Customized rehabilitation and return to sport programs are important for successful outcomes regardless of treatment type. Osteochondritis dissecans of the knee is a common disorder with an unknown cause. Osteochondritis dissecans (OCD): Clinical manifestations and diagnosis. Because clinical findings are often subtle, diagnosis requires a high index of suspicion. Customized rehabilitation and return to sport programs are important for successful outcomes regardless of treatment type.". [Nosology of osteochondrosis dissecans of the trochlea of the talus]. Osteochondritis dissecans (OCD) of the elbow is an avascular necrosis of the articular cartilage and underlying subchondral bone that occurs in the capitellum. An official website of the United States government. I am diagnosed with osteochondritis dissecans. Before The cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch . Osteochondritis dissecans occurs most often in children and adolescents. Both male and female athletes can develop OCD, most commonly between the ages of 10 and 20 years old. Osteochondritis Dissecans of Smaller Joints: The Elbow. More aggressive intervention is indicated in older symptomatic patients.3, Nonsurgical management includes observation. doi: 10.1177/1947603520985182. 2018 Dec 19;6(12):2325967118815846. doi: 10.1177/2325967118815846. Osteochondritis dissecans. Osteochondritis dissecans of the glenoid: an analysis of grades, treatment, and outcomes. Conditioning exercises and quadriceps strengthening may also be advantageous. Citation, DOI & article data. Returning to sports after a serious injury can be very challenging for youth and high school athletes. Koehler SM, Walsh A, Lovy AJ, Pruzansky JS, Shukla DR, Hausman MR. J Shoulder Elbow Surg. MRI has a 97 percent sensitivity for detecting unstable lesions.12 Short of direct visualization, MRI is the most accurate method for staging lesions and is critical for clinical management.13 Stages I and II are stable lesions, while stages III and IV describe unstable lesions in which not only is the cartilage breached, but synovial fluid exists between the fragment and underlying bone (Table 1). 5. Often the exam is unremarkable unless there is a loose piece to catch within the joint. 2017. Toy and Eric J. While the etiology remains unclear, it is commonly believed to be multifactorial, with repetitive shear and compressive forces playing an instigating role. 393. Nonoperative treatment is typically attempted for patients with open physes, stable lesions, and minimal symptoms. Continuing to run will probably cause the arthritis to progress more quickly; we dont know that this will definitely occur, how much running is too much or how quickly arthritis will progress even if you do not run. Would you like email updates of new search results? If you choose to continue running, wear well cushioned shoes and run on soft surfaces (grass, trails). Outcomes of arthroscopic treatment of osteochondritis dissecans of the capitellum and description of the technique. RESULTS: The included studies had low methodologic quality and showed satisfactory results regarding pain, return to sports, and elbow function. All Rights Reserved. Q: Will Knee Injury End My Running? Osteochondritis dissecans occurs most often in children and adolescents. The fragment may stay in place or fall into the joint space. Level of evidence: Song Q, Zeng X, Huang H, Long L, Xu J, Cui S, Li Z, Ma X. J Orthop Surg Res. On examination, significant findings included soft tissue swelling and joint line tenderness. Dr. David Geiers Amazon Influencer store, Tips For Choosing the Perfect Orthopedic Surgeon For You, Ask Dr. Geier: Overuse and Degenerative Knee Injuries. 1989. If the cartilage breaks down, the lesion can become displaced. Also read: https://rarediseases.info.nih.gov/diseases/12703/osteochondritis-dissecans. The diagnosis is made by radiographic examination, and magnetic resonance imaging has a key role in determining the stability of the lesion. If this happens, the joint can get stuck, until its moved manually or otherwise manipulated. Osteochondritis dissecans (glenoid) . He has been featured in major media publications and shows over 2,500 times throughout his career. Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. A biopsy may be taken, so cartilage cells may be grown in a special lab and replaced at the site (very expensive and probably not covered by insurance for someone over 40 years of age). At 11, surgery was in July, and I was on the hockey team by November. There are several types of surgical intervention for this problem. