IEWG à long terme étaient similaires aux valeurs préopératoires dans 56 % des coudes et avaient progressé d'un grade dans 44 %. Les résultats à long terme basés sur la boiterie et les scores CBPI ont été considérés comme excellents chez 67 % des chiens, bons chez 27 % et intermédiaires chez 6 %. Le traitement arthroscopique est donc une procédure chirurgicale appropriée pour l'OCD de la trochlée humérale chez le chien et donne de bons résultats à long terme.(Traduit par les auteurs).

Subchondral defects resembling osteochondrosis dissecans in joint surfaces of the extinct saber-toothed cat Smilodon fatalis and dire wolf Aenocyon dirus.

Skeletal disease may hamper the behavior of large predators both living and extinct. We investigated the prevalence of osteochondrosis dissecans (OCD), a developmental bone disease affecting the joints, in two Ice Age predators: the saber-toothed cat Smilodon fatalis and dire wolf Aenocyon dirus. As published cases in modern Felidae and wild Canidae are rare, we predicted that subchondral defects resembling OCD would be rare in the extinct predators. We examined limb joints in juvenile and adult S. fatalis: 88 proximal humeri (shoulder), 834 distal femora (stifle), and 214 proximal tibiae. We also examined limb joints in juvenile and adult A. dirus: 242 proximal humeri, 266 distal femora, and 170 proximal tibiae. All specimens are from the Late Pleistocene Rancho La Brea fossil locality in Los Angeles, California, USA. While the Smilodon shoulder and tibia showed no subchondral defects, subchondral defects in the Smilodon femur had a prevalence of 6%; most defects were small (<7mm); and nine adult stifles with defects also showed osteoarthritis. Subchondral defects in the A. dirus femur had a prevalence of 2.6%; most defects were large (>12mm); and five stifles further developed mild osteoarthritis. Subchondral defects in the A. dirus shoulder had a prevalence of 4.5%; most defects were small, and three shoulders developed moderate osteoarthritis. No defects were found in the A. dirus tibia. Contrary to our prediction, we found a high prevalence of subchondral defects in the stifle and shoulder of S. fatalis and A. dirus resembling OCD found in humans and other mammals. As modern dogs affected by OCD are highly inbred, this high prevalence in the fossil taxa may suggest that they experienced inbreeding as they approached extinction. The deep-time history of this disease supports the need for monitoring of animal domestication, as well as conservation, to avoid unexpected surges in OCD under conditions like inbreeding.

EVALUATION OF THE EFFECTIVENESS OF PHYSIOTHERAPEUTIC INTERVENTIONS IN THE TREATMENT OF THORACIC PAІN IN PATIENTS WITH THORACIC OSTEOCHONDROSIS.

The purpose of the study is to improve the results of complex restorative treatment of patients with pain syndrome in osteochondrosis of the thoracic spine. The study was conducted on the basis of the Rehabilitation Department of the State Institution "ITO NAMSU" in Kiev (from 2020 to 2022). The study involved 150 patients with pain in the thoracic spine, who were treated in the rehabilitation department. The mean age of the patients was 44.7±1.5 years. The average duration of the disease was 10.2±0.3 years, treatment - 13.5±1.0 days. Evaluation of treatment results using the Visual Analogue Scale of pain (Visual Analogue Scale) and electromyography on DIGITAL M - TEST was carried out 14 days after the program of physiotherapy interventions. The developed program of rehabilitation interventions included the use of myofascial release of the thoracic spine, physical exercises, breathing exercises during the myofascial release of the thoracic spine. The analysis of the obtained results showed that after the rehabilitation measures with the use of myofascial release, there was a statistically significant decrease in the level of pain in the group of examined patients (before PT - 4.87±0.47 cm, after PT - 1.17±0.26*) * (x±S), (p<0.01), which allows us to conclude that the program of physiotherapy interventions is effective. The use of myofascial release in the complex of physiotherapeutic interventions improves the quality of life and saves patients from thoracic paіn caused by degenerative changes in the spine in the short term.

Do adolescents with Osgood-Schlatter display nociplastic pain manifestations compared to controls: A cross-sectional study.

