Patients close to or beyond skeletal maturity have a worse prognosis for healing with activity modifications. Looking for abbreviations of OCD? The Department of Orthopaedic Surgery at Washington University School of Medicine in St. Louis has no control over third-party websites and does not review such websites. There are limitations to the OAT procedure. Osteochondral defect. Figure 1. For the mosaic osteochondral autograft transplantation group, 83% had good or excellent outcomes. Osteochondral lesions, also known as osteochondritis dissecans, are areas of damaged bone and cartilage on the surface of the ankle bone (the talus), usually caused by an ankle injury. OCD and other traumatic injuries can lead to large osteochondral defects of the knee. Many patients, especially those who are skeletally immature, with significant growth remaining, have good potential for healing with appropriate activity modification, and in select cases, subchondral bone drilling. Patients with acute, traumatic cartilage injury with displaced fragments may be candidates for surgery. Long-standing radiographs are valuable in assessing limb length discrepancy and malalignment. Acute traumatic injuries can cause displacement of preexisting OCD lesions or the development of acutely displaced cartilage fragment on otherwise normal bone and cartilage structures. Osteochondritis Dissecans and Large Osteochondral Defects of the Knee Kevin G. Shea John Polousky Noah Archibald-Seiffer DEFINITION Osteochondritis dissecans (OCD) is a focal idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis. Definition and symptoms. The defect is stable without evidence of in situ loose body. In 1888, Konig coined the term when he sought to describe the pathologic process that led to atraumatic loose bodies of femoral origin in the knee and hip joints. The rationale for fresh osteochondral allograft transplantation is to replace diseased, unsalvageable bone, and cartilage defects in the context of an otherwise healthy joint. Classification of osteochondritis dissecans of the capitellum Difelice GS, Meunier MJ, Paletta GA Jr. Elbow injury in the adolescent athlete. Careful inspection for malalignment, kissing lesions, or signs of more diffuse cartilage injury is essential, as these factors may change the surgical management of the patient. OAT may have some advantages for treating OCD, as it can directly address the loss/abnormalities of subchondral bone. Both traumatic injuries and patients with OCD may present after months or years of milder symptoms. For larger cartilaginous or osteocartilaginous defects, marrow stimulation, osteochondral autografts, and ACI have limitations. Suites 110 & 210 juvenile form. use of any information on these sites. Fixation of the osteochondral fragment was achieved with autogenous osteochondral plugs through a posterior arthrotomy. These patients may describe the feeling of a loose body within the joint that can occasionally be palpated on the anterior aspect of the knee. Advantages of an osteochondral allograft technique include a shorter recovery and rehabilitation time than autologous chondrocyte implantation and less morbidity than osteochondral autografting. Osteochondraldefect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. Clot formation secondary to marrow stimulation produces disorganized fibrocartilage characterized by a high concentration of type I collagen rather than type II collagen, which comprises hyaline cartilage. Animals— Dogs (n=27) with medial humeral condylar OCD. He was now able to perform all activities of daily living without pain, including weight lifting, running, and swimming. In addition to poor wear properties, the fibrocartilage formed after marrow stimulation may not restore congruity of the articular surface in cases of OCD, where loss of the subchondral bone and débridement of fibrous tissue results in a deep crater with significant bone loss. age younger age correlates with better prognosis; open distal femoral physes are the best predictor of successful non-operative management ; location lesions in lateral femoral condyle and patella have poorer prognosis; appearance . Chondral and osteochondral lesions of the humeral capitellum, most notably osteochondritis dissecans, most commonly present in adolescent baseball players and gymnasts. When I see a child with an OCD of the elbow, we initiate treatment by limiting activities and sometimes simply backing off on gymnastics or baseball may be enough to help control the symptoms and allow the elbow to heal. The name osteochondritis dissecans (OCD) is a misnomer. Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. It is typically thought to be an overuse abnormality of the outside of the elbow or a part of the humerus bone called the capitulum. Animals: Dogs (n=14) with caudocentral humeral head OCD (16 shoulders). Due to the loss and/or abnormalities of the subchondral bone base, special ACI approaches have been developed. The older patients may not respond to less invasive surgeries such as subchondral bone drilling. This chapter focuses on the use osteochondral allografts to address these large, irreparable defects. This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space.That process can lead to pain, loose body formation and joint effusion. Some patients may be referred to a doctor for further diagnosis. The devices of MaioRegen system are indicated for the treatment of cartilage and osteochondral joint surface lesions . Osteochondritis Dissecans and Large Osteochondral Defects of the Knee. A Study of MACI in Patients Aged 10 to 17 Years With Symptomatic Chondral or Osteochondral Defects of the Knee. I'm an Orthopedic Surgeon at Washington University in St. Louis. It is Osteochondral Defect. Fresh osteochondral allografts address both the cartilage and bone deficits. For patients that have focal, full-thickness cartilage defects, several techniques can be used to restore the joint cartilage surface. MRI provides a more detailed look at the condition of the lesion and surrounding cartilage. OCD lesions occur when a segment of subchondral bone… Review of previous imaging studies (typically radiographs and/or magnetic resonance imaging [MRI]), operative reports, and arthroscopic imaging is critical in the evaluation of these patients. Osteochondral Defect listed as OCD Looking for abbreviations of OCD? A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Town and Country, MO 63017, 14532 S. Outer Forty Drive At an average follow-up of 4.2 years, 63% of the microfracture group had good or excellent outcomes, but this group had some deterioration in outcome over 1 to 4 years. Conditions: Osteochondral Defect; Osteochondritis Dissecans . Another multicenter case series using ACI for OCD demonstrated significant improvements, but more than a third of patients required secondary surgical débridement. Some of these injuries can be osteochondral lesions such as osteochondral defects, osteochondrosis of the capitulum humeri or osteochondritis dissecans (OCD). Osteochondritis dissecans differs from "wear and tear" degenerative arthritis, which is primarily an articular surface problem. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. Evaluation of the Agili-C Biphasic Implant in … It can be in the dominant hand or the non-dominant hand and it typically causes pain but also can cause other problems which we call mechanical problems which include locking of the elbow, popping in the elbow and an inability to perform daily activities. For the purposes of this article, the abbreviation OCD will be used only for osteochondritis dissecans. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Surgeon, both with microfracture, and there may be an option, techniques... 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