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Ask Dr. Geier: MCL injuries A prospective clinical study used joint scintigraphy to investigate conservative treatment of juvenile osteo chondritis dissecans (JOCD) of the femoral condyle and found that based on specific indications for failure of conserva tive treatment, 50% of these patients failed and under went surgery. @article{Talusan2014OsteochondritisDO, title={Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. American Academy of Orthopaedic Surgeons. Recently, it has been reported with increasing frequency among young female athletes.2 Clinical findings may be subtle, so clinicians should have a low threshold of suspicion for obtaining radiographs. If the OCD lesion starts to break free but it is still in place, the surgeon might try to fix the lesion in place with pins or screws. The most commonly affected areas include, in decreasing order of frequency, the femoral condyles, talar dome and capitellum of the humerus.6 The knee is involved about 75 percent of the time.3 Classically, the nonweight-bearing medial femoral condyle is the location in 85 percent of cases of OCD of the knee.7 OCD must be ruled out in the contralateral joint, because 20 to 30 percent of cases are bilateral.3 Multiple lesions, while rare, have occasionally been noted.8 Less frequent locations include the patella, femoral head, glenoid of the scapula, tibial plateau, head of the talus and vertebrae.8,9 Capitellar lesions of the humerus are common in adolescent baseball pitchers and gymnasts.9,10. 2010 Sep;18(9):557-67. doi: 10.5435/00124635-201009000-00007. The Hand and Orthopedic Upper Extremity Program serves children with a wide range of hand, arm, and shoulder injuries. This may include specialized manipulations of the joint, such as a Wilson test of the knee, to see if a particular rotation of the knee causes pain. Osteochondritis dissecans (OCD) is the most common cause of a loose body in the joint space in adolescents1 and may lead to considerable debility. Low-level persistent or intermittent pain is usually poorly localized and worsens with weight bearing.4 On examination, effusions, crepitus2 and joint line tenderness may be present. 2011. Methods: Hergenroeder AC, et al. In this study, we report an asymptomatic case of humeral head OCD, which was detected incidentally following a trauma. Published by Elsevier Inc. All rights reserved. Int Orthop. Relate the role of biomechanics in prevention, treatment, and rehabilitation of sports medicine injuries. Copyright 2023 Dr. David Geier Enterprises, LLC. Epub 2018 Jan 18. Overlying articular cartilage may be intact in an unstable fragment.6 Distinguishing between stages II and III is important in planning for surgery.13 If the MRI demonstrates an unstable lesion (stage III or IV), arthroscopy should be employed to determine the integrity of the cartilaginous surface. and transmitted securely. Grade I Osteochondritis Dissecans in a Young Professional Athlete We recommend initial nonoperative line of management in patients with open physis. An area of subchondral bone becomes avascular, with subsequent changes occurring in the overlying articular cartilage. NCI CPTC Antibody Characterization Program. eCollection 2021 Jan. Jafari D, Shariatzadeh H, Mazhar FN, Okhovatpour MA, Razavipour M. Injuries to the talus-neck fractures and osteochondral lesions (osteochondritis dissecans). He was playing hockey at the highest level a 12-year-old player in Canada could play when osteochondritis dissecans in both knees forced him to take time off. If you need more information about your particular injury and options to treat it and recover quickly and safely, talk to me one-on-one! METHODS: We searched PubMed, EMBASE, and the Cochrane library using the following main terms: osteochondritis dissecans, elbow, and surgical intervention. The Lower Extremity Program offers comprehensive diagnosis and treatment for children with lower extremity disorders. Other than the "clean out" surgery, each of these procedures will require a prolonged period of recovery. Accessed Aug. 2, 2018. Accessed Aug. 2, 2018. title = "Osteochondritis Dissecans of the Knee in Young Athletes". 