OBJECTIVES: Osgood-Schlatter disease is an overuse musculoskeletal pain condition. The pain mechanism is considered nociceptive, but no studies have investigated nociplastic manifestations. This study investigated pain sensitivity and inhibition evaluated through exercise-induced hypoalgesia in adolescents with and without Osgood-Schlatter. DESIGN: Cross-sectional study. METHODS: Adolescents underwent a baseline assessment comprising clinical history, demographics, sports participation, and pain severity rated (0-10) during a 45-second anterior knee pain provocation test, consisting of an isometric single leg squat. Pressure pain thresholds were assessed bilaterally at the quadriceps, tibialis anterior muscle, and the patella tendon before and after a three-minute wall squat. RESULTS: Forty-nine adolescents (27 Osgood-Schlatter, 22 controls) were included. There were no differences in the exercise-induced hypoalgesia effect between Osgood-Schlatter and controls. Overall, an exercise-induced hypoalgesia effect was detected at the tendon only in both groups with a 48 kPa (95 % confidence interval 14 to 82) increase in pressure pain thresholds from before to after exercise. Controls had higher pressure pain thresholds at the patellar tendon (mean difference 184 kPa 95 % confidence interval 55 to 313), tibialis anterior (mean difference 139 kPa 95 % confidence interval 24 to 254), and rectus femoris (mean difference 149 kPa 95 % confidence interval 33 to 265). Higher anterior knee pain provocation severity was associated with lower exercise-induced hypoalgesia at the tendon (Pearson correlation = 0.48; p = 0.011) in participants with Osgood-Schlatter. CONCLUSIONS: Adolescents with Osgood-Schlatter display increased pain sensitivity locally, proximally, and distally but similar endogenous pain modulation compared to healthy controls. Greater Osgood-Schlatter severity appears to be associated with less efficient pain inhibition during the exercise-induced hypoalgesia paradigm.

Eccentric contractions during downhill running induce Osgood‒Schlatter disease in the tibial tuberosity in rats: a focus on histological structures.

Osgood-Schlatter disease (OSD), a condition that affects adolescents, causes inflammation, pain, and prominence at the tibial tuberosity. The causes of OSD are not well understood, but eccentric contractions in the quadriceps have been suggested as a possible factor. To investigate this, a study was conducted in which 24 rats were divided into two groups: the downhill treadmill running (DR) group and the control (CO) group. The DR group underwent a preliminary running program for 1 week, followed by a main running program for 3 weeks. The results showed that the deep region of the tibial tuberosity in the DR group was larger than that in the CO group, and inflammatory cytokines involved in gene expression were upregulated in the DR group. The anterior articular cartilage and deep region in the DR group were also immunoreactive to substance P. Additionally, high-activity chondrocytes of small size were observed in the non-calcified matrix. Thus, the DR group exhibited symptoms similar to OSD, including inflammation, pain, and prominence. These findings suggest that eccentric contractions in the quadriceps may play a role in the development of OSD. Further research is needed to better understand the pathophysiology of this condition and develop effective treatment options.

Assessing Knee Stability in Adolescent Athletes with Osgood-Schlatter Disease Using the Y-Balance Test.

PURPOSE OF THE STUDY Osgood-Schlatter disease develops secondary to chronic patellar tendon overloading. The present study was designed to determine whether athletes with Osgood-Schlatter disease perform significantly worse in the Y-Balance Test compared to healthy subjects in a control group. MATERIAL AND METHODS The study involved ten boys (average age 13.7 years). Seven participants had bilateral knee pain, swelling and tenderness whereas three had unilateral knee pain, swelling and tenderness (left knee in two cases, and right knee in one). Overall, 17 knees were assessed (left knee in nine cases and right knee in eight).Ten healthy adolescent professional football players (mean age 14.6 years) were selected as a control group. In both groups, complex knee stability was assessed using the Y-Balance Test and their data were analyzed using the methodology developed by Plisky et al. The test outcome was expressed in indexed (normalized) values for the right and left lower extremities, and averaged values for the individual directions were compared. RESULTS Significant differences between both groups were shown in the posteromedial and posterolateral directions. CONCLUSIONS Using the Y-Balance Test, our study documented reduced performance in the above directions in patients with OsgoodSchlatter disease. Key words: Osgood-Schlatter disease, knee, balance test, movement patterns patellar tendon overload.

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.

Evaluation of the appearance of osteochondrosis lesions by two radiographic examinations in sport horses aged from 12 to 36 months.

Osteochondrosis is a developmental orthopedic disease characterized by a defect of enchondral ossification. This pathological condition develops and evolves during growth and is influenced by various factors, in particular genetic and environmental. However, little research has been conducted on the dynamic of this condition in horses after the age of 12 months. The retrospective study presented here investigates changes in osteochondrosis lesions through two standardized radiographic examinations carried out on young Walloon sport horses after one year of age (mean age at first and second examination was 407 (±41) and 680 (±117) days respectively). Each examination, analyzed independently by three veterinarians, included latero-medial views of the fetlocks, hocks, stifles, plantarolateral-dorsomedial hocks view and additional radiograph if the operator deemed it necessary. Each joint site was graded as healthy, osteochondrosis (OC) or osteochondrosis dissecans (OCD) affected. A group of 58 horses was studied, among them 20 presented one or more osteochondrosis lesions for a total of 36 lesions present during at least one examination. In this population, 4 animals (6.9%) presented osteochondrosis during only one examination (2 at the first examination and 2 at the second one). Moreover, it was possible to demonstrate the appearance, disappearance and more generally the evolution of 9/36 lesions (25%) within the different joints. The results of the study suggest that, although substantial main limitations, osteochondrosis lesions can evolve after the age of 12 months in sport horses. Knowing this is useful in helping to decide the appropriate radiographic diagnosis timing and management.