Surgical treatment of stable foci of the osteochondritis dissecans in children: a systematic review

Introduction. The osteochondritis dissecans (OCD) is a pathologic condition of osteochondral tissue predominantly in the femoral condyles, which is met most often in adolescents and which can lead to the formation of early arthrosis in the knee joint in the remote time. By modern concepts, stable OCD foci are the foci with intact articular cartilage without the risk of migration into the joint cavity. To date, there are very few studies in the world literature on the treatment of early stages of osteochondrosis dissecans.Material and methods. Two independent researchers have carried out a systematic review of literature sources (2000-2020 ) using Pubmed, Medline and GoogleScholar. 9 publications were selected for data analysis out of 5184 publications after the qualitative assessment by the Yang scale and the obtained consensus in disputable situations.Results. Statistical analysis of the obtained data with the Statistica program revealed that the average rate of OCD foci healing was seen in 86.7% (from 70.6 to 100%). The most effective outcomes were in the group of antegrade drilling (95.3% of healed foci), then in the group with biodegradable implants fixation (88.5%), then the group of antegrade drilling with the introduction of bone marrow aspirate concentrate (BMAC) - 76.9%, and then the retrograde drilling - 76.8%.Conclusion. The analysis performed have shown a significant heterogeneity in data reporting, different methods for diagnosing osteochondritis dissecans, different approaches to healing assessment as well as a small number of children in samples what determined the lack of statistical significance between different options of surgical treatment (p = 0.27). Carefully planned trials with a proper design, standardized techniques for healing assessment and time of their application as well as the assessment of comparison groups and of all other necessary factors affecting lesion healing are needed.

Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients

Introduction Osteochondrosis dissecans (OCD) is considered to be one of the main causes for pain, discomfort and morbidity in the pediatric elbow joint. Few treatment options, such as microfracture or autologous transplantation, of osteochondral bone grafts have been described to address advanced OCD. The aim of this retrospective case series is to present preliminary clinical and radiologic findings following advanced stage OCD repair using a novel combination of a hyaluronic acid-based scaffold with autologous iliac crest bone grafting. Materials and methods Five adolescents, who underwent treatment of OCD (grade 3 or 4 according to Nelson) using a combination technique of defect debridement, transplantation of cancellous iliac crest bone and application of a HYALOFAST® membrane (Anika Therapeutics S.r.L., Italy), were re-assessed using clinical and radiologic examinations (defect diameter, depth, sclerosis, congruency, fragmentation, dissection, radiolucency, growth plate status; MRI) after a minimum of 2 years (mean, 34 months; range, 24–45) postoperatively. Dedicated outcome scores (Numeric Rating Scale [NRS], Pediatric Outcome Data Collection Instrument [PODCI], Mayo Elbow Performance Score [MEPS], and Timmerman-Andrews Score [TIMM] were collected. Results All patients reported a NRS score of 0. The mean total TIMM, MEPS and PODCI (Global Functioning Scale) scores were 189 (range 165–200), 94 (range, 70–100), and 92 (range 83–98; normative score 47; range 35–55), respectively, indicating good to excellent clinical outcomes. The radiographic analysis showed overall improvements with regard to OCD width and depth reduction (35%, − 27–100%; 52%, 4–100%), but full resolution in only 2 of 5 cases. Elbow motion improved slightly after surgery. No complications were noted. Conclusion This study showed promising clinical short- to mid-term results in adolescent patients with advanced OCD using a novel surgical treatment combination. Radiographic results showed partial healing; hence, residual changes should be monitored over a longer period.

Electromagnetic navigation reduces radiation exposure for retrograde drilling in osteochondrosis dissecans of the talus

Background Retrograde drilling in osteochondrosis dissecans (OCD) is a widely used surgical intervention. A radiation-free electromagnetic navigation system (ENS)-based method was compared with the standard freehand fluoroscopic (SFF) method regarding clinical applicability. Methods We performed a clinical cohort study at a department of Orthopaedics in a Level 1 children’s hospital with 40 patients (20 SFF and 20 ENS). Retrograde drilling of the talar dome was used in patients with unstable medial OCD (MRI stage 2 according to Hepple’s revised classification; stage 2 according to the International Cartilage Repair Society). The outcome measurements were: (a) Intraoperative fluoroscopy exposure and length of surgery and (b) Postoperative serial follow-up MRIs every 6 months. Results 22 female and 18 male patients aged 13.8 ± 1.6 years (range: 11–17 years) were included. Using the ENS technique, length of surgery was significantly reduced to 20.2 ± 6.4 min compared to 36.1 ± 11.8 min (p < 0.01) for the SFF technique. The average x-ray radiation time for the SFF technique was 23.5 ± 13.5 sec and 1.9 ± 1.7 sec for the ENS technique (p < 0.01). Radiation exposure was significantly reduced from 44.6 ± 19.7 mSv (SFF technique) to 5.6 ± 2.8 mSv (ENS technique) (p < 0.01). Intraoperative perforation of cartilage occurred once in the SFF group. Correct placement of the drilling channel was verified in all patients on follow-up MRI after six months and a timely healing was seen after two years. Conclusions The ENS method provides for a significant reduction in length of surgery and radiation exposure. ENS was without intraoperative cartilage perforation. The clinical and radiological follow-up parameters are comparable for SFF- and ENS-guided retrograde drilling. Trial registration WF – 085/20, 05/2020 “retrospectively registered” https://www.aerztekammer-hamburg.org/ethik_kommission.html.