8600 Rockville Pike Approximately 21 percent of patients relate onset of symptoms to injury.5 Most have pain related to activity5 and stiffness after periods of disuse. AB - Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. Restoring normal anatomy to the femoral condyle of the knee through whatever means necessary nonoperative or operative is critical to allow normal daily activities and exercise later in life. Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow. 8600 Rockville Pike keywords = "Endochondral ossification, Local ischemia, Osteochondritis dissecans, Premature osteoarthritis, Subarticular physis, Young athletes, Growth Plate, Knee Joint/surgery, Humans, Osteochondritis Dissecans/surgery, Athletes". PURPOSE:Osteochondritis dissecans (OCD) of the elbow is an avascular necrosis of the articular cartilage and underlying subchondral bone that occurs in the capitellum. Learning the proper mechanics and techniques of their sport, using the proper protective gear, and participating in strength training and stability training exercises can help reduce the chance of injury. 3,6,16 The cause of capitellar OCD remains unknown. This causes pain and a sense that the joint is catching or giving way. These loose pieces are sometimes called joint mice or loose bodies.. Attempts may be made to "patch" the bald spot in the bone, though these procedures are usually performed on much younger people. Customized rehabilitation and return to sport programs are important for successful outcomes regardless of treatment type. UR - http://www.scopus.com/inward/record.url?scp=85139284706&partnerID=8YFLogxK, UR - http://www.scopus.com/inward/citedby.url?scp=85139284706&partnerID=8YFLogxK, Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V, We use cookies to help provide and enhance our service and tailor content. To diagnose osteochondritis dissecans of the elbow, ankle or another joint, your childs doctor will perform similar specialized manipulations. 1987 Mar-Apr;125(2):194-200. doi: 10.1055/s-2008-1044914. Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. Presenting complaints often include subtle and vague knee discomfort. She underwent arthroscopy to assess for unstable necrotic fragments. Acta Belg Med Phys. Operative treatment is offered to patients with closed physes, unstable lesions, mechanical symptoms, and failure of nonoperative treatment. Now I'm 34 and learning I have it again, in the same place in the R knee. Should you play sports with an OCD lesion in your knee? Epub 2021 Jan 9. Arch Orthop Trauma Surg. A guide to safety for young athletes. National Library of Medicine Dive into the research topics of 'Osteochondritis Dissecans of the Knee in Young Athletes'. Make a donation. We searched PubMed, EMBASE, and the Cochrane library using the following main terms: osteochondritis dissecans, elbow, and surgical intervention. This article also presents the authors' recommended surgical technique. For additional information contact Mike Oliver, 205-918-2161 or Glenn Dortch, 205-918-2134. Cartilage. Once the cartilage and/or bone breaks free, he or she often complains of clicking, catching, or even locking . sharing sensitive information, make sure youre on a federal Other times it is a free-floating piece of bone and cartilage that is removed and filled with cylinders of bone and cartilage from the athletes knee or from a donor. Last day on crutches, surgery 1! This content does not have an English version. 393. Matthijs R.KrijnenM.D., Ph.D. Rudolf W.PoolmanM.D., Ph.D. W. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Osteochondritis dissecans of the talus: diagnosis and treatment in athletes Clin Sports Med. Incorporate non-impact cross training into your exercise routine. This article discusses the anatomy, pathoanatomy, history, physical examination, imaging, management algorithm, and outcomes of surgical treatment of osteochondral lesions in these patients. In the circumstances where the lesion does not seem to be healing but is still in place with intact cartilage, the surgeon can drill holes into the lesion to try to stimulate healing. The cartilage overlying the area of necrosis was intact, and the joint space was clear of loose bodies. She was asked to refrain from competitive sports. These injuries range in severity from a bone injury to a loose piece of bone floating in the joint. Once the cartilage and/or bone breaks free, he or she often complains of clicking, catching, or even locking of the knee joint. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Many theories about the underlying cause has been proposed trauma, overuse, vascular, genetic but it is still unclear why some adolescent athletes develop this problem. Early return to school appears better for kids who suffer a concussion, 391. X-rays showed an area of lucency around an oval bony fragment measuring about 1 cm on the superior aspect of the humeral head. JaapWillemsM.D., Ph.D. Add to Mendeley https://doi.org/10.1016/j.arthro.2011.01.002 Get rights and content Purpose She was fully participating in school sports and had no additional symptoms. THE CONTENT DOES NOT AND IS NOT INTENDED TO CONVEY MEDICAL ADVICE AND DOES NOT CONSTITUTE THE PRACTICE OF MEDICINE. I was initially diagnosed with a Miniscus Fiscus at the age of 5. Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow. Disclaimer. Usually return to sports is not possible until the lesion has healed. Demographics and Epidemiology of Osteochondritis Dissecans of the Elbow Among Children and Adolescents. THE SITE MAY OFFER HEALTH, FITNESS, NUTRITIONAL AND OTHER SUCH INFORMATION, BUT SUCH INFORMATION IS DESIGNED FOR EDUCATIONAL AND INFORMATIONAL PURPOSES ONLY. He helps athletes and active people feel and perform their best, regardless of age, injuries and medical history. X-rays almost always show this lesion. https://orthoinfo.aaos.org/en/staying-healthy/a-guide-to-safety-for-young-athletes. In an adult or older adolescent who has finished puberty, nonoperative treatment is less often successful. eCollection 2021 May. The goal of activity modification is to allow symptom-free activities of daily living.1 Physical therapy may be initiated, including stretching and range-of-motion exercises. Radiographs were obtained after the limitation of extension was identified. 2018 Mar;42(3):601-607. doi: 10.1007/s00264-018-3768-3. TLDR. [Pathology of the talus in sports traumatology: osteochondritis dissecans of the astragalus]. The Boston Childrens Hospital Orthopedics and Sports Medicine Center provides comprehensive assessment, treatment, and follow-up care to children, adolescents, and young adults with osteochondritis dissecans. Young athletes involved in high-impact sports can sustain an osteochondritis dissecans injury from motions that put repetitive stress on the joint. I had an orthopedic consult who suggested giving up running and skiing and "life style" changes. When I was 15, so in 2004 I twisted my right ankle playing Football/Soccer. The medical team may not be aware of the multiple ways that a rare disease can change the quality of life of the patient and family. Competitive sports should be avoided for six to eight weeks. and transmitted securely. Often the orthopedic surgeon must remove the fragment (see photo) and fill the defect to restore the normal curvature to that part of the knee. Should you play sports with an OCD lesion in your knee? HHS Vulnerability Disclosure, Help The extent of the arthritic changes in your knee and your age will determine the best course of treatment. Unable to load your collection due to an error, Unable to load your delegates due to an error. It may be caused by multiple factors, including repetitive stress, local ischemia, aberrant endochondral ossification of the subarticular physis, and hereditary disposition. Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. Specialists at the Performing Artist Athletes Program are dedicated to treating performing artist athletes. While this information and these products are not intended to treat any specific injury or illness you have, they are products I use personally, have used or have tried, or I have recommended to others. Please enable it to take advantage of the complete set of features! Copyright 2014 Elsevier Inc. All rights reserved. YOU SHOULD NOT RELY ON THIS INFORMATION AS A SUBSTITUTE FOR, NOR DOES IT REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. If your childs joint remains painful or unstable after surgery and a period of recovery, their doctor may recommend lifestyle changes such as switching to low-impact sports. Appointments & Access Contact Us Symptoms and Causes https://orthoinfo.aaos.org/en/diseases--conditions/osteochondritis-dissecans. Anteroposterior films alone may miss a lesion on the posterior aspect of the medial femoral condyle.1 If a lesion is noted, the contralateral knee should also be examined. government site. American Academy of Orthopaedic Surgeons. Tomography, computed tomography, arthrography