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Background: Retrograde drilling in osteochondrosis dissecans (OCD) is a widely used surgical intervention. A radiation-free electromagnetic navigation system (ENS)-based method was compared with the standard freehand fluoroscopic (SFF) method regarding clinical applicability.Methods: We performed a clinical cohort study at a department of Orthopaedics in a Level 1 children’s hospital with 40 patients (20 SFF and 20 ENS). Retrograde drilling of the talar dome was used in patients with unstable medial OCD (MRI stage 2 according to Hepple’s revised classification; stage 2 according to the International Cartilage Repair Society). The outcome measurements were: a) Intraoperative fluoroscopy exposure and length of surgery and b) Postoperative serial follow-up MRIs every 6 months.Results: 22 female and 18 male patients aged 13.8 ± 1.6 years (range: 11-17 years) were included. Using the ENS technique, length of surgery was significantly reduced to 20.2 ± 6.4 min compared to 36.1 ± 11.8 min (p<0.01) for the SFF technique. The average x-ray radiation time for the SFF technique was 23.5 ± 13.5 sec and 1.9 ± 1.7 sec for the ENS technique (p<0.01). Radiation exposure was significantly reduced from 44.6 ± 19.7 mSv (SFF technique) to 5.6± 2.8 mSv (ENS technique) (p<0.01). Intraoperative perforation of cartilage occurred once in the SFF group. Correct placement of the drilling channel was verified in all patients on follow-up MRI after six months and a timely healing was seen after two years. No differences were detected on follow-up MRI between the two methods.Conclusions: The ENS method provides for a significant reduction in length of surgery and radiation exposure. ENS was without intraoperative cartilage perforation. The clinical and radiological follow-up parameters are comparable for SFF- and ENS-guided retrograde drilling.Trial registration: WF – 085/20, 05/2020 “retrospectively registered”

Computed tomography findings in a cohort of 169 dogs with elbow dysplasia

Background: Canine elbow dysplasia (CED) is a complex developmental skeletal disorder associated with a number of pathological conditions within the cubital joint in dogs. Complex primary conditions associated with CED included medial coronoid disease without fragmented medial coronoid process, medial coronoid disease with fragmented medial coronoid process, osteochondrosis and/or osteochondrosis dissecans, ununited anconeal process, and joint incongruency and may be identified separately as a singular cause of elbow dysplasia, or occur as a combination of lesions presented simultaneously. The objective of this study was to assess the percentage prevalence of different components of CED in dogs suffering from this condition with the use of CT imaging. In addition, the correlations between various CED lesions and demographic features of the tested dogs were investigated. Results: 169 dogs of various breeds met the inclusion criteria. Statistically significant differences were found between the age of affected dogs in individual weight groups. Moreover, the significant correlation between weight and age in the cohort of large-size dogs with CED was noted. In 96 dogs OA of varying severity was found. 11.6% of dogs were diagnosed with unilateral CED and 88.4% suffered from bilateral CED. The majority of dogs diagnosed with CED were young with an average age of 2.26 ± 0.18 years old. Significant differences in the occurrence of CED components in different-size groups were also noted. Males represented the majority in this study population. Conclusion: CT-imaging allowed for the assessment of the prevalence of CED components in affected dogs of different breeds. The use of CT imaging as a screening test in puppies of the breeds of which CED is the most prevalent facilitates the selection of dogs with joint incompatibility, which increases the risk of MDC, at time when no other changes are present. An early diagnosis of the mentioned pathology may allow for the introduction of less invasive therapeutic strategies, ensuring the improvement of joint biomechanics. The correlation between different components of CED and demographic features found in our study may provide valuable prognostic criteria and help in the future identification of various risk factors or therapeutic strategies.

Osteochondrosis dissecans des Ellenbogengelenks

ZusammenfassungDie Osteochondrosis dissecans (OD) ist eine weiterhin nicht vollständig verstandene Erkrankung, die in verschiedenen Gelenken auftreten kann. Der Ellenbogen, vornehmlich das Capitulum, stellt den zweithäufigsten Manifestationsort der OD dar. Auch wenn die OD eine seltene Erkrankung ist, erzeugt sie bei den meist jungen Patienten einen hohen Leidensdruck. Schmerzen, Bewegungseinschränkungen bis hin zur vollständigen Destruktion des Ellenbogengelenks können resultieren. Die unspezifischen Symptome der OD sorgen für eine häufig verspätete Diagnosestellung. Allgemeingültige Therapieempfehlungen speziell für den Ellenbogen sind rar. Die geeignete Therapiewahl hängt dabei entscheidend von dem Schweregrad und der Qualität der osteochondralen Läsion ab. Ebenso ist die genaue Beschreibung und Klassifikation des Defekts aufgrund unterschiedlichster Klassifikationssysteme aktuell erschwert. Diese basieren meist auf bildgebenden Verfahren wie dem nativem Röntgenbild oder der Magnetresonanztomographie. Die konservative Therapie ist nur bei stabilen Läsionen empfohlen. Sie beinhaltet eine mehrmonatige Sportkarenz und manuelle Therapie bis zur Beschwerdelinderung. Das operative Spektrum ist groß und reicht von arthroskopischem Débridement und Mikrofrakturierung, offenen Umstellungsosteotomien, neueren autologen Verfahren wie der autologen Chondrozytentransplantation (ACT) und der matrixinduzierten Chondrogenese (AMIC) bis hin zum osteochondralen Transfer (OATS). Ist die Indikation gut gestellt, lassen sich für die meisten Therapien hohe Erfolgsquoten generieren. Mit diesem Übersichtsartikel wurde der Versuch unternommen, die jeweiligen Indikationsschwerpunkte aus der aktuellen Literatur zu extrahieren und eine übersichtliche Behandlungsempfehlung vorzulegen.