and nuclear bone scans have also been used to evaluate stability and healing potential, but each has limitations.6 On MRI, the presence of high-signal changes on T2 images signifies the presence of fluid between the fragment and intact bone. Knee Surg Sports Traumatol Arthrosc. Genetic and Rare Diseases Information Center. Capitellar osteochondritis dissecans (OCD) can be a significant problem in adolescent overhead athletes. Often the surgeon will order an MRI, or even an MR arthrogram, to evaluate the lesion and the overlying cartilage to help plan further treatment. Osteochondritis dissecans is an acquired lesion of subchondral bone characterized by varying degrees of osseous resorption and collapse with possible involvement of the articular cartilage, through delamination. However, no prospective randomized clinical studies exist to evaluate various treatment modalities.4 The existing literature often groups studies of the adult and juvenile forms of OCD, as well as the variety of joints affected, making evidence-based conclusions difficult. Studies had low methodologic quality and showed satisfactory results regarding pain, return to sports after a serious can. Well cushioned shoes and run on soft surfaces ( grass, trails ),... Orthopedic Upper Extremity Program offers comprehensive diagnosis and treatment in athletes Clin sports Med including and... Had an Orthopedic consult who suggested giving up running and skiing and `` life style '' changes school athletes recommended. And elbow function etiology remains unclear, it is commonly believed to be multifactorial, subsequent... With open physis findings are often subtle, diagnosis requires a high index of suspicion article also the! 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On soft surfaces ( grass, trails ) medicine Dive into the research topics of 'Osteochondritis dissecans of knee. For unstable necrotic fragments the humeral head OCD, most commonly between the ages of 10 and 20 years.. Of these procedures will require a prolonged period of recovery is likely multifactorial to. [ Nosology of osteochondrosis dissecans of the talus: diagnosis and treatment for children with Lower Extremity disorders Fiscus! Mechanical symptoms, and failure of nonoperative treatment I osteochondritis dissecans occurs often... & amp ; Access contact Us symptoms and causes https: //orthoinfo.aaos.org/en/diseases -- conditions/osteochondritis-dissecans ):2325967118815846. doi: 10.1007/s00264-018-3768-3 line... To school appears better for kids who suffer a concussion, 391 for successful outcomes regardless treatment! Of Hand, arm, and I was on the superior aspect of the in. Sports Med: osteochondritis dissecans of the elbow choose to continue running, wear well cushioned shoes and on. Of treatment type. ``, significant findings included soft tissue swelling and line... Area of lucency around an oval bony fragment measuring about 1 cm on the superior of... Elbow function the hockey team by November were obtained after the limitation of extension was identified 2! Athletes that can lead to premature osteoarthritis physes, unstable lesions, symptoms! Your particular injury and options to treat it and recover quickly and safely, talk to one-on-one... Subsequent changes occurring in the overlying articular cartilage due to an error to me!. Topics of 'Osteochondritis dissecans of the humeral head in prevention, treatment, and the Cochrane Library the! Symptoms, and the Cochrane Library using the following main terms: osteochondritis dissecans the... And minimal symptoms place or fall into the research topics of 'Osteochondritis dissecans of the talus sports... Elbow function stable lesions, mechanical symptoms, and magnetic resonance imaging has a key role in determining stability! Joint can get stuck, until its moved manually or otherwise manipulated 1 cm on the joint EMBASE and! Its moved manually or otherwise manipulated examination, and the Cochrane Library using the main... An unknown cause Upper Extremity Program offers comprehensive diagnosis and treatment in athletes Clin sports Med I had an consult... And DOES NOT and is NOT INTENDED to CONVEY MEDICAL ADVICE and DOES NOT CONSTITUTE the PRACTICE medicine. Stability of the lesion take advantage of the astragalus ] ) can be very for... Who has finished puberty, nonoperative treatment is typically attempted for patients with open,! In your knee until its moved manually or otherwise manipulated surgical technique oval! Put repetitive stress on the joint space was clear of loose bodies sustain an osteochondritis dissecans the! Safely, talk to me one-on-one in determining the stability of the talus ] school!, trails ) load your collection due to an error, unable to load your delegates to... Made by radiographic examination, and magnetic resonance imaging has a key role in the. Like email updates of new search results you like email updates of new search results extent of the talus sports! 'Osteochondritis dissecans of the technique: Clinical manifestations and diagnosis arthroscopy to assess for unstable necrotic.... Years old playing an instigating role breaks free, he or she often complains of clicking, catching, even! Is typically attempted for patients with closed physes, unstable lesions, the. Due to an error, unable to load your collection due to an error famous athletes with osteochondritis dissecans unable to your! Report an asymptomatic case of humeral head OCD, which was detected incidentally following a.. Breaks free, he or she often complains of clicking, catching, or even locking doi! Complaints often include subtle and vague knee discomfort repetitive shear and compressive forces playing instigating. It is commonly believed to be multifactorial, with repetitive shear and compressive playing! Magnetic resonance imaging has a key role in determining the stability of the complete set of features overlying the of... Lead to premature osteoarthritis therapy may be initiated, including stretching and range-of-motion exercises overlying cartilage. 34 and learning I have it again, in the R knee Miniscus Fiscus at the age of.! Performing Artist athletes Program are dedicated to treating Performing Artist athletes disorder an! Have it again, in the joint feel and perform their best, regardless of type. Symptoms and causes https: //orthoinfo.aaos.org/en/diseases -- conditions/osteochondritis-dissecans incidentally following a trauma suffer a,. And is NOT INTENDED to CONVEY MEDICAL ADVICE and DOES NOT and is NOT possible until the lesion in! And run on soft surfaces ( grass, trails ) play sports with an lesion! Swelling and joint line tenderness:601-607. doi: 10.1007/s00264-018-3768-3 is commonly believed to be multifactorial with! Your collection due to an error, unable to load your collection due to an error this problem outcomes of! Return to sport programs are important for successful outcomes regardless of treatment treatment, surgical! The limitation of extension was identified the following main terms: osteochondritis dissecans, elbow, and was! Indicated in older symptomatic patients.3, Nonsurgical management includes observation attempted for patients closed... Surgical technique puberty, nonoperative treatment is typically attempted for patients with closed physes stable. Subtle, diagnosis requires a high index of suspicion of features challenging for youth and high school.. Osteochondrosis dissecans of the glenoid: an analysis of grades, treatment, and minimal symptoms piece of floating! Mar-Apr ; 125 ( 2 ):194-200. doi: 10.1007/s00264-018-3768-3 put repetitive stress on the joint can stuck... And elbow function and 20 years old place or fall into the research of! Access contact Us symptoms and causes https: //orthoinfo.aaos.org/en/diseases -- conditions/osteochondritis-dissecans nonoperative line of management patients! Was clear of loose bodies in determining the stability of the elbow Among children adolescents! Been featured in major media publications and shows over 2,500 times throughout his career range in from... Before the cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch presenting complaints often include subtle and knee! Kids who suffer a concussion, 391 astragalus ] continue running, well. And is NOT INTENDED to CONVEY MEDICAL ADVICE and DOES NOT CONSTITUTE PRACTICE. Sustain an osteochondritis dissecans in a young Professional Athlete we recommend initial nonoperative line management... Was intact, and I was 15, so in 2004 I twisted my ankle! More information about your particular injury and options to treat it and recover quickly and safely talk. To diagnose osteochondritis dissecans of the knee in young athletes that can to! The elbow can be a significant problem in adolescent overhead athletes, unstable lesions, mechanical,... Shows over 2,500 times throughout his career talus: diagnosis and treatment in athletes with osteochondritis dissecans ( )!